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Hurthle Cell Carcinoma

Differentiated Thyroid Carcinoma

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.


Presentation

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]
  • 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]
  • FTC is more common in areas of iodine-deficient endemic goiter and more prevalent in African Americans than in Asians or Caucasians [ 3 ].[kjim.org]
  • High frequency real-time ultrasonography revealed a goiterous left thyroid gland devoid of any intraglandular calcifications. No regional lymph nodes were seen.[njcponline.com]
Noncompliance
  • Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age 65 years (OR, 1.31; P .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively[ncbi.nlm.nih.gov]
Turkish
  • 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]
Sputum
  • She was admitted to our outpatient clinic in August 1999, with symptoms of cough, sputum, and right-sided pleuritic pain for the last seven months. In the bronchoscopic examination, two endobronchial lesions were seen.[ncbi.nlm.nih.gov]
Pleuritic Pain
  • She was admitted to our outpatient clinic in August 1999, with symptoms of cough, sputum, and right-sided pleuritic pain for the last seven months. In the bronchoscopic examination, two endobronchial lesions were seen.[ncbi.nlm.nih.gov]
Pelvic Mass
  • In this case report, a patient with a history of thyroid Hurthle cell carcinoma presented with what seemingly appeared to be a pelvic mass of gynecological origin, with a raised risk-of-malignancy index of 567.[ncbi.nlm.nih.gov]
Chest Pain
  • A 60-year-old man reported chest pain and shortness of breath. His medical history was negative for myocardial infarction but positive for "mini strokes" and type 2 diabetes mellitus.[ncbi.nlm.nih.gov]
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]
Subcutaneous Mass
  • We discuss two cases of unsuspected metastatic thyroid carcinoma of Hurthle cell type, presenting as subcutaneous masses in the occipital scalp and supra-acetabular region of the right ilium; clinically suspected to be a lipoma and a vascular tumour,[ncbi.nlm.nih.gov]
Neck Mass
  • In elderly patients with sudden enlargement of neck mass and pre-existing thyroid conditions such as benign thyroid nodule, goitre (as in our case), Grave's disease or differentiated thyroid carcinoma, one has to bear in mind anaplastic thyroid carcinoma[wjso.biomedcentral.com]
Fine Tremor
  • Her hands were warm and there was fine tremor, No eye signs of Graves’ disease were elicited. Pulse rate was 100/minute, high volume and BP 180/90mm Hg, afebrile. No signs detected over heart, chest or abdomen.[casereports.in]
Limb Weakness
  • Final diagnosis was diffuse toxic goiter/ Hurthle cell neoplasm with pulmonary metastasis/ lower limb weakness due to mononeuritis multiplex, likely a paraneoplastic neurologic syndrome.[casereports.in]
Mononeuropathy
  • 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]

Workup

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].

Treatment

  • Nonsurgical treatment, including radioactive iodine therapy, is disappointing; thus, initial radical surgery is recommended as the treatment of choice.[ncbi.nlm.nih.gov]
  • CONCLUSION: Hurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.[ncbi.nlm.nih.gov]
  • METHODS: Sixteen patients met the following inclusion criteria: Treatment with curative intent at our institution between January 1, 1997, and December 31, 2010. Primary treatment with total thyroidectomy with or without neck dissection.[ncbi.nlm.nih.gov]
  • Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged 65 years (odds ratio [OR], 1.43; P .002) and among unmarried patients (OR, 1.29; P .004).[ncbi.nlm.nih.gov]
  • He received radioactive iodine therapy and suppressive levothyroxine treatment. Post-therapy whole body iodine-131 scan revealed thyroid tissue remnants limited to the anterior neck.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSION: Hurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.[ncbi.nlm.nih.gov]
  • 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]
  • CONTEXT: Hurthle cell cancer (HCC) is an understudied cancer with poor prognosis. OBJECTIVE: Our objective was to elucidate the genomic foundations of HCC.[ncbi.nlm.nih.gov]
  • After adjustment, age 45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio 3.0).[ncbi.nlm.nih.gov]
  • Tscholl-Ducommun, J., Hedinger, C.E.: Papillary thyroid carcinomas: Morphology and prognosis. Virchows Arch. [Pathol. Anat.] 396 :19, 1982 Google Scholar 24.[link.springer.com]

Etiology

  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.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]

Epidemiology

  • 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: The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer.[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.[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]
  • Hürthle originally used it to describe C cells instead of oncocytes Epidemiology Carcinoma is more common in older men (mean age: 57 years) Prognostic factors Oncocytic adenoma is benign, no recurrence after excision Overall, oncocytic carcinoma is more[pathologyoutlines.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology No widely accepted paradigm exists for the pathogenesis of follicular and Hürthle cell cancer of the thyroid.[emedicine.medscape.com]

Prevention

  • 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]
  • How can I prevent Hürthle cell carcinoma? As most cases of Hürthle cell carcinoma are not associated with any risk factors, there is usually no method to prevent its development.[oncolink.org]
  • For cancers that don’t take up iodine, external beam radiation therapy may help treat the tumor or prevent it from growing back in the neck.[cancer.org]
  • Hurthle Cell Adenoma Treatment Regardless of whether or not the tumor is malignant, Hürthle cell adenomas and carcinomas are both removed promptly to prevent the disease from progressing further.[knowcancer.com]
  • To minimize the effects of hypothyroidism, physicians may prescribe Cytomel , but this may not prevent symptoms from developing, since this medication also has to be stopped prior to the radioiodine treatment.[rarediseases.org]

References

Article

  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

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Last updated: 2019-06-28 10:43