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]

  Patients with multinodular goiter or those who have ... [accesssurgery.mhmedical.com]

  High frequency real-time ultrasonography revealed a goiterous left thyroid gland devoid of any intraglandular calcifications. No regional lymph nodes were seen. [njcponline.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]

• 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]

• 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]

• Dysphagia

  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]

  Dysphagia, dyspnea, voice changes and an apparent mass in the neck are main findings. [symptoma.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]

  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]

  In ATC local compression symptoms such as hoarseness, strider, dyspnoea and dysphagia occur as a rule [ 15 – 17 ]. [wjso.biomedcentral.com]

• 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]

• 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]

  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]

• 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]

• Myoclonus

  Case reported by Hyar et al. describes a woman with papillary carcinoma of thyroid and paraneoplastic myoclonus [ 2 ]. [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 [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].

• Anisocytosis

  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]

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