Hürthle Cell Carcinoma Research Articles

Hürthle Cell Carcinoma of the Thyroid Gland: Systematic Review and Meta-analysis.

Hürthle cell carcinoma (HCC) comprises about 5% of thyroid carcinoma cases. Partly because of its rarity there is much we still need to know about HCC as compared to other histological cancer subtypes. We conducted a systematic literature review following PRISMA guidelines and meta-analysis, from 2000 to 2020, to investigate the main characteristics of HCC and clarify information concerning tumor behavior and treatment. Our review included data from 9638 patients reported in 27 articles over the past 20years. This tumor occurred more frequently in women (67.5%). The mean age was 57.6years, and the mean size of the neoplasm at diagnosis was 30mm. Extrathyroidal extension was common (24%) but lymph node metastasis was not (9%). Total thyroidectomy was the most common surgical approach, with neck dissection usually performed in cases with clinically apparent positive neck nodes. Radioiodine therapy was frequently applied (54%), although there is no consensus about its benefits. The mean 5- and 10-year overall survival was 91% and 76%, respectively. This review serves to further elucidate the main characteristics of this malignancy. HCC of the thyroid is rare and most often presents with a relatively large nodule, whereas lymph node metastases are rare. Given the rarity of HCC, a consensus on their treatment is needed, as doubts remain concerning the role of specific tumor findings and their influence on management.

Thyroid Nodule Size as a Predictor of Malignancy in Follicular and Hurthle Neoplasms.

Introduction:The management of follicular (FN) and Hurthle cell neoplasms (HCN) is often difficult because of the uncertainty of malignancy risk. We aimed to assess characteristics of benign and malignant follicular and Hurthle neoplasms based on their shape and size. Materials and methods:Patients with Follicular adenoma (FA) or carcinoma (FC) and Hurthle Cell adenoma (HCA) or carcinoma (HCC) who had preoperative ultrasonography were included. Demographic data were retrieved. Size and shape of the nodules were measured. Logistic regression analyses and odds ratios were performed.Results:A total of 115 nodules with 57 carcinomas and 58 adenomas were included. Logistic regression analysis shows that the nodule height and the patient age are predictors of malignancy (p-values = 0.001 and 0.042). A cutoff value of nodule height ≥ 4 cm. produces an odds ratio of 4.5 (p-value = 0.006). An age ≥ 55 year-old demonstrates an odds ratio of 2.4-3.6 (p-value = 0.03). Taller-than-wide shape was not statistically significant (p-value = 0.613). Conclusion:FC and HCC are larger than FA and HCA in size, with a cutoff at 4 cm. Increasing age increases the odds of malignancy with a cutoff at 55 year-old. Taller-than-wide shape is not a predictor of malignancy.

Abstract 3012: Patient-derived models of rare cancers in the National Cancer Institute's patient-derived models repository

Abstract There is an unmet need for preclinical models of rare cancers and rare disease sub-types. The National Cancer Institute's Patient-Derived Models Repository (NCI PDMR; https://pdmr.cancer.gov) is developing quality-controlled, early-passage, clinically-annotated patient-derived tumor xenografts (PDXs), in vitro tumor cell cultures (PDCs), cancer associated fibroblasts (CAFs), and patient-derived organoids (PDOrg) and has focused on addressing unmet needs in the preclinical model space including developing models from adult and pediatric patients with rare cancers. To date, NCI has created and molecularly characterized over 150 preclinical models of rare cancer including indications such as Hurthle cell carcinoma, osteosarcomas, Merkel cell carcinomas, salivary gland cancers, synovial sarcomas, and carcinosarcomas. Rare cancer models developed to date will be reviewed and their histopathologic and molecular characteristics compared to that reported in the clinical setting. A pipeline to identify fusion proteins in these rare cancers such as the Ewing sarcoma EWSR1-FLI1 fusion and NAB2-STAT6 fusions in solitary fibrous tumors (SFT) has been implemented. Four malignant peripheral nerve sheath tumors (MPNST) PDX models are available for researches; these models were developed from patients diagnosed between the ages of 37-68. At the time of model development, two patients were treatment naïve and two had prior radiotherapy. Two of the MPNST PDX models have NF1 oncogenic mutations, three have deep deletions in CDKN2A/B, and three have a mutation in either EED or SUZ12 consistent with the reported molecular characteristics of patients with MPNST. Also of clinical relevance, of two mesothelioma models available, one carries an NF2 driver mutation and the other BAP1 and LATS2 and a PDX model for Hurthle cell carcinoma has wide-spread loss of heterozygosity (LOH 80%). Models for other rare cancers are in development, including four cholangiocarcinoma PDXs with histopathologic confirmation that are currently being expanded for molecular characterization and distribution. Funded by NCI Contract No. HHSN261200800001E Citation Format: Cindy R. Timme, Sergio Y. Alcoser, Devynn Breen, John Carter, Ting-Chia Chang, Alice Chen, Li Chen, Kristen Cooley, Biswajit Das, Emily Delaney, Michelle A. Eugeni, Michelle M. Gottholm-Ahalt, Tara Grinnage-Polley, Jenna Hull, Chris Karlovich, Kimberly Klarmann, Shahanawaz Jiwani, Candace Mallow, Chelsea McGlynn, Justine Mills, Malorie Morris, Michael Mullendore, Dianne Newton, Tia Shearer, Jesse Stottlemyer, Shannon Uzelac, Thomas Walsh, P. Mickey Williams, Yvonne A. Evrard, Melinda G. Hollingshead, James H. Doroshow. Patient-derived models of rare cancers in the National Cancer Institute's patient-derived models repository [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3012.

Whole-genome Sequencing of Follicular Thyroid Carcinomas Reveal Recurrent Mutations in MicroRNA Processing Subunit DGCR8.

BackgroundThe genomic and transcriptomic landscape of widely invasive follicular thyroid carcinomas (wiFTCs) and Hürthle cell carcinoma (HCC) are poorly characterized, and subsets of these tumors lack information on genetic driver events.ObjectiveThe aim of this study was to bridge this gap.MethodsWe performed whole-genome and RNA sequencing and subsequent bioinformatic analyses of 11 wiFTCs and 2 HCCs with a particularly poor prognosis, and matched normal tissue.ResultsAll wiFTCs exhibited one or several mutations in established thyroid cancer genes, including TERT (n = 4), NRAS (n = 3), HRAS, KRAS, AKT, PTEN, PIK3CA, MUTYH, TSHR, and MEN1 (n = 1 each). MutSig2CV analysis revealed recurrent somatic mutations in FAM72D (n = 3, in 2 wiFTCs and in a single HCC), TP53 (n = 3, in 2 wiFTCs and a single HCC), and EIF1AX (n = 3), with DGCR8 (n = 2) as borderline significant. The DGCR8 mutations were recurrent p.E518K missense alterations, known to cause familial multinodular goiter via disruption of microRNA (miRNA) processing. Expression analyses showed reduced DGCR8 messenger RNA expression in FTCs in general, and the 2 DGCR8 mutants displayed a distinct miRNA profile compared to DGCR8 wild-types. Copy number analyses revealed recurrent gains on chromosomes 4, 6, and 10, and fusion gene analyses revealed 27 high-quality events. Both HCCs displayed hyperploidy, which was fairly unusual in the FTC cohort. Based on the transcriptome data, tumors amassed in 2 principal clusters.ConclusionWe describe the genomic and transcriptomic landscape in wiFTCs and HCCs and identify novel recurrent mutations and copy number alterations with possible driver properties and lay the foundation for future studies.

Genetics, Diagnosis, and Management of Hürthle Cell Thyroid Neoplasms.

Hürthle cell lesions have been a diagnostic conundrum in pathology since they were first recognized over a century ago. Controversy as to the name of the cell, the origin of the cell, and even which cells in particular may be designated as such still challenge pathologists and confound those treating patients with a diagnosis of “Hürthle cell” anything within the diagnosis, especially if that anything is a sizable mass lesion. The diagnosis of Hürthle cell adenoma (HCA) or Hürthle cell carcinoma (HCC) has typically relied on a judgement call by pathologists as to the presence or absence of capsular and/or vascular invasion of the adjacent thyroid parenchyma, easy to note in widely invasive disease and a somewhat subjective diagnosis for minimally invasive or borderline invasive disease. Diagnostic specificity, which has incorporated a sharp increase in molecular genetic studies of thyroid tumor subtypes and the integration of molecular testing into preoperative management protocols, continues to be challenged by Hürthle cell neoplasia. Here, we provide the improving yet still murky state of what is known about Hürthle cell tumor genetics, clinical management, and based upon what we are learning about the genetics of other thyroid tumors, how to manage expectations, by pathologists, clinicians, and patients, for more actionable, precise classifications of Hürthle cell tumors of the thyroid.

ONCOCYTIC (HURTHLE CELL) THYROID CARCINOMA METASTASIS TO MANDIBLE: A RARE CASE REPORT

Introduction: Follicular thyroid carcinoma (FTC) accounts for ~10% of thyroid malignancies. Of all the oral malignancies only about 1% are metastases to the oral cavity. Focal oncocytic trans-differentiation results in neoplasia consisting predominantly of hurthle cells that can represent benign Hurthle cell adenoma or malignant Hurthle cell carcinoma. A 60 Case report: year female with complaint of left mandibular swelling came to opd, on CT it reveals lytic hyperenhancing solid expansile soft tissue lesion is seen in posterior body and ramus of mandible on left side, measuring 3.2*2.0*2.5 cms. In conclusion, fac Discussion: ial skeleton metastasis of thyroid malignancy is very rare. Most advantageous option in regards to treatment is surgical resection followed by radio-iodine therapy.

Abstract #1004282: Hurthle Cell Carcinoma of the Thyroid Gland with Breast Metastasis

Hurthle cell carcinoma is a form of differentiated follicular thyroid carcinoma and the presence of this histology is a poor prognostic feature. Hematogenous spread most often involves the bone, lung, or central nervous system. Metastases of differentiated thyroid cancer to other sites are extremely uncommon, often worrisome, and considered a main cause of cancer-specific mortality in these patients. We present a case of Hurthle cell thyroid carcinoma with breast metastases.

Cytological and molecular diagnosis of Hürthle cell thyroid tumors: Analysis of three cases.

The cytological diagnosis of Hürthle cell (oncocytic) thyroid tumors by means of fine-needle aspiration biopsy represents a challenge, as Hürthle cell polymorphism and atypia alone are not indications of malignancy. In our recent work, an original diagnostic algorithm was proposed, which identified and typed malignant thyroid tumors by analyzing the molecular markers of cytological preparations. The aim of the present study was to assess the effectiveness of this algorithm at detecting Hürthle cell thyroid tumors in clinical samples used for cytological examination. Cytological and histological examinations of the biopsy material were performed for three patients with nodular neoplasms. Biopsy material of these patients was analyzed by quantitative PCR using preselected molecular markers [normalized concentrations of High-mobility group AT-hook 2 mRNA, three microRNAs (miRNAs or miRs; miR-146b, miR-221 and miR-375) and the mitochondrial (mtDNA)/nuclear DNA ratio]. The results revealed that the molecular test determined the malignancy of three cases of Hürthle cell tumor. This method may therefore be used to complement the cytological diagnosis of fine-needle aspiration biopsy. In all three cases, there was an increased content of mtDNA, indicating Hürthle cell malignancies. Furthermore, in the first case [Hürthle cell carcinoma (HCC)], increased miRNA-221 content was detected, which also indicated malignancy. In the second case (Hürthle cell papillary thyroid carcinoma), an increased level of miRNA-146b was present, which indicated papillary carcinoma. In the third case (Hürthle cell adenoma), no markers of malignancy were identified. The present study demonstrated that molecular testing together with cytological analysis can reduce the isk of error in the preoperative cytological diagnosis of unclear or ambivalent cases.

Concurrent Papillary and Follicular Thyroid Cancer Presenting as Shoulder Pain

Differentiated thyroid cancer arises from thyroid follicular epithelial cells. It accounts for more than 90% of thyroid cancers. In areas of sufficient iodine nutrition, about 85% of differentiated thyroid cancers are papillary, 10% are follicular and 3% are Hurthle cell carcinomas. The coexistence of different types of thyroid cancer in a single patient is a rare condition.This is the case of a 56 year-old man with medical history of arterial hypertension who presented to clinics with right shoulder pain. Imaging of the right shoulder showed a osteolytic lesion involving the right humerus with associated cortical disruption consistent with pathological fracture secondary to metastatic disease. Bone biopsy showed papillary thyroid carcinoma. Subsequently, ultrasound-guided fine needle aspiration biopsy to a right lobe nodule was performed, which confirmed the presence of papillary thyroid carcinoma. There was also evidence of cervical lymph node involvement. Patient proceeded to total thyroidectomy with neck dissection, and surgical pathology revealed the presence of 2.5 cm right lobe papillary carcinoma and 1.5 cm left lobe follicular carcinoma. Postoperatively, he was found with persistent elevated thyroid-stimulating hormone (TSH) and elevated quantitative thyroglobulin with elevated thyroglobulin antibodies. Patient received therapeutic radioiodine (I-131) for ablation of thyroid cancer. Whole body iodine scan demonstrated residual functioning thyroid tissue within post-thyroidectomy bed, with or without residual carcinoma, and large expansile uptake lesion involving the right humeral head and neck. Therefore, patient will receive a second dose of radioactive iodine. He has been started on thyroid hormone replacement with a goal of TSH <0.1 uIU/mL for high risk American Thyroid Association (ATA) stratification, and has remained clinically euthyroid.Thyroid carcinoma is the most common endocrine malignancy and one of the most rapidly increasing cancers in the United States. This increase in incidence is largely due to incidental detection on diagnostic imaging. Here we present an uncommon case of two distinct thyroid malignancies occurring simultaneously in a patient presenting with a pathological fracture. Synchronous occurrence of two types of differentiated thyroid cancer is a rare event, and has only been reported in case series. Bone metastasis from differentiated thyroid cancer can occur in 2-13% of patients. Despite the therapy for papillary thyroid carcinoma and follicular thyroid carcinoma remain the same, proper identification will lead to prompt therapy and increased survival. Physicians should be aware of this variety.

Impaired Sleep Influences Health Care Related Quality of Life in Patients With Well Differentiated Thyroid Carcinoma

Background: Most patients with well differentiated thyroid carcinoma (WDTC) have a favorable prognosis but often report lower health care related quality of life (HRQoL). Sleep quality is one contributor to HRQoL that has also been reported to be impaired in WDTC patients. We evaluated patient reported outcome measures (PROM) of HRQoL and sleep quality in patients with WDTC, and compared them to patients with thyroid nodules.Methods: This is a single institution cohort study utilizing data on consented adult patients with WDTC or thyroid nodules from an integrated cancer research database. We included participants with WDTC and thyroid nodules who completed the SF-36v2 HRQoL survey and the Pittsburgh Sleep Quality Index (PSQI). HRQoL was reported as a composite mental (MCS) and physical (PCS) component score that was compared with population-based norms and reported as the frequency of patients scoring below or well below the age-controlled reference population. Sleep quality was reported as PSQI raw score. Poor sleep quality was defined as a PSQI score >5. Cancer stage was calculated as American Joint Commission on Cancer (AJCC) 7th and 8th edition for each subject in the registry.Results: We evaluated 727 patients and 424 (58%) had WDTC: 219 (72%) with papillary thyroid carcinoma (PTC), 28 (9%) with follicular variant of PTC, 53 (18%) with follicular thyroid carcinoma and 3 (1%) with Hurthle cell carcinoma. Of these, 208 (68.7%) were treated with radioactive iodine ablation with a mean cumulative dose of 197.7 (range 29-700) mCi. Mean age for WDTC was 42.7 years (standard deviation SD 15.4), and 53.4 years (SD 14.3) for nodules (p < 0.001). Eighty one percent of WDTC and 368 (87%) of nodules were female (p = 0.022). PSQI indicated worse sleep quality for WDTC patients with a mean of 6.85 (SD 3.97) and 174 (57.4%) reporting poor sleep quality with a PSQI > 5, compared with a mean score of 6.8 (SD 4.05) and 170 (40.1%) with PSQI > 5 for nodules (p < 0.001). WDTC diagnosis was associated with poor sleep quality with an odds ratio of 2.02 (95% confidence interval 1.48 - 2.75), p < 0.001. Poor quality sleep was also associated with WDTC stage using AJCC8 (0.017) but not AJCC7 (p = 0.067). Overall PCS, MCS, and HRQoL category were not significantly different between WDTC and nodule groups. When stratified by stage, MCS was inversely associated with cancer stage using AJCC7 (p = 0.035) but not AJCC8 (p = 0.96); PCS was associated with cancer stage using both AJCC7 (p = 0.003) and AJCC8 (p < 0.001).Conclusions: Patients with WDTC report worse sleep quality than those with thyroid nodules and it is correlated with AJCC8 stage. HRQoL is similar between all WDTC patients and those with thyroid nodules in this cohort, though WDTC patients with higher stage reported worse physical function. The AJCC 8th was more sensitive to differences in sleep quality and physical function by stage than AJCC 7th.

Molecular alterations in Hürthle cell nodules and preoperative cancer risk.

Hürthle cell carcinoma (HCC) is a distinct type of thyroid cancer genetically characterized by DNA copy number alterations (CNA), typically of genome haploidization type (GH-type). However, whether CNA also occurs in benign Hürthle cell adenomas (HCA) or Hürthle cell hyperplastic nodules (HCHN), and have diagnostic impact in fine-needle aspiration (FNA) samples, remains unknown. To address these questions, we (1) analyzed 26 HCC, 24 HCA, and 8 HCHN tissues for CNA and other mutations using ThyroSeq v3 (TSv3) next-generation sequencing panel, and (2) determined cancer rate in 111 FNA samples with CNA and known surgical outcome. We identified CNA, more often of the GH-type, in 81% of HCC and in 38% HCA, but not in HCHN. Among four HCC with distant metastasis, all had CNA and three TERT mutations. Overall, positive TSv3 results were obtained in 24 (92%) HCC, including all with ATA high risk of recurrence or metastasis. Among 111 FNA cases with CNA, 38 (34%) were malignant and 73 (66%) benign. A significant correlation between cancer rate and nodule size was observed, particularly among cases with GH-type CNA, where every additional centimeter of nodule size increased the malignancy odds by 1.9 (95% CI 1.3-2.7; P = 0.001). In summary, the results of this study demonstrate that CNA characteristic of HCC also occur in HCA, although with lower frequency, and probability of cancer in nodules with CNA increases with nodule size. Detection of CNA, in conjunction with other mutations and nodule size, is helpful in predicting malignancy in thyroid nodules.

Incident of Thyroid Carcinomas and Other Pathologies with Age Correlation in Patients Presented with Palpable Thyroid Masses Undergoing Thyroidectomies

Background: Thyroid cancer is the leading cause of death both in developing and developed countries. Patients present with enlarged thyroid. Radiology shows hot and cold nodules. Thyroidectomy or lobectomy is done to rule out malignancy. Objective: To determine the incidence of thyroid carcinomas and other pathologies in thyroidectomy specimen of different age group patients presenting with clinically enlarged thyroid. Study Design: Cross-sectional study. Settings: Department of Histopathology, Foundation University Medical College (FUMC), Islamabad and Department of surgery, Fauji Foundation Hospital (FFH), Rawalpindi Pakistan. Duration: from Jan 2012 to March 2019. Methodology: All the thyroidectomies specimens send from Surgery department of FFH to Histopathology Department of FUMC during study period and fulfilling the pre-set criteria were included in the study. All the data and results were analyzed using SPSS version 17.0. Results: Out of 500 total patients, 89% (n=445) were diagnosed as having multinodular goiter, 2.6% (n=13) thyroiditis, 2.2% (n=11) follicular adenoma, 0.8% (n=4) Hurthle cell adenoma, 0.2%(n=1) hyalinizing trabacular adenoma and thyroid carcinomas. The carcinomas comprised 2.6%(n=13) papillary carcinoma, 0.8%(n=4) poorly differentiated carcinoma,0.8%(n=4) anaplastic carcinoma,0.6%(n=3) medullary carcinoma and 0.4%(n=2) follicular carcinoma. In 445 patients of multinodular goiter 158 patients were in the age range of 41-50 years, in 13 cases of thyroiditis 7 were in the age range of 31-40 years, in 11 cases of follicular adenoma 4 patients were in the age range of 31-40 years, in 4 cases of hurthle cell adenoma 3 patients were in the age range of 41-50 years, in 13 cases of papillary thyroid carcinoma 5 patients were in the age range of 31-40 years, in 4 cases of poorly differentiated carcinoma 2 patients were in the age range of 41-50 years and in 4 cases of anaplastic carcinoma 2 patients were in the age range of 61-70 years. Conclusion: The study concluded that thyroid carcinomas collectively constituted 5.20% of the study cases. Papillary carcinoma was the most frequent malignant neoplasm constituting 2.6 % and occurring mostly in the age range of 31-40 years, while anaplastic carcinoma comprised of 0.8% of malignant lesions occurring in the age range of 61-70 years. The most frequent cause of thyroid enlargement was multinodular goiter (89%) with majority of the patients in the age range of 41-50 years.

Hurthle cell adenoma and papillary microcarcinoma: a rare case of thyroid collision tumor

&lt;p class="abstract"&gt;Collision tumors of the thyroid gland are histologically distinct tumors coexisting within the gland. Here, we depict a case of a 36-year-old woman who presented with anterior neck swelling of one-year duration. Local examination revealed a 3×2 cm, firm, right solitary thyroid nodule. Fine needle aspiration cytology was suggestive of Hurthle cell neoplasm. Patient underwent a right hemi-thyroidectomy. Histopathological examination showed co-existence of Hurthle cell adenoma and papillary thyroid microcarcinoma. The patient was asymptomatic during six months follow up. It is important that the surgeons and pathologists are aware of these collision tumors so that optimal therapeutic interventions can be carried out. &lt;/p&gt;

Outcomes following I-131 treatment with cumulative dose exceeding or equal to 600 mCi in differentiated thyroid carcinoma patients.

To evaluate treatment outcomes following radioactive iodine (RAI) treatment with a cumulative dose of ≥≥600 mCi in differentiated thyroid carcinoma (DTC) patients, a retrospective review of medical records was done in 176 DTC patients with a cumulative dose of ≥600 mCi from January 1993 to December 2013. All patients were followed up for at least 2 years after receiving 600 mCi of I-131 treatment. Remission criteria were no clinical and imaging evidence of disease and low serum thyroglobulin levels during thyroid-stimulating hormone suppression of <0.2 ng/ml or of <1 ng/ml after stimulation in the absence of interfering antibodies. A total of 176 patients were included in the study: 137 – papillary thyroid cancer, 29 – follicular thyroid cancer, 9 – mixed papillary and follicular thyroid cancer, and 1 – Hurthle cell carcinoma. Most of the patients (118, 67%) had locoregional metastasis, whereas 48 patients (27%) had distant metastases at presentation. The median cumulative dose was 900 mCi (range: 600–2200 mCi). The mean follow-up period was 82.84 ± 42.41 months. Only 16 patients (9.1%) met remission criteria at the end of treatment. The rest of patients (160, 90.9%) were not remitted: stable disease in 94 (53.4%), at least 1 metastasis without I-131 uptake in 34 (19.3%), progressive disease in 21 (11.9%), and death during the whole follow-up period in 11 (6.3%). Two patients (1.1%) developed second primary malignancy. Eighteen cases were suspected of bone marrow suppression (14 cases [7.9%] had anemia and 5 cases [2.8%] had neutropenia). Seven patients (3.9%) developed permanent salivary gland dysfunction. Although the complications after receiving RAI treatment with a cumulative dose of ≥≥600 mCi were low and not severe, the patients with remission were in <10%. Our study suggests that the decision to administer further treatments should be made on an individual basis because beneficial effects may be controversial.

Radiologic and clinicopathologic characteristics of thyroid nodules with focal 68Ga-DOTATATE PET activity.

Our aim was to determine the radiologic and clinicopathologic characteristics of thyroid nodules with focal 68Ga-DOTATATE activity. In this retrospective study of 1927 consecutive 68Ga-DOTATATE PET scans, 85 patients with incidental and nonincidental focal 68Ga-DOTATATE avid thyroid nodules were identified, of which 31 patients with 33 thyroid nodules underwent fine-needle aspiration (FNA) or surgery. These 33 nodules were reviewed for Krenning score and SUVmax of the thyroid nodule, contralateral thyroid lobe and left atrium. Cytology/histopathology included 58% (19/33) with benign findings, 18% (6/33) medullary thyroid carcinoma (MTC), 9% (3/33) atypia or follicular lesion of undetermined significance (AUS/FLUS), 9% (3/33) suspicious for follicular neoplasm and Hurthle cell adenoma (SFN/HCA) and 6% (2/33) nondiagnostic cytology. Median serum calcitonin was 1156 pg/mL (range, 460-1828) in MTC and was <5.0 pg/mL (<5.0-12.5) in patients with benign nodules. Nodules had Krenning score of 1, 2 and 3 in 46% (15/33), 27% (9/33) and 27% (9/33). The majority of MTC and AUS/FLUS nodules had a Krenning score of 3, and there was substantial intragroup variation in Krenning score among the benign nodules. The mean SUVmax for the entire cohort was 5.5 ± 2.9 (mean ± SD), and the range was 2.0-13.0. There was overlap in the nodule/contralateral thyroid SUVmax ratios between groups. The MTC and AUS/FLUS nodules tended to have a higher nodule/blood pool SUVmax ratio than the other pathologic groups. There was considerable variation in radiologic characteristics among benign thyroid nodules. The ratio of thyroid nodule SUVmax/blood pool SUVmax may be useful to differentiate pathologic groups, but larger studies are needed to investigate this further. Given the potential for malignancy in thyroid nodules with focal 68Ga-DOTATATE activity, further evaluation with serum calcitonin and FNA may be considered.Video Abstract: http://links.lww.com/NMC/A186.

Factores de riesgo y supervivencia en el carcinoma de células de Hürthle. Revisión sistemática y metanálisis

Background: Hurthle cell carcinoma (HCC) of the thyroid gland, which accounts for about 0.4–10% of all differentiated thyroid cancer, is considered differentiated carcinoma with a distinct entity. The treatment of this disease is controversial since there are no prospective randomized controlled trials validating the extent of thyroidectomy and the efficacy of adjuvant treatment with radioactive iodine or radiation therapy.Objective: The aim of this study is to analyze the prognostic factors affecting survival of patients with HCC.Material and methods: We performed an electronic search in MEDLINE, EMBASE, COCHRANE, and LILACS-BIREME databases to find relevant literature regarding risk and prognostic factors affecting survival.Results: Male sex, tumor size > 4 cm, lymph node involvement, extrathyroid extension and distantmetastases were associated with adverse outcome. Total thyroidectomy showed a trend toward higher survival.Conclusions: The management of patients with HCC is still controversial. Large-scale research on multimodal treatments is required. The AACCyC national registry which is opened to all surgeons will provide high quality evidence on the matter. The authors are aware of the strengths and weaknesses of this presentation. This is the first meta-analysis on risk factors and survival of HCC; however, the degree of heterogeneity of the studies was very high for some variables and it was not possible to include in this analysis other risk factors that could affect the prognosis. .

Cytopathological Evaluation of Thyroid Lesions Based on Bethesda System in Patients Attending Birat Medical College and Teaching Hospital

More than 50% of the world’s population has at least a thyroid nodule. Detail clinical examination and radiology may help in diagnosing thyroid lesions but the management depends upon the cytopathological diagnosis. Optimum use of fine needle aspiration cytology (FNAC) and better understanding of cytomorphological characteristic of thyroid lesions by using Bethesda system, triaging of patients who are to be treated medically or surgically is more accurate. The objective of this present study is cytopathological evaluation of thyroid lesions based on Bethesda System in patients attending Birat Medical College and Teaching Hospital. The objective was also to correlate the cytological findings with histopathological findings where ever possible. A total of 104 patients with thyroid lesions underwent fine needle aspiration cytology in a period of a year (September 1, 2019 to August 31, 2020). Cytological features were evaluated and classified according to the Bethesda system. Histopathological features were evaluated and correlated wherever available. Among 104 patients with thyroid lesions 93 were female and 11 were male. Four cases turned out to be non diagnostic, 85 benign, three Atypia of undetermined significance, three Suspicious for follicular neoplasm and eight Suspicious of malignancy and one Malignant according to Bethesda system. Histopathology specimen was received in 31 patients out of whom 20 (64.5%) patients were reported as colloid nodule, two follicular adenoma, one Hurthle cell adenoma, six papillary carcinoma and two follicular carcinoma. Medullary carcinoma and anaplastic carcinoma were not seen in the patients evaluated. Specificity and sensitivity of fine needle aspiration cytology was 94.7% and 88.9% respectively. Thus reporting thyroid lesions FNAC with Bethesda system allow a more specific cytological diagnosis.

Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features.

Simple SummaryHürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is characterized by its large, granular and eosinophilic cytoplasm, due to an excessive number of mitochondria. Hürthle cells can be identified only after fine needle aspiration cytology biopsy or by histological diagnosis after the surgical operation. Published studies on HCC indicate its putative high aggressiveness. In this article, current knowledge of HCC focusing on clinical features, cytopathological features, genetic changes, as well as pitfalls in diagnosis are reviewed in order to improve clinical management.Hürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is considered to be more aggressive than non-oncocytic thyroid carcinomas. However, due to its rarity, the pathological characteristics and biological behavior of HCC remain to be elucidated. The Hürthle cell is characterized cytologically as a large cell with abundant eosinophilic, granular cytoplasm, and a large hyperchromatic nucleus with a prominent nucleolus. Cytoplasmic granularity is due to the presence of numerous mitochondria. These mitochondria display packed stacking cristae and are arranged in the center. HCC is more often observed in females in their 50–60s. Preoperative diagnosis is challenging, but indicators of malignancy are male, older age, tumor size > 4 cm, a solid nodule with an irregular border, or the presence of psammoma calcifications according to ultrasound. Thyroid lobectomy alone is sufficient treatment for small, unifocal, intrathyroidal carcinomas, or clinically detectable cervical nodal metastases, but total thyroidectomy is recommended for tumors larger than 4 cm. The effectiveness of radioactive iodine is still debated. Molecular changes involve cellular signaling pathways and mitochondria-related DNA. Current knowledge of Hürthle cell carcinoma, including clinical, pathological, and molecular features, with the aim of improving clinical management, is reviewed.

Hurthle Cell Carcinoma of the Thyroid: A Case Report of 12 Cases

Hurthle cell carcinoma (HCC) is a relatively rare disease, which comprises about 3% of differentiated thyroid carcinoma. HCC is considered to have more aggressive clinical behavior compared with other differentiated thyroid carcinoma. However, there has been no consensus about clinical behavior and optimal treatment of HCC because of insufficient reports. Moreover, owing to geographical characteristics, HCC is rarer in Korea than in western countries. Based on 2017 World Health Organization classification, HCC is newly classified as an individual group, not as a subtype of follicular thyroid carcinoma. Therefore, we report data of 12 HCC patients who underwent surgery in our center from January 2000 to May 2020 with a review of the literature.

Analysis of diagnosis and treatment of 100 patients with Hürthle cell adenoma

Objective To summarize and analyze the clinical data and prognosis of the patients with Hurthle cell tumor (HCT) in order to raise the clinicians' awareness of the disease. Methods The clinical data on patients with histopathologically proven HCT, without other thyroid carcinomas, were collected retrospectively in Peking University First Hospital from January 2001 to February 2017. All the patients underwent surgery due to thyroid nodules. The follow-up information was also collected. Results A total of 100 patients were enrolled in the current study. All of them were diagnosed with Hurthle cell adenoma (HCA). There were 77 females and 23 males, with the male-to-female ratio of 1 : 3.3. The average age of these patients was (52±14) years at the time of operation. Fifty-one patients were found their thyroid nodules accidentally by ultrasonography during their health check-ups. 69.4% of the 49 symptomatic patients presented with painless cervical nodules. 83.0% HCA patients were combined with multinodular goiters (MNGs). 88.4% (76/86) patients were euthyroid and 53.8% (21/39) had increasing thyroglobulin levels. The mean longest diameter of HCAs was (3.2±1.5) cm (range: 0.9-7.3 cm) on ultrasonography. There were a series of sonographic features of HCA, such as larger, solidity, hypoecho, a smooth outline, intranodular vascularization, perinodular vascularization, absence of calcification in nodules and absence of enlarged cervical lymph nodes. Compared with the histological diagnosis, the diagnostic accuracy by frozen section (FS) during operation was 97.4%. Twenty-nine patients were followed up with an average period of (49.2±22.1) months and none of them had local recurrence or cervical lymph node metastasis. Six patients accepted thyroid hormone replacement treatment and one had thyrotoxicosis due to over-dose. Conclusion HCA is more common in women. It is often found accidentally by ultrasonography during their health check-ups or presented with painless cervical nodules. It is combined with MNG frequently. HCA exhibits numerous sonographic features but not unique. FS during operation is a reliable method to identify HCA with high diagnostic accuracy. Patients with thyroid hormone administration should be monitored for thyroid function after thyroid surgery.