Pathologic Features, Proliferative Activity, and Cyclin D1 Expression in Hurthle Cell Neoplasms of the Thyroid (original) (raw)
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Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy?
Annals of surgery, 1998
To determine if any preoperative or intraoperative factors can reliably predict malignancy in patients with Hürthle cell neoplasms. Most experienced surgeons recommend total thyroidectomy for Hürthle cell carcinomas and reserve thyroid lobectomy for Hürthle cell adenomas. However, delineation between Hürthle cell adenoma versus carcinoma often cannot reliably be made either before or during surgery. Medical records from 57 consecutive patients who underwent thyroid resections for Hürthle cell neoplasms between October 1984 and April 1995 at The Johns Hopkins Hospital were analyzed to determine if any factors were predictive of malignancy. Of the 57 patients with Hürthle cell neoplasms, 37 had adenomas and 20 had carcinomas, resulting in a 35% prevalence of malignancy. Patients with adenomas did not differ from those with carcinoma with respect to age, sex, or history of head and neck irradiation. However, patients with Hürthle cell carcinomas had significantly larger tumors (4.0 +/-...
Immunohistochemical analysis of thyroid adenomas with Hurthle cells
Pathology, 1998
Twenty-five cases of thyroid adenomas with Hurthle cell changes, both pure and focal, were studied histologically and immunohistochemically with two objectives: first to elucidate the relationship between the normal uninvolved thyroid and the adenoma; and second, to evaluate the role of immunohistochemical studies in adenomas with Hurthle cell changes. Representative sections were stained with a panel of nine antibodies directed against thyroglobulin (TG), high molecular weight keratin (HMK), low molecular weight keratin (LMK), p53, bcl-2, epithelial membrane antigen (EMA), S100, carcinoembryonic antigen (CEA) and HMB45. In all cases, uniform strong positive staining (+ + +) with TG and bcl-2 was seen in the normal thyroid tissue while the adenoma stained moderately positive (+ +). The reverse pattern was observed with LMK staining. Non-adenomatous thyroid cells were p53-negative, the majority of the Hurthle cells, however, were p53-positive and adenomas with an increased number of Hurthle cells had an increased percentage of p53 staining. The expression of EMA was variable. All thyroid cells both outside and within the adenoma were S100-, CEA-4 and HMB45-negative in all cases. The exact significance of p53 overexpression in the Hurthle cells needs further evaluation.
Clinical and Molecular Features of Hürthle Cell Carcinoma of the Thyroid
The Journal of Clinical Endocrinology & Metabolism, 2015
Context: Hürthle cell cancer (HCC) of the thyroid remains the subject of controversy with respect to natural course, treatment, and follow-up. Objective: The objective of the study was to evaluate the clinical and molecular features associated with outcome in HCC. Design: The study was a review of 173 HCC cases treated at Mayo Clinic over 11 years with a median 5.8-year follow-up. Results: None of the patients with minimally invasive histology had persistent disease, clinical recurrence, or disease-related death. Male gender and TNM stage were independently associated with increased risk of clinical recurrence or death in widely invasive patients. The 5-year cumulative probability of clinical recurrence or death was higher in patients with TNM stage III–IV (females, 74%; males, 91%) compared with patients with TNM stage I–II (females, 0%; males, 17%). Pulmonary metastases were best identified by computed tomography, whereas radioactive iodine scans were positive in only two of 27 ca...
Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid
World Journal of Surgery, 2008
Background A fine needle aspiration (FNA) diagnosis of a Hürthle cell neoplasm is associated with a 20% risk of malignancy. We sought to determine if the primary tumor size correlated with the risk of malignancy in patients with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Methods Between January 2000 and November 2006, 57 patients underwent a thyroidectomy with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Patient histories, FNA reports, operative notes, and pathology reports were retrospectively reviewed. Statistical analysis was performed. Results The overall rate of malignancy in patients with Hürthle cell neoplasms was 21%. The average tumor size was 3.2 cm, with malignant tumors being significantly larger than benign tumors (5.0 vs. 2.7 cm, p \ 0.01). The risk of malignancy directly correlated with tumor size. No
Thyroid, 1999
Neoplastic growth results from cell production that exceeds cell loss. We registered mitotic and apoptotic indices (MI and AI) in 97 immunohistochemically verified oncocytic (Hürthle cell) tumors of the thyroid (OT; 50 ade¬ nomas [OA], 20 atypical adenomas [aOA], and 27 carcinomas [OC]) and compared these kinetic data with his¬ tological diagnoses and other parameters. MI, although very low in all, was significantly higher in carcinomas than in adenomas. Conversely, AI did not differ as much among the 3 groups. This indicates that the magnitude of cell deletion did not play a prominent role in determining the disparate growth of the 3 types of oncocytic tu¬ mors. Cluster analysis with MI and AI per case as variables revealed the existence of 3 groups of neoplasms with highly distinct growth characteristics: (1) near-steady state (n = 78, all diagnostic categories represented); (2) pro¬ gressive (« = 9, mostly carcinomas); and (3) regressive (« = 10, mostly adenomas). MI distinguished between his¬ tologically benign and malignant with the greatest discriminant power of the variables tested. Proliferative indices should thus be included in the differential diagnostic evaluation of oncocytic thyroid tumors. Our study also sug¬ gests that invasiveness and growth are 2 diverging properties of carcinomas.
2017
Background: Hurthle cell neoplasms (HCN) are considered a variant of follicular thyroid neoplasms, and accounts for 3-10% of neoplasms of the thyroid gland. They include Hurthle cell adenomas (HCA) and carcinomas (HCC). Differentiating HCA from HCC preoperatively is currently not possible. We retrospectively searched for demographic and histopathological factors which can be used to predict the risk of malignancy in HCN. Aim: To determine the prevalence of HCC and its demographic factors and histopathological features that can be used to predict the risk of malignancy in HCN. Methods: Records of all patients who underwent thyroidectomy at Academic Hospitals associated with University of the Witwatersrand from January 2001 to October 2015 were reviewed. Patients' demographic data and the final histology of HCN were further analyzed including pre-operative fine needle aspiration cytology (FNAC) results. Data collected included patients' demographic, final histology, tumor size and preoperative FNAC result. Data was entered into Excel Spreadsheet and analyzed using STATICA 13.1 program. Results: At total of 2641 records of thyroidectomies were found of which 25.6% (676/2641) were for thyroid neoplasms. Only 15.8% (107/676) of the neoplasms were HCNs and 25.2% (27/107) of HCNs were HCCs. Hurthle cell carcinoma made up 5.6% (27/481) of thyroid carcinomas. 70.4% (19/27) of HCCs were incidentally found following thyroidectomy for multinodular goiter (MNG). The mean tumor size was significantly greater for carcinomas than for adenomas (4.9 cm vs. 3.5 cm; p = 0.016). The risk of malignancy increased from 11.1% when the size was less or equal to 1cm, through 33.3% for size of 1-4cm to 51.8% when the size was greater than 4cm in diameter. A total of 58 FNACs results of 107 HCNs were available for further analysis. Thirty one (53.4%: 31/58) of FNAC results were suspicious for HCN (Bethesda IV), seven (12.1%: 7/58) suspicious of papillary carcinoma (Bethesda V) and eight (13.8%: 8/58) were reported as benign (Bethesda II). Around 10.3% (6/58) were non-diagnostic (Bethesda I) whereas 8.6% (5/58) were reported as atypia of unknown significance (Bethesda III). Both HCA and HCC were more prevalent in females, 88.7% (71/80) and 77.8% (21/27); respectively. The mean age of the patients who had HCA and HCC in years was 52.3+/-15.6 SD and 55.0 +/-15.0 SD, respectively. v Conclusion: Majority of HCCs are diagnosed following thyroidectomy for benign disease. Close to a quarter of HCNs are malignant and the risk of malignancy increases with size. Age and gender are not useful to predict malignancy in HCNs. We recommend total thyroidectomy for thyroid nodule greater than 4cm in diameter if FNAC result is suggestive of HCN as the risk of malignancy is above 50%. vi xi Table of Contents
International Journal of Surgery, 2013
Background: Our aim was to evaluate predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm (HCN) of thyroid nodules. Materials and methods: We searched cases with cytologically suspicious for HCN from 11,569 ultrasoundguided fine-needle aspirations (US-FNA) performed at our institution. Nodules that were confirmed surgically or followed-up for at least 2 years were compared with respect to age, gender, tumor size, US diagnosis, and US findings to predict malignancy. Results: The incidence of cases with cytologically suspicious for HCN was 1.2% (143 of 11,569). Of 75 nodules that underwent sufficient follow-up or surgery, malignancies were found in 11 (14.7%). Malignant histological examination revealed oncocytic variants of papillary thyroid carcinoma (PTC) in 3 cases, classic PTC in 1, Hurthle cell carcinoma in 3, follicular carcinoma in 3 and an unclassified carcinoma in 1. In univariate analysis, tumor size was significantly larger in malignant nodules compared to benign nodules (p ¼ 0.026). The best cutoff value of tumor size in predicting malignancy was 2.5 cm. (p ¼ 0.006, sensitivity: 63.6%, specificity: 79.7%). The incidences of hypoechogenicity and malignant US diagnoses were higher in malignant nodules than in benign nodules (p < 0.001). In multivariate analysis, tumor size was an independent factor in predicting malignancies. (p ¼ 0.037, odd ratio: 2.09, confidence interval: 1.046e4.161). Conclusion: Preoperative US provides predictive factors of malignancy in thyroid nodules with cytologically suspicious for HCN. Predictive factors include tumor size of 2.5 cm or greater, hypoechoic nodule and malignant US diagnosis.
Genetics, Diagnosis, and Management of Hürthle Cell Thyroid Neoplasms
Frontiers in Endocrinology, 2021
Hürthle cell lesions have been a diagnostic conundrum in pathology since they were first recognized over a century ago. Controversy as to the name of the cell, the origin of the cell, and even which cells in particular may be designated as such still challenge pathologists and confound those treating patients with a diagnosis of “Hürthle cell” anything within the diagnosis, especially if that anything is a sizable mass lesion. The diagnosis of Hürthle cell adenoma (HCA) or Hürthle cell carcinoma (HCC) has typically relied on a judgement call by pathologists as to the presence or absence of capsular and/or vascular invasion of the adjacent thyroid parenchyma, easy to note in widely invasive disease and a somewhat subjective diagnosis for minimally invasive or borderline invasive disease. Diagnostic specificity, which has incorporated a sharp increase in molecular genetic studies of thyroid tumor subtypes and the integration of molecular testing into preoperative management protocols,...
innovative publication, 2017
Introduction: Hurthle cells (HC) are an enigma in thyroid lesions, from being a misnomer, their association with a variety of thyroid nodules and their unpredictable clinical behavior. These can be seen in many thyroid lesions ranging from inflammatory conditions, benign neoplasms and malignant lesions. This study was done to assess the spectrum of hurthle cell lesions of thyroid on cytology and try to establish features that can accurately differentiate between non-neoplastic and neoplastic thyroid lesions. Materials and Methods: The thyroid FNA cases done during Jan 2015-Dec 2015 were collected from the archives of pathology department. Those cases were collected for study where the cytological diagnosis of hurthle cell lesions was made. The diagnosis was divided into follicular neoplasm, hurthle cell neoplasms and thyroid lesions with hurthle cell change. Cytohistological correlation was done wherever possible. Observations & Results: 101 cases contained hurthle cells were identified and studied. The cytological diagnosis was 27 follicular neoplasms (FN) (26.7%), 04 hurthle cell neoplasms (HCN) (3.9%), 51 adenomatous goiter (50.5%) and 19 Hashimotos thyroiditis (HT) (18.8%). Of 27 FN, 22 were diagnosed as FA and 5 as FC. Of 4 HCN, 2 were diagnosed as HCA, 1 as HCC and 1 as PTC on histopathology. Conclusion: Hurthle cells can be found in a large number of thyroid lesions both neoplastic and non-neoplastic. Although no particular finding can differentiate between non-neoplastic and neoplastic hurthle cell containing lesions but certain cytological features can help to diagnose the neoplastic nature of these lesions.