Hürthle cell carcinoma is a better gold standard than Hürthle cell neoplasm for fine-needle aspiration of the thyroid

<p class="abstract">Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid. Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies<span lang="EN-IN">.</span></p>

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Clinical Outcomes for “Suspicious” Category in Thyroid Fine-Needle Aspiration Biopsy: Patient's Sex and Nodule Size Are Possible Predictors of Malignancy

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.5.787 ◽

2009 ◽

Vol 133 (5) ◽

pp. 787-790

Author(s):

Kirtee Raparia ◽

Soo Kee Min ◽

Dina R. Mody ◽

Rose Anton ◽

Mojgan Amrikachi

Keyword(s):

Surgical Resection ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Cytologic Diagnosis ◽

Fine Needle ◽

Female Patients ◽

Hürthle Cell ◽

Significant Difference ◽

Cell Neoplasm ◽

Male Patients

Abstract Context.—Fine-needle aspiration (FNA) is recommended as an initial screening tool for the diagnosis of thyroid nodules. Approximately 10% of thyroid FNA diagnoses are “suspicious for neoplasm,” warranting surgical resection. Objectives.—To examine the role of a patient's age, sex, size of nodule, and morphologic features as possible predictors of malignancy in patients with cytologic diagnosis of “suspicious for neoplasm.” Design.—Cytopathology slides and reports of 402 consecutive thyroid FNAs from 2000–2005 interpreted as “suspicious” were reviewed. Of these, 180 cases that had subsequent surgical resection were selected. Results.—Of the 108 cases suspicious for follicular neoplasm on cytologic evaluation, histologic follow-up showed malignancy in 26 (24%). Of the 37 cases suspicious for Hürthle cell neoplasm, 15 (41%) had malignancy. Of the 35 cases suspicious for malignancy, 29 had malignant histologic diagnoses. Among cases with cytologic diagnoses of “suspicious for follicular or Hürthle cell neoplasm,” the rate of malignancy in female patients was 22% as compared to 43% in male patients (P = .02). The rate of malignancy in nodules less than 2 cm was 19% compared to 47% in nodules measuring 2 cm or larger (P < .001). These differences were statistically significant. No statistically significant difference was noted between the age of the patient and the rate of benign versus malignant diagnosis. Conclusions.—Malignant tumors were more frequent in male patients with a cytologic diagnosis of “suspicious for follicular or Hürthle cell neoplasm” than in female patients. Risk of malignancy was higher in nodules measuring 2 cm or larger. Age of the patient was not a predictor of malignancy.

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Comparison of Folicular, Hurthle Cell Neoplasm and Oncocytic Changes Diagnosed by Thyroid Fine Needle Aspiration with Postoperative Histopathological Results

Turkish Journal of Endocrinology and Metabolism ◽

10.4274/tjem.2408 ◽

2014 ◽

Vol 18/ (1) ◽

pp. 5-12

Author(s):

Yusuf Aydın ◽

Mehmet Turgut ◽

Melih Engin Erkanlı ◽

İsmet Özaydın ◽

Murat Oktay ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Needle Aspiration ◽

Fine Needle ◽

Hürthle Cell ◽

Cell Neoplasm ◽

Thyroid Fine Needle Aspiration ◽

Histopathological Results

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Appearance of Hürthle cell carcinoma soon after surgical extirpation of Hürthle cell adenoma and follicular adenoma of the thyroid gland

Radiology and Oncology ◽

10.2478/raon-2014-0047 ◽

2015 ◽

Vol 49 (1) ◽

pp. 26-31 ◽

Cited By ~ 4

Author(s):

Nevena Ristevska ◽

Sinisa Stojanoski ◽

Daniela Pop Gjorceva

Keyword(s):

Thyroid Gland ◽

Cell Carcinoma ◽

Tumour Size ◽

Follicular Adenoma ◽

Needle Aspiration ◽

Cell Adenoma ◽

Rare Tumour ◽

Hürthle Cell ◽

Hürthle Cell Carcinoma ◽

Hurthle Cell Carcinoma

Abstract Background. Hürthle cell neoplasms could be benign (Hürthle cell adenoma) or malignant (Hürthle cell carcinoma). Hürthle cell carcinoma is a rare tumour, representing 5% of all differentiated thyroid carcinomas. The cytological evaluation of Hürthle cell neoplasms by fine needle aspiration biopsy (FNAB) is complicated because of the presence of Hürthle cells in both Hürthle cell adenoma and Hürthle cell carcinoma. Thus, the preoperative distinction between these two entities is very difficult and possible only with pathohistological findings of the removed tumour. Case report. A 57-year old female patient was admitted at our Department, for investigation of nodular thyroid gland. She was euthyroid and FNAB of the nodules in both thyroid lobes were consistent of Hürthle cell adenoma with cellular atypias. After thyroidectomy the histopathology revealed Hürthle cell adenoma with high cellular content and discrete cellular atypias in the left lobe and follicular thyroid adenoma without cellular atypias in the right lobe. One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on 99mTc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB. Tumorectomy was performed and well-differentiated Hürthle cell carcinoma detected. The patient received ablative dose of 100 mCi 131I. No signs of metastatic disease are present up to date. Conclusions. The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation. Patients with cytological diagnosis of Hürthle cell neoplasms should proceed to total thyroidectomy, especially if tumour size is > 1cm, FNAB findings comprise cellular atypias and/or multiple bilateral nodules are detected in the thyroid gland.

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