(2011). Oncocytesin the thyroid are often called Hürthle cells. Most of the radioiodine passes quickly through the body and is excreted in the urine. [5] Tumors displaying only capsular invasion tend to behave less aggressively than those with vascular invasion. [4], Hürthle cell tumors can be separated into Hürthle cell adenoma and carcinomas, which are respectively benign and malignant tumors arising from the follicular epithelium of the thyroid gland. As stated previously, the vast majority of thyroid nodules are benign….probably over 90% benign. The Hürthle cell is named after German histologist Karl Hürthle, who investigated thyroid secretory function, particularly in dogs. One of the mainstays of treatment of follicular thyroid cancer is thyroid hormone suppression therapy. These tumors do have a similar presentation to papillary thyroid cancer. The follicular cancers are often cured with surgery, however, they do have the ability to metastasize. The female to male ratio for Hurthle cell adenomas is 8:1, while the ratio is 2:1 for the malignant version. Archives of Pathology and Laboratory Medicine 132.8 (2008): 1241-1250. The cytopathologist will review the slides and score the biopsy using the Bethesda classification system. Hurthle cell carcinoma is a variant of follicular thyroid cancer (FTC). Papillary Thyroid Carcinoma, Follicular Thyroid Carcinoma, and Hürthle Cell Carcinoma. Several factors contribute to this decision making process. [4], Hürthle cell adenomas are most likely diagnosed much more frequently than Hürthle cell carcinomas. Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type. The … The … The biopsy results are often confusing and frustrating for patients who expected a clear diagnosis from the needle biopsy. Hürthle cells (HC) are characterized by abundant granular eosinophilic cytoplasm containing accumulated dysfunctional mitochondria and large nuclei with prominent nucleoli. [6] On few occasions, patients with Hürthle cell carcinoma have distant metastases in the lungs or surrounding bones. The treatment for follicular and Hurthle cell cancer is a total thyroidectomy (removal of the entire gland), while the treatment for a benign tumor is removing just the half of the thyroid that contains the tumor. [5] A Hürthle cell is larger than a follicular cell, and its cellular material stains pink. Although the terms oncocyte, oxyphilic cel… Abstract. 33 Although Hürthle cell neoplasm (HCN) should be categorized as a distinct category separate from FN, historically this has not always been the case. Hi Michelle, I had a FNA that was suspicious for Hurthle Cell in Feb. 2017. Suspicious for follicular neoplasm, Hurthle cell type Bethesda class IV - Thyroid cancer. If the cytopathologist sees a highly cellular specimen of monotonous, atypical follicular cells sometimes arranged in a microfollicular patter, it will be classified as a follicular neoplasm (Bethesda IV). Atlas of Endocrine Pathology. Follicular carcinoma of Hürthle cell type as cause of hemoptysis. © 2021 The Endocrine Surgery Program, All Rights Reserved. [5] Hürthle cell cancer tends to occur in older patients. To screen for potential recurrence, patients undergo physical examination and ultrasound of the neck and blood is drawn to determine the thyroglobulin level. The cells may be arranged in groups or in microfollicles. One case was an infarcted Hürthle cell follicular adenoma (case 1), a second was a 11 mm-sized follicular adenoma with variable oncocytic change (case 2), a third was a non-invasive follicular thyroid neoplasm with papillary like nuclei (NIFTP) but with background oncocytic change (case 3), a fourth case (case 5) showed multiple benign adenomatoid nodules focally with oncocytic … [5] Hürthle cell neoplasms are somewhat difficult to differentiate between being benign or malignant. Hurtle cell cancers behave similarly to follicular cancers. Follicular thyroid cancer incidence … The obtained material is place on glass slides and then put into fixative for review by the cytopathologist. However, some of these cancers do respond to radioiodine and ablation of the any remaining normal gland can be helpful when screening for potential recurrence in the future. For this reason, patients with papillary thyroid cancer are placed on dose of thyroid hormone that is high enough to suppress release of TSH from the brain. The Significance of Hurthle Cells in Thyroid Disease. So, to distinguish between benign and malignant, the pathologist must evaluate the entire circumference of the tumor. Encyclopedia of Cancer. A needle biopsy cannot distinguish between a benign follicular adenoma and a malignant follicular carcinoma (which is why a Bethesda IV is sometimes called an “indeterminate” biopsy). However, distinguishing between a benign follicular or Hurthle cell “adenoma” and a malignant “carcinoma” is not possible by preoperative needle biopsy or by intraoperative frozen section. This version is a relatively rare form of differentiated thyroid cancer, accounting for only 3-10% of all differentiated thyroid cancers. [5] The mitochondrial DNA of Hürthle cell carcinoma contain somatic mutations. The aim of this study was to determine the risk of … It is also possible to develop papillary thyroid carcinoma with Hurthle cell variant/features. These terms are synonyms; a laboratory should choose the one it prefers and use it exclusively for this interpretation. 5, 32, 42 Although there is usually no significant nuclear atypia in the context of a benign follicular … The only way it can be determined if its cancer or or not is to have the nodule/thyroid removed and sent to pathology. [8] However, this is a misnomer since Hürthle actually described parafollicular C cells. Hürthle cell neoplasms are made up of a pure, often showing cellular dyscohesion, population of Hürthle cells. doi:10.1634/theoncologist.2010-0253, Schwab, M. (2011). Int J Cancer 1991; 48:28. [4] This high amount of mitochondria is reported to be a result of mutations in the mitochondrial DNA. Most patients with follicular or Hurthle cell thyroid cancer initially have an “indeterminate” biopsy (Bethesda IV, follicular neoplasm, Hurthle cell neoplasm). These tumors do not overexpress thyroid hormone, so the thyroid function blood tests are typically normal. A majority of cases diagnosed as HCN undergo surgical excision for definite characterization. This is why surgical removal is required to make this determination and this is also why needle biopsy and frozen section at the time of surgery are not able to yield a reliable diagnosis. And fourth, the complication rate from having half versus all of the thyroid removed is about the same. The thyroid gland is located in front of the windpipe in the neck, and a large neoplasm may cause symptoms such as a hoarse … H. Colledge Date: January 20, 2021 A radioactive form of iodine can be used to help treat a follicular neoplasm.. A neoplasm is a tumor, or growth, and a follicular neoplasm arises from what are called follicular cells inside the thyroid gland. "Beitrage zur Kenntnis des Sekretionsvorgangs in der Schilddruse", https://en.wikipedia.org/w/index.php?title=Hürthle_cell&oldid=994400834, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License, This page was last edited on 15 December 2020, at 15:02. The reason for this is that the individual cells within both the benign and malignant tumors look the same under the microscope. [5] Hürthle cell carcinomas consists of at least 75% Hürthle cells. Therefore, if you have a thyroid biopsy by another doctor or surgeon which shows follicular cells… [4][9], Cannon, J. https://columbiasurgery.org/.../follicular-and-hurthle-cell-thyroid-cancer "Hurthle Cell Thyroid Neoplasms." Follicular neoplasms, other than the Hürthle cell subtype, were classified according to the type of atypia, namely, architectural (microfollicular formations, crowding, and isolated cells) or nuclear (nuclear enlargement, chromatin clearing, nuclear grooves, and nuclear membrane irregularity) . [5], Hürthle cells arise from the follicular epithelium. If the tumor cells remain within that capsule, then the tumor is benign (having not yet achieved the ability to metastasize). Rarely, the cancer can spread to the lymph nodes. On this page: “FTC” in red represents for follicular thyroid carcinoma, “FA” in green is for benign follicular adenoma, and abbreviation “N” in black represents normal samples. Follicular thyroid cancer. Sex, Hürthle cell change, histologic type, and gene alternations for the specimens are indicated. Erickson, Lori A. Follicular neoplasms (FNs) are diagnosed in 10% to 20% of FNA biopsies and are characterized by follicular cells with a paucity of colloid. If the surgical pathology reveals capsular or vascular invasion, then these nodules are diagnosed as follicular carcinomas, Hürthle cell (oncocytic) type. 9 As defined by WHO, Hürthle-cell neoplasms are composed of 75% or greater Hürthle cells… A, The thyroid fine-needle aspirate is composed exclusively of Hürthle cells. [7] Hürthle cell carcinomas are characterized as either minimally invasive or widely invasive tumors. Patient diagnosed with follicular or Hurthle cell cancer are seen in follow up every 6 to 12 months. doi:10.1016/B0-12-227555-1/00151-9. Once a nodule greater than 1 cm or with worrisome ultrasound characteristics is identified, the next step is a fine needle aspiration biopsy. Following a total thyroidectomy for follicular thyroid cancer, your doctor may recommend radioactive iodine ablation. Thyroid fine needle aspiration biopsy (FNAB): a simple procedure that is done in the doctor’s office to determine if a thyroid nodule is benign (non- cancerous) or cancerous. [5] Classification is important since widely invasive tumors can have outcomes with a 55% mortality rate. What defines a cancer is the behavior of those cells. Hurthle cells have a distinctive appearance under the microscope. Management of follicular and Hürthle cell neoplasms of the thyroid gland is a common clinical problem. Montone, Kathleen T., Zubair W. Baloch, and Virginia A. LiVolsi. [5] Typically a painless thyroid mass is found in patients with this type of cancer. The diagnosis of follicular or Hurthle cell thyroid cancer is determined using the algorithm outline above for the work up of a thyroid nodule. It typically takes several weeks on a fixed dose of thyroid hormone before reliable changes in the blood work are seen. Deutsches Archiv für klinische Medicin, Leipzig, 1898, 61:118-186. The Oncologist. Follicular and Hurthle cell thyroid cancer are forms of differentiated thyroid cancer that are less common than papillary thyroid cancer. 63-66. Aschebrook-Kilfoy B, Grogan RH, Ward MH, et al. Sadbutrue. The predictive value of the fine-needle aspiration diagnosis “Suspicious for a follicular neoplasm, Hürthle cell type” in patients with Hashimoto thyroiditis. Patients with FCDC with documented distant metastases (e.g., lung, bone) at presentation undergo RAI scanning 6 to 8 weeks postoperatively and are treated with 131 I therapy; the dose depends on the extent of metastases and avidity for RAI. This determination can only be made by the pathologist once the nodule has been surgically removed. [5] A Hürthle cell adenoma or a minimally invasive tumor can be treated by a thyroid lobectomy, although some surgeons will perform a total thyroidectomy to prevent the tumor from reappearing and metastasizing. The median age at diagnosis for Hürthle cell carcinomas is approximately 61 years old. Harach HR, Escalante DA, Onativia A, et al. FNAs from a benign follicular nodule exhibiting Hürthle cell metaplasia are characterized by a mixture of follicular cells and Hürthle cells arranged in macrofollicles, a mixture of macro‐ and microfollicles, or in monolayers with a honeycomb arrangement.
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