Hurthle cell carcinoma is rare, but usually, an aggressive tumor of the thyroid gland, as it possesses a rather high rate of metastatic spread compared to other thyroid malignancies. Dysphagia, dyspnea, voice changes and an apparent mass in the neck are main findings. The initial diagnosis can be made through a thorough clinical exam, ultrasonography, and a fine-needle aspiration biopsy, but a histological exam showing > 75% of hurthle cells is necessary in order to confirm this malignancy.
Hurthle cells (large, polygonal and well-demarcated cells containing a granular cytoplasm, a large hyperchromatic nucleus, and a prominent nucleolus) are considered to be a rather common finding on histological samples of thyroid nodules, which are present in up to 8% of the population . Many different disorders of the thyroid gland have been associated with the appearance of hurthle cells, including chronic lymphocytic thyroiditis (CLT), Graves' disease, and multinodular goiter, but also a range of benign and malignant neoplasms   . Hurthle cell carcinoma accounts for < 5% of all differentiated thyroid tumors and is suspected when the biopsy specimen contains > 75% of hurthle cells, with the absence of a complete lesional capsule     . Hurthle cell carcinoma must be included in the differential diagnosis when patients present with a hard and immobile mass that may be accompanied by dysphagia, voice changes, or even dyspnea , the reason being mechanical compression of the esophagus and/or the trachea. Unfortunately, hurthle cell carcinoma is known for its potentially aggressive clinical course with a higher rate of metastatic spread when compared with other malignancies of the thyroid gland, and in addition to male gender and increased age, both being established as poor prognostic factors, the size of the tumor is important in determining the survival rates .
Entire Body System
Keywords : Adenocarcinoma, Goiter, Mononeuropathies, Paraneoplastic Syndromes, Thyroid Neoplasms. Introduction Diffuse toxic goiter a common autoimmune thyroid disease, usually presents with clinical features of thyrotoxicosis. [casereports.in]
High frequency real-time ultrasonography revealed a goiterous left thyroid gland devoid of any intraglandular calcifications. No regional lymph nodes were seen. [njcponline.com]
Many different disorders of the thyroid gland have been associated with the appearance of hurthle cells, including chronic lymphocytic thyroiditis (CLT), Graves' disease, and multinodular goiter, but also a range of benign and malignant neoplasms. [symptoma.com]
Upon excision, the FNA diagnosis of HLN group had 14 cases of goiter/nodular hyperplasia (16%), 46 cases of adenoma (12 follicular adenoma (14%) and 34 cases of Hurthle cell adenoma (39%)), and 27 cases of carcinoma (31%, 12 papillary carcinoma and 15 [ncbi.nlm.nih.gov]
(plunging) (substernal) E04.9 ICD-10-CM Diagnosis Code E04.9 Nontoxic goiter, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Goiter NOS Nodular goiter (nontoxic) NOS cancerous C73 malignant C73 Hurthle cell adenocarcinoma C73 carcinoma [icd10data.com]
History Play ENTRENus Play ENTRENuk Play ENTRENau Meanings of "hurthle cell carcinoma of thyroid" in Turkish English Dictionary : 1 result(s) Category English Turkish Medical 1 Medical hurthle cell carcinoma of thyroid tiroid bezinin hurthle hücreli kanseri [tureng.com]
Physical examination revealed marfanoid features with arachnodactyly, a positive Walker's sign, and a high arched palate, with no specific features of acromegaly. [journals.aace.com]
Dysphagia, dyspnea, voice changes and an apparent mass in the neck are main findings. [symptoma.com]
Asymptomatic patients require thyroxine supplementation to manage hypothyroidism and mild dysphagia. Surgical intervention is required in dysphagia, respiratory obstruction, haemorrhage, and, rarely, malignancy. [karger.com]
Symptoms The signs and symptoms of Hürthle cell thyroid cancer are similar to other types of cancer of the thyroid gland and may include: A growth or lump on the thyroid gland (at the base of the neck) A chronic hoarse voice Dysphagia (difficulty swallowing [news-medical.net]
Secondary syntoms due to compression of the adjacent structures in the neck (e.g. dysphonia, dysphagia) may be present, particularly in patients with malignant tumors. [atlasgeneticsoncology.org]
When referred to a hospital, he did not complain of cough, dysphagia or pain. A thorax computed tomography (CT) scan showed non-unusual disease in the lungs and the mediastinum. [academic.oup.com]
Liver, Gall & Pancreas
- Long Arm
Loss of heterozygosity from the q (long) arm of chromosome 10 is also detected in oncocytic tumors. [emedicine.medscape.com]
- Numbness of the Feet
On questioning she admits numbness in both feet. No weakness of upper limbs, bladder dysfunction, symptoms related to cranial nerves or cardiorespiratory symptoms were elicited. [casereports.in]
Face, Head & Neck
- Neck Mass
There was a 3 cm complex mass on the left side of the neck, posterior to the carotid sheath structures and deep to the sternomastoid, indicative of lymph node metastases. Thyroid profile and routine blood investigations were unremarkable. [wjso.biomedcentral.com]
In 1986, Har-El et al. reported that after incomplete resection and EBRT of inoperable neck mass a patient survived 14 years . Foote et al. from the Mayo Clinic stated that HCTC is a radiosensitive tumor . [bmccancer.biomedcentral.com]
Case reported by Hyar et al. describes a woman with papillary carcinoma of thyroid and paraneoplastic myoclonus [ 2 ]. [casereports.in]
- Limb Weakness
No weakness of upper limbs, bladder dysfunction, symptoms related to cranial nerves or cardiorespiratory symptoms were elicited. [casereports.in]
Mononeuropathy multiplex (AAEE case report #11) Muscle Nerve. 1985;8(6):493-498. Kelkar P, Parry GJ. Mononeuritis multiplex in Diabetes Mellitus: evidence for underlying immune pathogenesis. [casereports.in]
An early diagnosis of hurthle cell carcinoma may significantly improve patient outcomes, which is why physicians must obtain a detailed patient history and conduct a thorough physical examination . The presence of previously mentioned symptoms of dysphagia/dyspnea and detection of a palpable mass in the neck mandates a more advanced workup. Ultrasonography of the neck is a valuable initial tool in the assessment of thyroid masses (and examination of proximal lymph node spread), but because both hypoechoic and hyperechoic (and sometimes isoechoic) appearance of hurthle cell carcinoma has been observed (as well as marked variations in vascularity of the tumor) , the use of fine-needle aspiration biopsy (FNAB) is imperative    . When an abundance of hurthle cells is observed in biopsy samples (>75%), a lesion of > 4 cm is highly suggestive of a hurthle cell carcinoma , in which case additional imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) are recommended for assessing potential spread to the adjacent structures in the neck and distal organs . To solidify the diagnosis, a histological examination must show capsular and/or vascular invasion of the tumor  .
This finding parallels with nuclear atypia and anisocytosis. The demonstration of aneuploidy may be a marker for a particularly aggressive clinical behavior compared with euploid tumors. [emedicine.medscape.com]
- Abnormal Thyroid Function Test
Conclusions: In Hürthle cell carcinomas treated with partial thyroidectomy, subsequent abnormal thyroid functions tests may herald a more sinister underlying diagnosis. [journals.aace.com]
Nonsurgical treatment, including radioactive iodine therapy, is disappointing; thus, initial radical surgery is recommended as the treatment of choice. [ncbi.nlm.nih.gov]
Treatment The data on the type of treatment of patients are summarized in Table 1. All patients had surgical treatment on their primary tumor. [bmccancer.biomedcentral.com]
Other Remedies Treatment for Hurthle cell carcinoma can be frightening and challenging. [newhealthadvisor.com]
Prognosis Because younger patients with thyroid cancer tend to have a better prognosis than older patients with a very similar tumour, and because Hurthle cell cancers occur in older patients, they have the reputation for having a worse prognosis However [thyroid.com.au]
However, more precise molecular, genetic, and histopathologic characterization of Hürthle cell tumors has led us to recognize that while Hürthle cell carcinoma carries a worse prognosis as compared to papillary thyroid cancer (PTC), the prognosis of Hürthle [accesssurgery.mhmedical.com]
OBJECTIVES: There is controversy about the prognosis of Hurthle cell carcinoma of the thyroid. The purpose of this project is to report the outcome of a well-defined group of patients treated at a single institution in the modern era. [ncbi.nlm.nih.gov]
Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]
Etiology HIDS is an autosomal recessively inherited syndrome caused by mutations in the mevalonate kinase ( MVK ) gene. Due to this mutation HIDS patients have MVK enzymes with reduced, but not abolished activity. [orpha.net]
Key words: hyperammonemia, etiology, congenital hyperammonemia, inborn errors of metabolism, urea cycle disorders. [medigraphic.com]
Note Widely invasive oncocytic thyroid carcinoma Etiology Unknown. The precise cellular derangements that lead to the abnormal accumulation of mitochondria in oncocytes and tumor development are obscure. [atlasgeneticsoncology.org]
Etiology Virtually all patients with the syndrome have mutations in the gene for mevalonate kinase, which is part of the HMG-CoA reductase pathway, an important cellular metabolic pathway. [slideshare.net]
Methods The Surveillance, Epidemiology and End Results database identified patients with HCFC and non-HCFC from 1988 to 1993 who were followed to 2001. [surgjournal.com]
We aimed to clarify this controversy by analyzing HCC survival over a 35-year period using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Cases of HCC and FCC were extracted from the SEER-9 database (1975-2009). [ncbi.nlm.nih.gov]
Methods Data for all cases of Hürthle cell carcinoma that occurred between January 1, 1988, and December 31, 1998, were extracted from the Surveillance, Epidemiology, and End Results database. [jamanetwork.com]
The extracted information was categorized as 1) host/parasite interaction: the pathophysiological aspects; 2) clinical-pathological features; 3) diagnosis; and 4) therapy. [scielo.br]
Hyperammonemia in review: pathophysiology, diagnosis, and treatment. Pediatr Nephrol. 2012;27(2):207-22. Bireley WR, Van Hove JL, Gallagher RC, Fenton LZ. Urea cycle disorders: brain MRI and neurological outcome. [medigraphic.com]
The hemozoin and other toxic factors such as glucose phosphate isomerase (GPI) stimulate macrophages and other cells to produce cytokines and other soluble factors which act to produce fever and rigors and probably influence other severe pathophysiology [cdc.gov]
Pathophysiology No widely accepted paradigm exists for the pathogenesis of follicular and Hürthle cell cancer of the thyroid. [emedicine.medscape.com]
Talk to your doctor about long-term prevention if you live in an area where malaria is common. Sleeping under a mosquito net may help prevent being bitten by an infected mosquito. [healthline.com]
Aside from these, blood tests for thyroglobulin, a cancerous tumor marker produced by Hurthle cells, may be done to monitor your condition and prevent recurring cancer. [newhealthadvisor.com]
Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J. 2007 Dec 4. 6:160. [Medline]. [Full Text]. Trape JF, Tall A, Diagne N, et al. [medscape.com]
For preventing attacks, anakinra or canakinumab For symptoms, NSAIDs, corticosteroids, and anakinra Anakinra and canakinumab are proved to prevent attacks ( 1 ). [merckmanuals.com]
Antimalarial drugs Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. [who.int]
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- Ahmadi S, Stang M, Jiang X “Sara”, Sosa JA. Hürthle cell carcinoma: current perspectives. Onco Targets Ther. 2016;9:6873-6884.
- Gross M, Eliashar R, Ben-Yaakov A, Weinberger JM, Maly B. Clinicopathologic features and outcome of the oncocytic variant of papillary thyroid carcinoma. Ann Otol Rhinol Laryngol. 2009;118(5):374–381.
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- Bhattacharyya N. Survival and prognosis in Hürthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg. 2003;129(2):207-210.
- Maizlin ZV, Wiseman SM, Vora P, et al. Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics. J Ultrasound Med. 2008;27(5):751–757. quiz 759