Difference between revisions of "Hürthle cell neoplasm"
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'''Hürthle cell neoplasm''' is a rare tumour of the [[thyroid gland]] that can have a benign or malignant behaviour. | |||
==General== | |||
*Incidence: uncommon. | |||
*This is a general category - includes: | |||
**Hürthle cell adenoma. | |||
**Hürthle cell carcinoma. | |||
*Some advocate ''total thyroidectomy'' for all Hürthle cell neoplasms, as it is difficult to reliably differentiate adenomas and carcinomas.<ref name=pmid9697901>{{Cite journal | last1 = Wasvary | first1 = H. | last2 = Czako | first2 = P. | last3 = Poulik | first3 = J. | last4 = Lucas | first4 = R. | title = Unilateral lobectomy for Hurthle cell adenoma. | journal = Am Surg | volume = 64 | issue = 8 | pages = 729-32; discussion 732-3 | month = Aug | year = 1998 | doi = | PMID = 9697901 }}</ref> | |||
*It can be understood as a special type of ''follicular neoplasm'' (including ''[[follicular thyroid adenoma]]'' and ''[[follicular thyroid carcinoma]]'').<ref name=Ref_EP104>{{Ref EP|104}}</ref> | |||
*High stage HCC has a poor prognosis.<ref name=pmid25259908>{{Cite journal | last1 = Chindris | first1 = AM. | last2 = Casler | first2 = JD. | last3 = Bernet | first3 = VJ. | last4 = Rivera | first4 = M. | last5 = Thomas | first5 = C. | last6 = Kachergus | first6 = JM. | last7 = Necela | first7 = BM. | last8 = Hay | first8 = ID. | last9 = Westphal | first9 = SA. | title = Clinical and molecular features of Hürthle cell carcinoma of the thyroid. | journal = J Clin Endocrinol Metab | volume = 100 | issue = 1 | pages = 55-62 | month = Jan | year = 2015 | doi = 10.1210/jc.2014-1634 | PMID = 25259908 }}</ref> | |||
===Adenoma versus carcinoma=== | |||
Suggestive for carcinoma:<ref name=pmid9697901/> | |||
*Male. | |||
*>4 cm | |||
**Adenomas usu. <3 cm. | |||
Definite for carcinoma:<ref name=pmid9697901/> | |||
*Lymphovascular invasion. | |||
*Capsular invasion. | |||
===Gross=== | |||
*Yellow. | |||
*Encapsulated. | |||
==Microscopic== | |||
Features:<ref name=Ref_EP104>{{Ref EP|104}}</ref> | |||
*Oncocytes >= 75% of cells: | |||
**Abundant granular, eosinophilic cytoplasm. | |||
**Round regular nucleus +/- prominent nucleolus. | |||
*+/-Degenerative changes. | |||
Negatives: | |||
*Lack nuclear features of [[papillary thyroid carcinoma]]. | |||
*Lack features of [[medullary thyroid carcinoma]]. | |||
DDx:<ref name=pmid18684023>{{cite journal |author=Montone KT, Baloch ZW, LiVolsi VA |title=The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=8 |pages=1241–50 |year=2008 |month=August |pmid=18684023 |doi= |url=}}</ref> | |||
*Papillary thyroid carcinoma oncocytic variant. | |||
*Medullary thyroid carcinoma oncocytic variant. | |||
*Others. | |||
==IHC== | |||
Features: | |||
*TTF-1 +ve (2 of 6 cases in Bejarno ''et al.'',<ref name=pmid10981870>{{Cite journal | last1 = Bejarano | first1 = PA. | last2 = Nikiforov | first2 = YE. | last3 = Swenson | first3 = ES. | last4 = Biddinger | first4 = PW. | title = Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms. | journal = Appl Immunohistochem Mol Morphol | volume = 8 | issue = 3 | pages = 189-94 | month = Sep | year = 2000 | doi = | PMID = 10981870 }}</ref> or 6 of 6 cases in Choi ''et al.''<ref name=pmid16224162/>). | |||
*Thyroglobulin (6 of 6 cases<ref name=pmid10981870/>). | |||
*CK7 (4 of 6 cases<ref name=pmid10981870/>). | |||
*HBME-1 +ve (focal in 4 of 6 cases<ref name=pmid16224162>{{Cite journal | last1 = Choi | first1 = YL. | last2 = Kim | first2 = MK. | last3 = Suh | first3 = JW. | last4 = Han | first4 = J. | last5 = Kim | first5 = JH. | last6 = Yang | first6 = JH. | last7 = Nam | first7 = SJ. | title = Immunoexpression of HBME-1, high molecular weight cytokeratin, cytokeratin 19, thyroid transcription factor-1, and E-cadherin in thyroid carcinomas. | journal = J Korean Med Sci | volume = 20 | issue = 5 | pages = 853-9 | month = Oct | year = 2005 | doi = | PMID = 16224162 }}</ref>). | |||
*HCK -ve (6 of 6 cases<ref name=pmid16224162/>). | |||
*CK19 +ve (focal in 4 of 6 cases<ref name=pmid16224162/>). | |||
==See also== | |||
*[[Thyroid gland]]. | |||
*[[Oncocytoma]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Thyroid gland]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
Revision as of 04:48, 15 December 2015
Hürthle cell neoplasm is a rare tumour of the thyroid gland that can have a benign or malignant behaviour.
General
- Incidence: uncommon.
- This is a general category - includes:
- Hürthle cell adenoma.
- Hürthle cell carcinoma.
- Some advocate total thyroidectomy for all Hürthle cell neoplasms, as it is difficult to reliably differentiate adenomas and carcinomas.[1]
- It can be understood as a special type of follicular neoplasm (including follicular thyroid adenoma and follicular thyroid carcinoma).[2]
- High stage HCC has a poor prognosis.[3]
Adenoma versus carcinoma
Suggestive for carcinoma:[1]
- Male.
- >4 cm
- Adenomas usu. <3 cm.
Definite for carcinoma:[1]
- Lymphovascular invasion.
- Capsular invasion.
Gross
- Yellow.
- Encapsulated.
Microscopic
Features:[2]
- Oncocytes >= 75% of cells:
- Abundant granular, eosinophilic cytoplasm.
- Round regular nucleus +/- prominent nucleolus.
- +/-Degenerative changes.
Negatives:
- Lack nuclear features of papillary thyroid carcinoma.
- Lack features of medullary thyroid carcinoma.
DDx:[4]
- Papillary thyroid carcinoma oncocytic variant.
- Medullary thyroid carcinoma oncocytic variant.
- Others.
IHC
Features:
- TTF-1 +ve (2 of 6 cases in Bejarno et al.,[5] or 6 of 6 cases in Choi et al.[6]).
- Thyroglobulin (6 of 6 cases[5]).
- CK7 (4 of 6 cases[5]).
- HBME-1 +ve (focal in 4 of 6 cases[6]).
- HCK -ve (6 of 6 cases[6]).
- CK19 +ve (focal in 4 of 6 cases[6]).
See also
References
- ↑ 1.0 1.1 1.2 Wasvary, H.; Czako, P.; Poulik, J.; Lucas, R. (Aug 1998). "Unilateral lobectomy for Hurthle cell adenoma.". Am Surg 64 (8): 729-32; discussion 732-3. PMID 9697901.
- ↑ 2.0 2.1 Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 104. ISBN 978-0443066856.
- ↑ Chindris, AM.; Casler, JD.; Bernet, VJ.; Rivera, M.; Thomas, C.; Kachergus, JM.; Necela, BM.; Hay, ID. et al. (Jan 2015). "Clinical and molecular features of Hürthle cell carcinoma of the thyroid.". J Clin Endocrinol Metab 100 (1): 55-62. doi:10.1210/jc.2014-1634. PMID 25259908.
- ↑ Montone KT, Baloch ZW, LiVolsi VA (August 2008). "The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review". Arch. Pathol. Lab. Med. 132 (8): 1241–50. PMID 18684023.
- ↑ 5.0 5.1 5.2 Bejarano, PA.; Nikiforov, YE.; Swenson, ES.; Biddinger, PW. (Sep 2000). "Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms.". Appl Immunohistochem Mol Morphol 8 (3): 189-94. PMID 10981870.
- ↑ 6.0 6.1 6.2 6.3 Choi, YL.; Kim, MK.; Suh, JW.; Han, J.; Kim, JH.; Yang, JH.; Nam, SJ. (Oct 2005). "Immunoexpression of HBME-1, high molecular weight cytokeratin, cytokeratin 19, thyroid transcription factor-1, and E-cadherin in thyroid carcinomas.". J Korean Med Sci 20 (5): 853-9. PMID 16224162.