Difference between revisions of "Hürthle cell neoplasm"

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'''Hürthle cell neoplasm''' is a rare tumour of the [[thyroid gland]] that can have a benign or malignant behaviour.
[[Image:Hurthle cell carcinoma -- very high mag.jpg|thumb|right|300px|Micrograph showing a (metastatic) Hürthle cell carcinoma. [[H&E stain]].]]
'''Hürthle cell neoplasm''' is a rare tumour of the [[thyroid gland]] that can have a benign or malignant behaviour. They are generally considered a subset of [[follicular neoplasm]],<ref name=pmid26530486>{{Cite journal  | last1 = Wei | first1 = S. | last2 = LiVolsi | first2 = VA. | last3 = Montone | first3 = KT. | last4 = Morrissette | first4 = JJ. | last5 = Baloch | first5 = ZW. | title = PTEN and TP53 Mutations in Oncocytic Follicular Carcinoma. | journal = Endocr Pathol | volume = 26 | issue = 4 | pages = 365-9 | month = Dec | year = 2015 | doi = 10.1007/s12022-015-9403-6 | PMID = 26530486 }}</ref><ref name=pmid24753500>{{Cite journal  | last1 = Ustun | first1 = B. | last2 = Chhieng | first2 = D. | last3 = Van Dyke | first3 = A. | last4 = Carling | first4 = T. | last5 = Holt | first5 = E. | last6 = Udelsman | first6 = R. | last7 = Adeniran | first7 = AJ. | title = Risk stratification in follicular neoplasm: a cytological assessment using the modified Bethesda classification. | journal = Cancer Cytopathol | volume = 122 | issue = 7 | pages = 536-45 | month = Jul | year = 2014 | doi = 10.1002/cncy.21425 | PMID = 24753500 }}</ref> which includes [[follicular thyroid carcinoma]] and [[follicular thyroid adenoma]].


It may be referred to as ''[[oncocytic neoplasm]]''.
It may be referred to as ''[[oncocytic neoplasm]]''.  


'''Hürthle cell carcinoma''' and '''Hürthle cell adenoma''' redirect to here.
'''Hürthle cell carcinoma''' and '''Hürthle cell adenoma''' redirect to here.
==General==
==General==
*Incidence: uncommon.
*Incidence: uncommon.
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**Adenomas usu. <3 cm.
**Adenomas usu. <3 cm.
Definite for carcinoma:<ref name=pmid9697901/>
Definite for carcinoma:<ref name=pmid9697901/>
*Lymphovascular invasion.
*[[Lymphovascular invasion]].
*Capsular invasion.
*Capsular invasion.


====Risk of malignancy by tumour size====
====Risk of malignancy by tumour size====
Risk of malignancy by size:<ref name=pmid9563543></ref>
Risk of malignancy by size - based on a series of 57 cases:<ref name=pmid9563543>{{Cite journal  | last1 = Chen | first1 = H. | last2 = Nicol | first2 = TL. | last3 = Zeiger | first3 = MA. | last4 = Dooley | first4 = WC. | last5 = Ladenson | first5 = PW. | last6 = Cooper | first6 = DS. | last7 = Ringel | first7 = M. | last8 = Parkerson | first8 = S. | last9 = Allo | first9 = M. | title = Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy? | journal = Ann Surg | volume = 227 | issue = 4 | pages = 542-6 | month = Apr | year = 1998 | doi =  | PMID = 9563543 }}</ref>
{| class="wikitable sortable"  
{| class="wikitable sortable"  
!Size  
!Size  
!Percentage malignant
!Percentage<br>malignant
|-
|-
| <=1 cm  
| <=1 cm  
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|-
|-
| 1-4 cm
| 1-4 cm
| 23% malignant
| 23%
|-
|-
| >4 cm  
| >4 cm  
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*Medullary thyroid carcinoma oncocytic variant.
*Medullary thyroid carcinoma oncocytic variant.
*Others.
*Others.
===Images===
<gallery>
Image: Hurthle cell carcinoma -- intermed mag.jpg | HCC - intermed. mag. (WC)
Image: Hurthle cell carcinoma -- high mag.jpg | HCC - high mag. (WC)
Image: Hurthle cell carcinoma -- very high mag.jpg | HCC - very high mag. (WC)
Image: Hurthle cell carcinoma - atl -- very high mag.jpg | HCC - very high mag. (WC)
</gallery>


==IHC==
==IHC==
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*[[Thyroid gland]].
*[[Thyroid gland]].
*[[Oncocytoma]].
*[[Oncocytoma]].
*[[Follicular neoplasm]].


==References==
==References==

Latest revision as of 14:04, 17 February 2016

Micrograph showing a (metastatic) Hürthle cell carcinoma. H&E stain.

Hürthle cell neoplasm is a rare tumour of the thyroid gland that can have a benign or malignant behaviour. They are generally considered a subset of follicular neoplasm,[1][2] which includes follicular thyroid carcinoma and follicular thyroid adenoma.

It may be referred to as oncocytic neoplasm.

Hürthle cell carcinoma and Hürthle cell adenoma redirect to here.

General

  • Incidence: uncommon.
  • This is a general category - includes:
    • Hürthle cell adenoma.
    • Hürthle cell carcinoma.
  • Some advocate total thyroidectomy for all Hürthle cell neoplasms, as it is difficult to reliably differentiate adenomas and carcinomas.[3]
  • It can be understood as a special type of follicular neoplasm (including follicular thyroid adenoma and follicular thyroid carcinoma).[4]
  • High stage HCC has a poor prognosis.[5]

Adenoma versus carcinoma

Suggestive for carcinoma:[3]

  • Male.
  • >4 cm.
    • Adenomas usu. <3 cm.

Definite for carcinoma:[3]

Risk of malignancy by tumour size

Risk of malignancy by size - based on a series of 57 cases:[6]

Size Percentage
malignant
<=1 cm 17%
1-4 cm 23%
>4 cm 65%

Gross

  • Yellow.
  • Encapsulated.

Microscopic

Features:[4]

  • Oncocytes >= 75% of cells:
    • Abundant granular, eosinophilic cytoplasm.
    • Round regular nucleus +/- prominent nucleolus.
  • +/-Degenerative changes.

Negatives:

DDx:[7]

  • Papillary thyroid carcinoma oncocytic variant.
  • Medullary thyroid carcinoma oncocytic variant.
  • Others.

Images

  • HCC - intermed. mag. (WC)

  • HCC - high mag. (WC)

  • HCC - very high mag. (WC)

  • HCC - very high mag. (WC)

IHC

Features:

  • TTF-1 +ve (2 of 6 cases in Bejarno et al.,[8] or 6 of 6 cases in Choi et al.[9]).
  • Thyroglobulin (6 of 6 cases[8]).
  • CK7 (4 of 6 cases[8]).
  • HBME-1 +ve (focal in 4 of 6 cases[9]).
  • HCK -ve (6 of 6 cases[9]).
  • CK19 +ve (focal in 4 of 6 cases[9]).

See also

References

  1. ↑ Wei, S.; LiVolsi, VA.; Montone, KT.; Morrissette, JJ.; Baloch, ZW. (Dec 2015). "PTEN and TP53 Mutations in Oncocytic Follicular Carcinoma.". Endocr Pathol 26 (4): 365-9. doi:10.1007/s12022-015-9403-6. PMID 26530486.
  2. ↑ Ustun, B.; Chhieng, D.; Van Dyke, A.; Carling, T.; Holt, E.; Udelsman, R.; Adeniran, AJ. (Jul 2014). "Risk stratification in follicular neoplasm: a cytological assessment using the modified Bethesda classification.". Cancer Cytopathol 122 (7): 536-45. doi:10.1002/cncy.21425. PMID 24753500.
  3. ↑ 3.0 3.1 3.2 Wasvary, H.; Czako, P.; Poulik, J.; Lucas, R. (Aug 1998). "Unilateral lobectomy for Hurthle cell adenoma.". Am Surg 64 (8): 729-32; discussion 732-3. PMID 9697901.
  4. ↑ 4.0 4.1 Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 104. ISBN 978-0443066856.
  5. ↑ Chindris, AM.; Casler, JD.; Bernet, VJ.; Rivera, M.; Thomas, C.; Kachergus, JM.; Necela, BM.; Hay, ID. et al. (Jan 2015). "Clinical and molecular features of Hürthle cell carcinoma of the thyroid.". J Clin Endocrinol Metab 100 (1): 55-62. doi:10.1210/jc.2014-1634. PMID 25259908.
  6. ↑ Chen, H.; Nicol, TL.; Zeiger, MA.; Dooley, WC.; Ladenson, PW.; Cooper, DS.; Ringel, M.; Parkerson, S. et al. (Apr 1998). "Hürthle cell neoplasms of the thyroid: are there factors predictive of malignancy?". Ann Surg 227 (4): 542-6. PMID 9563543.
  7. ↑ Montone KT, Baloch ZW, LiVolsi VA (August 2008). "The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review". Arch. Pathol. Lab. Med. 132 (8): 1241–50. PMID 18684023.
  8. ↑ 8.0 8.1 8.2 Bejarano, PA.; Nikiforov, YE.; Swenson, ES.; Biddinger, PW. (Sep 2000). "Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms.". Appl Immunohistochem Mol Morphol 8 (3): 189-94. PMID 10981870.
  9. ↑ 9.0 9.1 9.2 9.3 Choi, YL.; Kim, MK.; Suh, JW.; Han, J.; Kim, JH.; Yang, JH.; Nam, SJ. (Oct 2005). "Immunoexpression of HBME-1, high molecular weight cytokeratin, cytokeratin 19, thyroid transcription factor-1, and E-cadherin in thyroid carcinomas.". J Korean Med Sci 20 (5): 853-9. PMID 16224162.
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