Hürthle cell neoplasm

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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,[1][2] 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.[3]
  • It can be understood as a special type of follicular neoplasm (including follicular thyroid adenoma and follicular thyroid carcinoma).[4]
  • High stage HCC has a poor prognosis.[5]

Adenoma versus carcinoma

Suggestive for carcinoma:[3]

  • Male.
  • >4 cm.
    • Adenomas usu. <3 cm.

Definite for carcinoma:[3]

Risk of malignancy by tumour size

Risk of malignancy by size - based on a series of 57 cases:[6]

Size Percentage
malignant
<=1 cm 17%
1-4 cm 23%
>4 cm 65%

Gross

  • Yellow.
  • Encapsulated.

Microscopic

Features:[4]

  • Oncocytes >= 75% of cells:
    • Abundant granular, eosinophilic cytoplasm.
    • Round regular nucleus +/- prominent nucleolus.
  • +/-Degenerative changes.

Negatives:

DDx:[7]

  • Papillary thyroid carcinoma oncocytic variant.
  • Medullary thyroid carcinoma oncocytic variant.
  • Others.

Images

IHC

Features:

  • TTF-1 +ve (2 of 6 cases in Bejarno et al.,[8] or 6 of 6 cases in Choi et al.[9]).
  • Thyroglobulin (6 of 6 cases[8]).
  • CK7 (4 of 6 cases[8]).
  • HBME-1 +ve (focal in 4 of 6 cases[9]).
  • HCK -ve (6 of 6 cases[9]).
  • CK19 +ve (focal in 4 of 6 cases[9]).

See also

References

  1. Wei, S.; LiVolsi, VA.; Montone, KT.; Morrissette, JJ.; Baloch, ZW. (Dec 2015). "PTEN and TP53 Mutations in Oncocytic Follicular Carcinoma.". Endocr Pathol 26 (4): 365-9. doi:10.1007/s12022-015-9403-6. PMID 26530486.
  2. Ustun, B.; Chhieng, D.; Van Dyke, A.; Carling, T.; Holt, E.; Udelsman, R.; Adeniran, AJ. (Jul 2014). "Risk stratification in follicular neoplasm: a cytological assessment using the modified Bethesda classification.". Cancer Cytopathol 122 (7): 536-45. doi:10.1002/cncy.21425. PMID 24753500.
  3. 3.0 3.1 3.2 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.
  4. 4.0 4.1 Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 104. ISBN 978-0443066856.
  5. 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.
  6. Chen, H.; Nicol, TL.; Zeiger, MA.; Dooley, WC.; Ladenson, PW.; Cooper, DS.; Ringel, M.; Parkerson, S. et al. (Apr 1998). "Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy?". Ann Surg 227 (4): 542-6. PMID 9563543.
  7. 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.
  8. 8.0 8.1 8.2 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.
  9. 9.0 9.1 9.2 9.3 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.