Hürthle Cell Research Articles

International Multi-institutional Experience with the Transoral Endoscopic Thyroidectomy Vestibular Approach.

Background: Surgical approaches to thyroidectomies have undergone a rapid evolution over the past three decades. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the latest remote access procedure for the treatment of benign and malignant thyroid disease. The purpose of this article is to present the results of TOETVA from five different international institutions. Materials and Methods: From 2016 to 2019, 152 TOETVA procedures were performed on 149 patients at five separate international institutions. Outcomes were analyzed from a prospectively maintained database. There were 12 (8%) men and 137 (92%) women with mean ages of 41.5 ± 10.3 (27-69) and 46.9 ± 1.8 (17-78), respectively. Results: There were 3 (2%) cases that required conversion from the endoscopic approach to an open procedure. A thyroid lobectomy was performed in 111 (73.0%) cases, total thyroidectomy in 38 (25.0%) cases whereas a completion thyroidectomy in 3 (2.0%) cases. Mean operative times were 161.8 ± 42.4 (83-304) minutes for the lobectomy, 213.4 ± 71.7 (120-430) minutes for the total thyroidectomy, and 136.7 ± 109.8 (64-263) minutes for the completion thyroidectomy. The final pathology report revealed 107 (70.4%) benign nodules, 44 (28.9%) nodules with underlying papillary thyroid carcinoma, and 1 (0.7%) case with Hurthle cell carcinoma. Of the 152 cases, 7 (4.7%) patients developed temporary hypoparathyroidism. There were 5 (3.3%) patients who developed transient recurrent laryngeal nerve (RLN) injury and 3 (2.0%) with persistent injury of the RLN. Temporary lower lip numbness was noted in 51 (33.6%) patients whereas 1 (0.7%) patient was noted to have persistent numbness. We reported 57 (38.5%) patients with temporary chin numbness, 9 (5.9%) patients with skin injuries, and 2 (1.3%) with tracheal perforation. Conclusion: To date, the literature and the outcomes from these 5 international institutions have determined that, in select patients, TOETVA can be as safe and efficacious as the traditional trans-cervical technique for the treatment of specific thyroid pathologies.

Cytomorphological patterns of thyroid lesions among 1646 Sudanese patients: what we can learn from fine needle aspiration cytology retrospective analysis?

Introduction: Fine-needle aspiration (FNA) cytology biopsy of the thyroid gland is an accurate and useful diagnostic tool in the initial evaluation of nodular thyroid lesions. We aimed in this study to determine the cytomorphological patterns of thyroid lesions diagnosed by FNA among Sudanese patients. Methods: A descriptive retrospective, clinic-based study was performed. Cytopathological records of patients that attended the Total Lab Care Clinic in Khartoum-Sudan between January 2016 and December 2017 were reviewed. Results: A total of 1646 patients records were reviewed; 1385 (84.1%) were females and 261 (15.9%) males. A total of 1563 (94.9%) were negative for malignancy, 39 (2.4%) were positive for malignancy, 42 (2.6%) were indeterminate for malignancy and 2 (0.1%) were non-diagnostic. Colloid goiter was seen in 1147 patients (73.4%), benign hemorrhagic cysts were seen in 257, Hashimoto thyroiditis was seen in 77, benign thyroid nodules were seen in 76, keratocysts were seen in 2, thyroglossal duct cysts were seen in 2, thyroid follicular adenoma was seen in 1 and myxedema was seen in 1. For malignant patients; 11 had anaplastic thyroid cancer, 8 had papillary thyroid cancer, 7 had follicular thyroid cancer, 5 had metastatic thyroid cancer, 4 had medullary thyroid cancer, 3 had non-Hodgkin lymphoma and 1 had thyroid follicular adenoma. For those indeterminate for malignancy, 24 had follicular neoplasm and 18 had Hurthle cell neoplasm. Conclusions: Fine needle aspiration cytology for thyroid nodules provides a rapid and non-invasive technique for the evaluation and differentiation between benign and malignant lesions. This study also addresses the increased predominance of benign thyroid lesions among young patients and thyroid malignancy among the 4th decade of life.

Fine-needle aspiration cytology-induced infarction of thyroid nodule hampers diagnosis

Fine-needle aspiration cytology (FNAC) is a useful procedure for the investigation of thyroid swellings. It is a safe and minimally invasive procedure but is accompanied by its own set of complications. Infarction of the parent tissue post-FNAC has been reported in the lymph node, salivary gland, and breast but is a rare phenomenon in the thyroid. We present a case of a 34-year-old female with a solitary thyroid nodule. FNAC smears were hypercellular and showed numerous Hurthle cells suggesting a possibility of Hurthle cell neoplasm. Hemithyroidectomy performed 1 month thereafter showed extensive necrosis and hemorrhage with only few atypical follicular epithelial cells and Hurthle cells at the periphery. The near-total infarction and paucity of viable cells made it extremely difficult to make a histopathological diagnosis. The case highlights the need for extensive sampling and thorough examination of the periphery for any viable foci on histopathology along with cytologic-histologic correlation in such cases.

RISK FACTORS OF MALIGNANCY IN PATIENTS WITH FINE NEEDLE ASPIRATION BIOPSY RESULTS INTERPRETED AS “SUSPICIOUS FOR FOLLICULAR NEOPLASM”

Introduction: Approximately 10% of fine needle aspiration biopsy (FNAB) of thyroid nodules may be verified as "suspicious for follicular neoplasm"; this category involves follicular adenoma, follicular carcinoma, follicular variants of papillary carcinoma and subclass "suspicious for Hurthle cell neoplasm". At present, there is no diagnostic tool to discriminate between follicular adenoma and cancer. Most patients are required surgery to exclude malignant process. The aim: To define factors correlating with risk of malignancy in patients with FNAB of thyroid focal lesions and nodules verified as Bethesda tier IV. Materials and Methods: In this study 110 consecutive patients were included. All patients were operated because of FNAB result "suspicious for follicular neoplasm" of thyroid gland at a single institution from January 2016 until March 2020. From this set, six specific categories were defined and the clinical records for patients were collected: sex, age, presence of oxyphilic cells, diameter of the tumour, presence of Hashimoto disease, aggregate amount of clinical and ultrasonographic features of malignancy according to ATA. Results: In 18 patients (16,3%) thyroid cancer occurred. Most frequent subtype turned out to be papillary cancer (66,6%). In group of benign lesion (92 patients) predominance of follicular adenoma was disclosed - (49%). Age, gender, tumour diameter, aggregate amount of clinical and ultrasonografic factors, presence of Hashimoto disease and fine needle aspiration biopsy result suspicious for Hurthle cell neoplasm did not correspond to increased risk of malignancy. Conclusions: In patients with FNAB results classified as Bethesda tier IV there are no reliable clinical features associated with low risk of malignancy and surgery should be consider in every case as most appropriate manner to exclude thyroid cancer .

Fine-needle aspiration of goiter (benign and non-neoplastic) with thyroid function abnormalities

Introduction: Thyroid nodule is the prime indication for FNA, which is also a cheap and effective investigation. The current study seeks an association between benign goiter and aberrant thyroid function tests (TFTs). Can thyroid FNA anticipate overt morbidity resulting from thyroid function abnormalities? Materials and Methods: FNA records of 173 patients were studied along with the TFT results. A slide review was undertaken where the FNA impression did not correspond to the TFT. Results: The female:male ratio was 149:24. Two (1.15%) had inadequate cellularity. Nearly 95/173 cases had abnormal TFTs. Multinodular goiter (126), Hashimoto's thyroiditis (43), and two and one cases of granulomatous and unclassified thyroiditis, respectively, constituted our diagnostic profile. Abnormalities in TFT did not correlate with age group, gender, or FNA diagnoses. However, hypothyroidism (clinical and subclinical) was significantly observed in Hashimoto's thyroiditis (HT) cases. Further, scant colloid and hurthle cell change were significantly correlated with HT. A histological correlation was obtained in 46 cases. Four neoplastic cases among which three papillary carcinomas arising in small focal areas within cysts were seen. Conclusions: The major observation in this study is the subset of euthyroid and subclinically hypothyroid cases (23/43, 53.48%) of Hashimoto's thyroiditis (P = 0.0021). If treated with thyroxine replacement, overt hypothyroidism, particularly in pregnant women who are at risk of developing antithyroid antibodies, may be prevented. Besides, the inadequacy rate (1.15%) in the current study is low. False negatives 3/46 (6.5%), though available on a meager and selected subset of the patient population is still within the range of published data.

An Unusual Presentation of Recurrence Hurthle Cell Carcinoma of Thyroid

This is the case of 55 years old male who was known of hurthle cell carcinoma (HCC) and underwent total thyroidectomy and right neck dissection in July 2015, followed by radioactive iodine (RAI). He was in close follow-up after the treatment when he presented with right sided neck swelling for 6 weeks followed by hoarseness for 4 weeks and fiber optic laryngoscopy revealed right vocal cod palsy. CT scan was done that showed a mass involving right supraglottic and glottis region, he then underwent right vertical partial laryngectomy. Tumor removed completely (grossly and histopathologically). The case was discussed in tumor board meeting and he was advised RAI scan to look for residual disease, by close follow-up. This case report emphasizes on the unusual clinical presentation and recurrence of HCC of thyroid.

Is Subdivision of Atypia of Undetermined Significance AUS/Follicular Lesion of Undetermined Significance Cases According to Detailed Nuclear Features Vital for Assessing the Risk of Malignancy?

Background:It has been known that the “atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)” category is the most problematic category in Bethesda system due to its highly heterogeneous morphological features. Recently, it has been reported that aspirates including nuclear atypia in the AUS/FLUS category have a higher risk of malignancy.Aims:This study aimed to assess each nuclear property in aspirates with cytological atypia and also to determine the relationship with the risk of malignancy.Material and Methods:We reviewed 980 AUS/FLUS fine-needle aspirations (FNAs) performed between '2012 and 2019' at a single institution. We classified these aspirates into four groups: AUS-N (nuclear atypia), AUS-A (architectural atypia), AUS-H (Hurthle cell change), and AUS-O (other). Nuclear features were detailed sub-classified; size and shape (enlargement, elongation, and overlapping), membrane irregularities (irregular contours, grooves, pseudoinclusion), and chromatin characteristics (pale chromatin). The estimated risk of malignancy (ROM) was calculated for each subgroup.Results:Of 980 AUS/FLUS cases, follow-up histological outcome data were available for 209 cases. Among these cases, the estimated ROM was 27.8%. The ROM were 26.4%, 15.4%, and 22.5% for AUS-N, A, and H, respectively. The most common nuclear findings associated with ROM were nuclear groove (67.9%); irregular contours (76.9%) suspected pseudoinclusion (100%) and overlapping (56%) (P < 0,001). But nuclear findings such as nuclear enlargement, mild pleomorphism, or pale chromatin have a similar ROM as architectural atypia.Conclusion:Although it is known that the presence of cytological atypia in an AUS/FLUS nodule increases the estimated risk of malignancy, all nuclear properties are not equally effective in predicting malignancy risk. Emphasizing nuclear atypia details in reports of AUS case may be a more sensitive way to identify nodules with a high risk of malignancy.

Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study

BackgroundDistant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC.MethodsA retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups.ResultsDistant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC.ConclusionsTS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients.Graphical abstract

The cytomorphological spectrum of Hashimoto thyroiditis and its correlation with serological parameters: A study in the coastal region

Objective: To analyse the detailed cytomorphological spectrum in Hashimoto thyroiditis (HT), cytological grading and its significance with the hormonal and antibody status Methods: This is both a prospective and retrospective study of 102 cases of HT in a tertiary care institute of the eastern part of India. Detailed cytological parameters were observed, graded and correlated with the serological parameters. Results: The majority of patients were females with a younger age group (21–30 years) and diffuse thyromegaly was the common presentation. A good number of cases showed neutrophilic infiltration, background colloid and follicular hyperplasia. Among the cytological parameters, Hurthle cell change was correlated with hypothyroidism (P 0.05). Conclusion: A younger age of presentation in a coastal area with iodine sufficiency and supplementation needs further epidemiological studies. Fine-needle aspiration cytology is superior to other sophisticated methods in diagnosing HT, even in seronegative cases. A good number of cases displaying folliculolysis by neutrophils needs to be corroborated by larger studies. One should be vigilant while examining slides to rule out associated malignancy.

Retrospective evaluation of clinicopathological characteristics of differentiated thyroid cancer patients with iodine-131-avid distant metastasis: A tertiary care centre experience

Introduction: Among various prognostic indicators, distant metastases have a strong impact on the overall survival of differentiated thyroid cancer (DTC) patients. Aim: The aim of this study was to know the incidence, pattern of iodine-131-avid distant metastases in DTC patients at presentation, long-term survival probability in DTC patients with distant metastases and also to know the relationship between the distant metastases and clinicopathological variables such as age, gender, and histopathological subtypes. Materials and Methods: Retrospective evaluation of case records and whole-body iodine scans of DTC patients referred to our hospital between January 2013 and December 2018 was done. Results: A total of 1336 DTC patients' case records were analyzed. Among them, 157 patients (11.7%) had distant metastases at presentation. Majority were female patients (63%). The mean age of patients in the study group was 48.4 years. Most of the patients had papillary histopathology (58.6%), followed by follicular (34.4%), poorly differentiated (5.73%), and Hurthle cell carcinoma (1.27%). Bone was the most common site of metastases in 49% of patients, followed by the lung in 25% of patients. Two (1.27%) patients had an unusual site of metastases involving the kidney and adrenal gland. Nearly one-third patients (25.5%) had multi-organ metastases. The 5 years specific survival probability of DTC patients with distant metastases at presentation was 47.3%. Conclusion: The incidence of distant metastases in our study is similar to the incidence rate reported in the literature. Distant metastasis is higher in female patients and in the age group of 45 years and above. Bone is the most common organ site of metastases rather than lung in the present study, which is pointing towards the high incidence of skeletal metastases in Indian patients. The specific survival probability at 5 years is 47.3%.

Quantitative Analysis of Galectin-3 Expression in Benign and Malignant Thyroid Nodules.

SUMMARYIn this study, galectin-3 was analyzed as a potential marker for preoperative detection of malignant thyroid lesions. Galectin-3 expression was analyzed by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) in preoperative thyroid fine-needle aspirates from 245 patients with thyroid nodules. Out of 245 samples, 238 were adequate for analysis by RT-PCR. Galectin-3 was positive in 34 (89.5%) of 38 papillary carcinomas, 3 (89.5%) of 4 follicular carcinomas, 17 (53.1%) of 32 follicular adenomas, 2 (33.3%) of 6 Hurthle cell adenoma, 11 (28.2%) of 39 Hashimoto thyroiditis, and 69 (57.9%) of 119 nodular goiter samples. Galectin-3 showed specificity of 49.5%, sensitivity of 88.1%, positive predictive value of 27.2%, and negative predictive value of 95.1% as a marker for detection of malignant thyroid nodules. Owing to the relatively low positive predictive value due to the relatively high false positive rate, the clinical value of galectin-3 analyzed by quantitative real-time RT-PCR as a marker for preoperative detection of malignant thyroid lesions is limited.

Histomorphologic spectrum of thyroid lesions in surgically treated thyroid specimens

Background: Diseases involving thyroid gland are myriad- they span from functional to goiterous which again can be non-neoplastic or neoplastic. The pattern and prevalence of these disorders depend on various factors like age, sex, ethnicity and geographic location of residence. The aim of the present study was to determine the pattern of thyroid lesions in surgically resected thyroid specimens.&#x0D; Methods: This retrospective study was conducted at Department of Histopathology ofArmed Forces Institute of Pathology (AFIP), Dhaka, Bangladesh. All thyroidectomy specimens received in the Department of Histopathology over the period from 1st January 2018 to 30th June 2019 were included in the study. Data including age, sex and histopathological diagnosis were collected from the records and histopathology slides of all cases were reviewed to verify diagnosis. Data were then analyzed by standard statistical methods.&#x0D; Results: A total of 377 specimens were collected, 301 specimens were from females and 76 from males (female to male ratio 4.01:1). The age ranged from 13 years to 82 years (mean 38.44±12.89 years). Nodular goiter (274, 72.62%) was the commonest thyroid lesion; other benign lesions included follicular adenoma (18) and Hashimoto thyroiditis (17). Overall malignancy was 18.03% (68). Papillary carcinoma (61, 89.70%) constituted majority of the malignant neoplasms. Other malignant neoplasms included follicular carcinoma (3 cases including 1 case of Hurthle cell carcinoma), anaplastic carcinoma (2) and medullary carcinoma and non-Hodgkin lymphoma 1 each.&#x0D; Conclusion: Our study revealed that the prevalent form of thyroid diseases is nodular goiter that mostly affects females. Papillary carcinoma is the commonest malignancy of thyroid gland which also predominantly affects females.&#x0D; Birdem Med J 2020; 10(1): 54-59

Hurtle-cell carcinoma of thyroid gland: literature review and own data

Hurthle cells (HC) and HC neoplasms attract attenti­­on of scientists, but some aspects are still controversial. Objective — to analyze modern literature data considering HC and toreveal the prevalence of onco­cytic transformation of thyrocytes and distribution of its types in Subcarpathian endemic goiter region. Materials and methods. We held a data search in Pubmed database and studied the revealed references. We also analyzed the results of pathohistological investigation of surgical material of 1233 patients who underwent surgery because of thyroid gland (TG) diseases. Results and discussion. HC were for the first time described by Max Ashkenasi in1898, but mistakenly called after Carl Hurthle. The main characteristics of HC include large number of mitochondria, clear borders, round shape, loss of cellular polarity, large hyper­chromatic round nucleus, its variable atypia, distinct nucleolus. Transformation of thyrocytes into oncocytes can accompany both benign and malignant processes, and also non-neoplasmatic diseases. All HC neoplasms, which are not definitely benign, must undergo surgical resection for final diagnosis. TG can form both HC adenomas (HCA) and carcinomas (HCC). The majority of analyzed patients were female (82.6 %). Oncocytic transformation of thyrocytes was revealed in 71 case (5.8 %). 50.7 % cases of oncocytic transformation were represented by HC clusters, 25.4 % — by oncocytic nodules. In males oncocytic transformation the most often was represented by HCA (40 %), in females — by HC clusters (57.4 %). Conclusions. HС have finely defined characteristics and can accompany both benign and malignant conditions. Oncocytic transformation was revealed in 5.8 % of patients; more often in women than in men. Oncocytic transformation of thyrocytes can be represented by HC clusters, hyperplastic nodules, HCA and HCC. HC clusters are the most typical type in women, HCA — in men. Frequency of HCC in men was higher than in women.

A 15 year institutional experience of well-differentiated follicular cell-derived thyroid carcinomas; impact of the new 2017 TNM and WHO Classifications of Tumors of Endocrine Organs on the epidemiological trends and pathological characteristics.

Our study aimed to describe the evolution of the rate of pathological subtypes of well-differentiated follicular-cell derived thyroid carcinomas (DTCs) in the Department of Pathology, Emergency County Hospital Targu-Mures, Romania over a 15 year period and to assess the impact the new 2017 WHO and TNM classifications of thyroid tumors had on our cases. The pathological data were retrieved from the original pathological reports. After applying the exclusion criteria the remaining cases were reviewed on a double-headed microscope and reclassified according to the 2017 WHO and TNM staging system. The follow-up data were collected from the Institute of Oncology Cluj-Napoca, Romania. Our study included 396 cases of DTCs (375 papillary, 11 follicular, and 10 Hürthle cell carcinomas). PTCs revealed a significant increasing trend over the study period, whereas follicular and Hurthle cell carcinomas remain rare; 125/131 of noninvasive encapsulated follicular variant PTC (EFVPTC) were reclassified as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), resulting in a 33.3% reduction in the number of PTCs. According to 2017 TNM stage-grouping 31% of 271 patients with DTC were downstaged. Follow-up data were available for most of the patients (65.7%, mean period 58.1 months). All patients with noninvasive EFVPTC were disease free at the last clinical assessment. The increasing rate of PTC was maintained even after exclusion of NIFTP. By applying 2017 TNM criteria, a significant number of DTC cases were downstaged into a more favorable group. Follow-up data highlight the indolent behavior of noninvasive EFVPTCs reclassified as NIFTPs.

Therapeutic breakthroughs for metastatic thyroid cancer.

Multikinase inhibitors are effective treatments for thyroid cancers, acting primarily as antiangiogenic agents. This year, advances have been made in selective targeting of RET and BRAF in patients with medullary and anaplastic thyroid cancers, respectively. However, Hurthle cell carcinomas have a unique genomic landscape with no dominant truncal drivers, precluding simplistic approaches to therapeutic targeting.

PAX8–GLIS3 gene fusion is a pathognomonic genetic alteration of hyalinizing trabecular tumors of the thyroid

The hyalinizing trabecular adenoma/tumor is a rare and poorly characterized follicular-derived thyroid neoplasm recently shown to harbor recurrent PAX8–GLIS1 or PAX8–GLIS3 gene fusions. Here we sought to define the repertoire of genetic alterations of hyalinizing trabecular tumors, and whether PAX8–GLIS3 fusions are pathognomonic for hyalinizing trabecular tumors. A discovery series of eight hyalinizing trabecular tumors was subjected to RNA-sequencing (n = 8), whole-exome sequencing (n = 3) or targeted massively parallel sequencing (n = 5). No recurrent somatic mutations or copy number alterations were identified in hyalinizing trabecular tumor, whereas RNA-sequencing revealed the presence of a recurrent genetic rearrangement involving PAX8 (2q14.1) and GLIS3 (9p24.2) genes in all cases. In this in-frame fusion gene, which comprised exons 1–2 of PAX8 and exons 3–11 of GLIS3, GLIS3 is likely placed under the regulation of PAX8. Reverse transcription RT-PCR and/or fluorescence in situ hybridization analyses of a validation series of 26 hyalinizing trabecular tumors revealed that the PAX8–GLIS3 gene fusion was present in all hyalinizing trabecular tumors (100%). No GLIS1 rearrangements were identified. Conversely, no PAX8–GLIS3 gene fusions were detected in a cohort of 237 control thyroid neoplasms, including 15 trabecular thyroid lesions highly resembling hyalinizing trabecular tumor from a morphological standpoint, as well as trabecular/solid follicular adenomas, solid/trabecular variants of papillary carcinoma, and Hurthle cell adenomas or carcinomas. Our data provide evidence to suggest that the PAX8–GLIS3 fusion is pathognomonic for hyalinizing trabecular tumors, and that the presence of the PAX8–GLIS3 fusion in thyroid neoplasms may be used as an ancillary marker for the diagnosis of hyalinizing trabecular tumor, thereby avoiding overtreatment in case of misdiagnoses with apparently similar malignant tumors.

Signification of forkhead box A1 (FOXA1) expression in thyroid cancers

BackgroundForkhead box A1 (FOXA1) plays an important role in several tumors. This study investigated the potential role of FOXA1 expression in thyroid tumors. We conducted a retrospective study of 110 thyroid lesions and tumors diagnosed during 1995–2018. The expression of FOXA1 was analyzed by immunohistochemistry on archival material.ResultsNo FOXA1 immunostaining was observed in all cases of Graves’ disease, Hashimoto’s disease, multi-nodular goiter, and adenoma. FOXA1 expression was absent as well in all papillary and follicular carcinomas, Hurthle cell carcinoma, and undifferentiated sarcoma. Only three anaplastic carcinomas exhibited focally FOXA1 staining. However, FOXA1 was expressed in all medullary carcinomas. No significant correlation was found with all clinicopathological features (p > 0.05 for all). The pattern of FOXA1 staining was similar to that of calcitonin and chromogranin A (p = 0.04 and p = 0.003, respectively).ConclusionsFOXA1 is expressed mostly in all medullary thyroid carcinomas. Hence, FOXA1 could serve as an additional marker for refining the diagnosis of medullary thyroid carcinoma.

Malignancy risk for solitary and multiple nodules in Hürthle cell-predominant thyroid fine-needle aspirations: A multi-institutional study.

Hürthle cell metaplasia is common in hyperplastic nodules, particularly within the setting of lymphocytic thyroiditis (LT). The Bethesda System for Reporting Thyroid Cytopathology indicates that it is acceptable to classify Hürthle cell-predominant fine-needle aspiration (HC FNA) specimens as atypia of undetermined significance (AUS) rather than suspicious for a Hürthle cell neoplasm (HUR) within the setting of multiple nodules or known LT. The goal of the current study was to address whether this approach is justified. HC FNA specimens were identified and correlated with ultrasound and surgical pathology reports if available. Multinodularity was determined based on findings on macroscopic examination if imaging results were unavailable. A total of 698 HC FNA specimens were identified, including 576 resected nodules, 455 of which (79%) were benign. The overall risk of malignancy for HUR was 27%, whereas the risk of malignancy for AUS was 10%. The mean size of the benign nodules was 2.1cm on surgical resection specimens, with multiple nodules noted in 293 cases (64%) and histologic LT noted in 116 cases (25%). The mean size of the malignant nodules was 2.8cm, with multiple nodules and histologic LT noted in 74 cases (61%) and 22 cases (18%), respectively. The malignancy rate did not differ between solitary or multiple nodules (P=.52) or in the presence or absence of LT (P=.12). However, size did significantly differ between malignant and benign nodules (P<0.01). The malignancy rate did not differ significantly in the presence of multiple nodules or LT, although the latter demonstrated a statistical trend. A diagnosis of AUS over HUR based solely on the presence of multinodularity is not warranted.

Combined use of galectin-3 and thyroid peroxidase improves the differential diagnosis of thyroid tumors.

The differential diagnosis of well-differentiated tumors of follicular cell origin remains the most problematic task in thyroid pathology. Specific morphologic criteria (capsular and/or vascular invasion, nuclear characteristics) are crucial in the diagnosis of these neoplasms. However, the assessment of malignant features is inconclusive in some cases. Moreover, oncocytic thyroid tumors remain controversial in a respect to their pathobiology, behavior and management. Therefore, the useful diagnostic/prognostic thyroid markers are awaited. The aim of our study was to evaluate the expression of galectin-3 and thyroid peroxidase (TPO) in benign and malignant thyroid tumors of follicular cell origin. A total of 186 archival thyroid samples including 38 non-oncocytic follicular adenomas, 53 oncocytic (Hürthle cell) adenomas, 6 non-oncocytic follicular carcinomas, 23 oncocytic (Hürthle cell) carcinomas, 43 non-oncocytic papillary carcinomas, and 23 oncocytic papillary carcinomas were analyzed for galectin-3 and TPO expression by immunohistochemistry. Both types of papillary carcinomas showed significant upregulation of galectin-3 in comparison with the other tumor types, likewise, significant differences in galectin-3 expression were discovered between non-oncocytic and oncocytic variants of studied tumors excluding follicular carcinoma. Significant lowering of TPO was revealed in oncocytic adenomas and papillary carcinomas. In conclusion, the combined use of galectin-3 and TPO markers could help to improve the differential diagnosis of thyroid tumors. Differences in the galectin-3 and TPO expression between some oncocytic and non-oncocytic tumors support their separation in the latest WHO classification of thyroid tumors.

Significance of Crushed Fragments and Eosinophils in Cytological Diagnosis of Hashimoto's Thyroiditis.

IntroductionHashimoto's thyroiditis (HT) is a chronic autoimmune inflammatory disorder of the thyroid gland with a prevalence of 1%-4%. The incidence of HT seems to be increasing in recent times. If serological parameters are used as sole criteria for diagnosis, cases of HT get missed or over-diagnosed. There are established cytological features of HT but that could, at times, be seen in other thyroid disorders, making cytological diagnosis difficult. The present study was undertaken to find out the significance of crushed fragments and eosinophils along with the well-known cytological features in the diagnosis of HT.MethodsThis study was carried out over a period of two years and a total of 114 patients were registered for the study; 48 patients were HT cases. The control group comprised of 66 non-thyroiditis patients. Fine-needle aspiration cytology (FNAC) was performed on all patients with palpable thyroid swelling to compare cytological features of thyroiditis (study group) with aspirates of non-thyroiditis lesions (controls).ResultsThe background lymphocytes were found to be present in all cases of the study group but in variable numbers. The lymphocytes infiltrating the follicular epithelial cells were seen in most (93.75%) of the study cases. The presence of Hurthle cells was significantly higher (83%) in the study group as compared to the control group (4.5%). The presence of crushed cells morphology (crushed fragments) were seen in 40 (83.33%) of these 48 HT cases while none in the control group showed this feature. The presence of eosinophilic infiltration shows a statistically significant association with FNA diagnosis of HT patients (P<0.05).ConclusionThe crushed fragments, if visible at low power, gives a diagnostic clue for looking up for other features of HT. Also, the crushed fragments and eosinophils could avoid the false negative and misdiagnosis of neoplasm in paucicellular and highly cellular smear respectively.