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 [1]. 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 [1] [2] [3]. 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 [1] [2] [3] [4] [5]. 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 [2], 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 [6].

• Goiter

  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]

  (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]

  This particular patient had the goiter for three years duration and its enlargement had been gradual with no symptoms of compression to trachea or esophagus. [firattipdergisi.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]

• Swelling

  This case presented is that of a 57-year-old woman with a recurrent thyroid swelling. She previously underwent a right hemithyroidectomy for thyroid mass 10 years prior. [njcponline.com]

  Case Report A 37-year-old female presented with a swelling in the oropharynx, dysphagia, and a change in the quality of her voice over the previous 5 months. The swelling was painless and progressive in nature. [karger.com]

  Cerebral malaria, which causes swelling of the blood vessels of the brain, can result in brain damage. The long-term outlook for patients with drug-resistant parasites may also be poor. In these patients, malaria may recur. [healthline.com]

  There is history of painless swelling of right lobe of thyroid gland for last 2 years, slowly increasing in size with no pressure symptoms. On questioning she admits numbness in both feet. [casereports.in]

  I don't believe that would cause your lymph nodes to swell. I am truly concerned about this and extremely tired. The pathology report says Hurthle cell carcinoma (benign). Scary. [cancercompass.com]

• Myxedema

  Friedman N (1949) Cellular involution in thyroid gland: significance of Hurthle cells in myxedema, exhaustion atrophy, Hashimotoa disease and reaction in irradiation, thiouracil therapy and subtotal resection. J Clin Endocrinol 9: 874-882. [omicsonline.org]

• Dysphagia

  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]

• Failure to Thrive

  There is a more severe condition, known as Mevalonate Aciduria (MA) that also involves a mutation in the MVK gene, but it is associated with significant, chronic inflammation, dysmorphic facial features, failure to thrive,systemic organ involvement and [autoinflammatory.org]

  Those less severely affected have mental retardation, failure to thrive, progressive cerebellar ataxia (unsteadiness) and anaemia. In childhood and adolescence, eye problems develop, including cataracts and uveitis. [slideshare.net]

  Affected infants and children may also have growth deficiency before and after birth, failure to grow and gain weight (failure to thrive), and distinctive facial features including widely spaced eyes (hypertelorism), a large forehead (frontal bossing) [rarediseases.org]

• Periodontitis

  Type-2 diabetes mellitus, metabolic control, serum inflammatory factors, lifestyle, and periodontal status. J Dent Sci. (2014) 9:1–9. doi: 10.1016/j.jds.2013.10.006 CrossRef Full Text | Google Scholar [frontiersin.org]

• Thrombosis

  She had been on enoxaparin for thrombosis prophylaxis for 3 months, and the lower-extremity deep vein thrombosis (DVT) studies were negative. The patient subsequently underwent a cardiac thrombectomy using a cardiopulmonary bypass support. [karger.com]

  Reasons offered [ 7 - 9 ] included interruption of microvascular supply, compromised vascular supply from the extraction of large amounts of tissue, traumatic venous thrombosis, rough needle use, and multiple passes with rigorous aspiration. [casereports.in]

  Hurthle cell carcinoma with jugulo-subclavian venous thrombosis. Acta Otorrinolaringol Esp 2015; 66(2): 125–126. doi: 10.1016/j.otorri.2013.07.003. Jillard CL, Youngwirth L, Scheri RP, Roman S, Sosa JA. [advmodoncolres.com]

  The intravenous infusion of this medication can lead to thrombosis, arterial hypertension and changes in heart rhythm. Quinine should be diluted and infused slowly. [scielo.br]

  Plasmodium vivax cerebral malaria complicated with venous sinus thrombosis in Colombia. Asian Pac J Trop Med. (2013) 6:413–5. doi: 10.1016/S1995-7645(13)60050-4 PubMed Abstract | CrossRef Full Text | Google Scholar 189. [frontiersin.org]

• Hypotension

  We describe the case of a 57-year-old female with thyroid HCC, 5 years after total thyroidectomy, who presented with dyspnea associated with hypoxia and hypotension. [karger.com]

  […] ventilation should be considered for patients with severe malaria, depending on the patient's clinical context and considering the potential risks of nosocomial pneumonia, pneumothorax and a prolonged length of stay in the intensive care unit (ICU).(55) Hypotension [scielo.br]

• Heart Disease

  CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW SLIDESHOW Heart Disease: Causes of a Heart Attack See Slideshow [medicinenet.com]

  The patient was a farmer non-smoker and a teetotaller and had no history of exposure to ionizing radiation, no history of thyroiditis or benign thyroid adenoma, no history of hypertension or heart disease and had no family history of thyroid cancer or [academic.oup.com]

• Heart Failure

  Left-sided intracardial metastases mimicking myxoma could induce obstructive heart failure, syncope or stroke; right-sided intracardial metastases can cause recurrent PE, refractory to anticoagulation treatment. [karger.com]

• Fracture

  Three years after a total thyroidectomy, she developed a right femoral pathological fracture due to bone metastasis of HCC. She started experimental treatment with lenvatinib 3 months prior to admission. [karger.com]

  In only two patients a pathologic bone fracture necessitated surgical approach: a right hip replacement because of fracture of femur and two surgical procedures of the right ulna. [bmccancer.biomedcentral.com]

• Suggestibility

  This suggests a closer relationship between papillary cell carcinoma and Hurthle cell tumors than previously appreciated. [ncbi.nlm.nih.gov]

• Aggressive Behavior

  Minimally invasive HCC demonstrates much less aggressive behavior; lesions 2 cm and those with nodal and distant metastases. [dovepress.com]

  CONCLUSIONS: HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines. [ncbi.nlm.nih.gov]

  […] course, while its relative prevalence and behavior in childhood is uncertain due to the lack of specific literature reviews. [abstracts.eurospe.org]

  behavior than conventional follicular carcinoma Terminology Synonym: oncocytic cell is also called Hürthle, Askanazy and oxyphilic cells "Hürthle cell" is a misnomer - Dr. [pathologyoutlines.com]

  Hurthle cell adenomas are encapsulated follicular lesions with benign behavior. Hurthle cell carcinomas exhibit unequivocal capsular and/or vascular invasion; they are aggressive tumors with a poor prognosis. [academic.oup.com]

• 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 [7]. Foote et al. from the Mayo Clinic stated that HCTC is a radiosensitive tumor [17]. [bmccancer.biomedcentral.com]

• Stroke

  His medical history was negative for myocardial infarction but positive for "mini strokes" and type 2 diabetes mellitus. Tc-99m sestamibi cardiac imaging revealed an abnormal focus of increased activity in the left lobe of the thyroid. [ncbi.nlm.nih.gov]

  Left-sided intracardial metastases mimicking myxoma could induce obstructive heart failure, syncope or stroke; right-sided intracardial metastases can cause recurrent PE, refractory to anticoagulation treatment. [karger.com]

  […] examination may show hyperreflexia and bilateral Babinski's sign, along with symptoms that indicate intracranial hypertension, especially in children.(41,42) Other concomitant causes for neurological changes should be ruled out, such as hypoglycemia and stroke [scielo.br]

  However, cerebral malaria cases with irreversible hypoxia-induced brain tissue damages (as in stroke patients) following microvasculature occlusion by the IRBCs are rarely seen (209). [frontiersin.org]

  Thalamichemorrhage:aprospectivestudyof00patients[J].Stroke,995,26: [5]BRANDT T,DIETERICH M.Perceivedverticaland lateropulsion:clinical syndromes,localization,and prognosis[j].neurorehab Neurol Repair,2000,4: -20. [6]BAIREB,DIETERICH M.Oculartiltreaction [docsplayer.com]

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 [2]. 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) [7], the use of fine-needle aspiration biopsy (FNAB) is imperative [1] [2] [3] [4]. 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 [2], 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 [2]. To solidify the diagnosis, a histological examination must show capsular and/or vascular invasion of the tumor [1] [2].

• Hepatocellular Carcinoma

  Primary squamous cell carcinoma of the breast: a case report in a review of current literature E Konuk, E Arpaci, S Ergen, E Isik, G Yurdakan Journal of Oncological Sciences 3 (1), 29-31, 2017 42017A Rare Metastatic presentation of Lobular Carcinoma of [scholar.google.com]

  年05月 Survival rates of early-stage HCV-related liver cirrhosis patients without hepatocellular carcinoma are decreased by alcohol, M.Yamada, H.Shiroeda, R.Hayashi, H.Yano, K.Sato, M.Tsutsumi, T.Arisawa, Journal of clinical biochemistry and nutrition, [nkrims.kanazawa-med.ac.jp]

  A liver biopsy was undertaken and reported as hepatocellular carcinoma on its morphologic basis despite negative immunochemistry for hepatocytes, synaptophysin, alpha fetoprotein, and chromogranin A. [journals.aace.com]

  carcinoma） 肝母细胞瘤（英语：Hepatoblastoma） 良性：肝细胞腺瘤（英语：Hepatocellular adenoma） 海绵状血管瘤（英语：Cavernous hemangioma） 增生：局灶性结节性增生（英语：Focal nodular hyperplasia） 结节性再生性增生（英语：Nodular regenerative hyperplasia） 胆道 膽管：胆管癌 Klatskin瘤（英语：Klatskin tumor） 胆囊：膽癌 胰腺 外分泌腺：腺癌（英语 [zh.wikipedia.org]

  carcinoma (17/436, 3.9 % versus 16/215, 7.4 %, p=0.047). [mymemory.translated.net]

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]

The clinical role of radioactive iodine treatment is largely limited to post-surgical ablation. [academic.oup.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]

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]

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]

For preventing attacks, anakinra or canakinumab For symptoms, NSAIDs, corticosteroids, and anakinra Anakinra and canakinumab are proved to prevent attacks ( 1 ). [merckmanuals.com]

1. Cannon J. The significance of hurthle cells in thyroid disease. Oncologist. 2011;16(10):1380-1387.
2. Ahmadi S, Stang M, Jiang X “Sara”, Sosa JA. Hürthle cell carcinoma: current perspectives. Onco Targets Ther. 2016;9:6873-6884.
3. 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.
4. Hanief MR, Igali L, Grama D. Hürthle cell carcinoma: diagnostic and therapeutic implications. World J Surg Oncol. 2004;2:27.
5. Barnabei A, Ferretti E, Baldelli R, Procaccini A, Spriano G, Appetecchia M. Hurthle cell tumours of the thyroid. Personal experience and review of the literature. Acta Otorhinolaryngol Ital. 2009;29(6):305-311.
6. Bhattacharyya N. Survival and prognosis in Hürthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg. 2003;129(2):207-210.
7. 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