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Hürthle cell neoplasm (view source)
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[[Image:Hurthle cell carcinoma -- very high mag.jpg|thumb|right|300px|Micrograph showing a (metastatic) Hürthle cell carcinoma. [[H&E stain]].]] | |||
'''Hürthle cell neoplasm''' is a rare tumour of the [[thyroid gland]] that can have a benign or malignant behaviour. They are generally considered a subset of [[follicular neoplasm]],<ref name=pmid26530486>{{Cite journal | last1 = Wei | first1 = S. | last2 = LiVolsi | first2 = VA. | last3 = Montone | first3 = KT. | last4 = Morrissette | first4 = JJ. | last5 = Baloch | first5 = ZW. | title = PTEN and TP53 Mutations in Oncocytic Follicular Carcinoma. | journal = Endocr Pathol | volume = 26 | issue = 4 | pages = 365-9 | month = Dec | year = 2015 | doi = 10.1007/s12022-015-9403-6 | PMID = 26530486 }}</ref><ref name=pmid24753500>{{Cite journal | last1 = Ustun | first1 = B. | last2 = Chhieng | first2 = D. | last3 = Van Dyke | first3 = A. | last4 = Carling | first4 = T. | last5 = Holt | first5 = E. | last6 = Udelsman | first6 = R. | last7 = Adeniran | first7 = AJ. | title = Risk stratification in follicular neoplasm: a cytological assessment using the modified Bethesda classification. | journal = Cancer Cytopathol | volume = 122 | issue = 7 | pages = 536-45 | month = Jul | year = 2014 | doi = 10.1002/cncy.21425 | PMID = 24753500 }}</ref> which includes [[follicular thyroid carcinoma]] and [[follicular thyroid adenoma]]. | |||
It may be referred to as ''[[oncocytic neoplasm]]''. | |||
'''Hürthle cell carcinoma''' and '''Hürthle cell adenoma''' redirect to here. | |||
==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. | |||
====Risk of malignancy by tumour size==== | |||
Risk of malignancy by size - based on a series of 57 cases:<ref name=pmid9563543>{{Cite journal | last1 = Chen | first1 = H. | last2 = Nicol | first2 = TL. | last3 = Zeiger | first3 = MA. | last4 = Dooley | first4 = WC. | last5 = Ladenson | first5 = PW. | last6 = Cooper | first6 = DS. | last7 = Ringel | first7 = M. | last8 = Parkerson | first8 = S. | last9 = Allo | first9 = M. | title = Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy? | journal = Ann Surg | volume = 227 | issue = 4 | pages = 542-6 | month = Apr | year = 1998 | doi = | PMID = 9563543 }}</ref> | |||
{| class="wikitable sortable" | |||
!Size | |||
!Percentage<br>malignant | |||
|- | |||
| <=1 cm | |||
| 17% | |||
|- | |||
|- | |||
| 1-4 cm | |||
| 23% | |||
|- | |||
| >4 cm | |||
| 65% | |||
|} | |||
==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. | |||
===Images=== | |||
<gallery> | |||
Image: Hurthle cell carcinoma -- intermed mag.jpg | HCC - intermed. mag. (WC) | |||
Image: Hurthle cell carcinoma -- high mag.jpg | HCC - high mag. (WC) | |||
Image: Hurthle cell carcinoma -- very high mag.jpg | HCC - very high mag. (WC) | |||
Image: Hurthle cell carcinoma - atl -- very high mag.jpg | HCC - very high mag. (WC) | |||
</gallery> | |||
==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]]. | |||
*[[Follicular neoplasm]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Thyroid gland]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||