Difference between revisions of "Hürthle cell neoplasm"

From Libre Pathology
Jump to navigation Jump to search
(redirect)
 
 
(12 intermediate revisions by the same user not shown)
Line 1: Line 1:
#redirect [[Thyroid_gland#Hürthle cell neoplasm]]
[[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]]''.
'''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.<ref name=pmid9697901>{{Cite journal  | last1 = Wasvary | first1 = H. | last2 = Czako | first2 = P. | last3 = Poulik | first3 = J. | last4 = Lucas | first4 = R. | title = Unilateral lobectomy for Hurthle cell adenoma. | journal = Am Surg | volume = 64 | issue = 8 | pages = 729-32; discussion 732-3 | month = Aug | year = 1998 | doi =  | PMID = 9697901 }}</ref>
*It can be understood as a special type of ''follicular neoplasm'' (including ''[[follicular thyroid adenoma]]'' and ''[[follicular thyroid carcinoma]]'').<ref name=Ref_EP104>{{Ref EP|104}}</ref>
*High stage HCC has a poor prognosis.<ref name=pmid25259908>{{Cite journal  | last1 = Chindris | first1 = AM. | last2 = Casler | first2 = JD. | last3 = Bernet | first3 = VJ. | last4 = Rivera | first4 = M. | last5 = Thomas | first5 = C. | last6 = Kachergus | first6 = JM. | last7 = Necela | first7 = BM. | last8 = Hay | first8 = ID. | last9 = Westphal | first9 = SA. | title = Clinical and molecular features of Hürthle cell carcinoma of the thyroid. | journal = J Clin Endocrinol Metab | volume = 100 | issue = 1 | pages = 55-62 | month = Jan | year = 2015 | doi = 10.1210/jc.2014-1634 | PMID = 25259908 }}</ref>
===Adenoma versus carcinoma===
Suggestive for carcinoma:<ref name=pmid9697901/>
*Male.
*>4 cm.
**Adenomas usu. <3 cm.
Definite for carcinoma:<ref name=pmid9697901/>
*[[Lymphovascular invasion]].
*Capsular invasion.
====Risk of malignancy by tumour size====
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"
!Size
!Percentage<br>malignant
|-
| <=1 cm
| 17%
|-
|-
| 1-4 cm
| 23%
|-
| >4 cm
| 65%
|}
==Gross==
*Yellow.
*Encapsulated.
==Microscopic==
Features:<ref name=Ref_EP104>{{Ref EP|104}}</ref>
*Oncocytes >= 75% of cells:
**Abundant granular, eosinophilic cytoplasm.
**Round regular nucleus +/- prominent nucleolus.
*+/-Degenerative changes.
Negatives:
*Lack nuclear features of [[papillary thyroid carcinoma]].
*Lack features of [[medullary thyroid carcinoma]].
DDx:<ref name=pmid18684023>{{cite journal |author=Montone KT, Baloch ZW, LiVolsi VA |title=The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=8 |pages=1241–50 |year=2008 |month=August |pmid=18684023 |doi= |url=}}</ref>
*Papillary thyroid carcinoma oncocytic variant.
*Medullary thyroid carcinoma oncocytic variant.
*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==
Features:
*TTF-1 +ve (2 of 6 cases in Bejarno ''et al.'',<ref name=pmid10981870>{{Cite journal  | last1 = Bejarano | first1 = PA. | last2 = Nikiforov | first2 = YE. | last3 = Swenson | first3 = ES. | last4 = Biddinger | first4 = PW. | title = Thyroid transcription factor-1, thyroglobulin, cytokeratin 7, and cytokeratin 20 in thyroid neoplasms. | journal = Appl Immunohistochem Mol Morphol | volume = 8 | issue = 3 | pages = 189-94 | month = Sep | year = 2000 | doi =  | PMID = 10981870 }}</ref> or 6 of 6 cases in Choi ''et al.''<ref name=pmid16224162/>).
*Thyroglobulin (6 of 6 cases<ref name=pmid10981870/>).
*CK7 (4 of 6 cases<ref name=pmid10981870/>).
*HBME-1 +ve (focal in 4 of 6 cases<ref name=pmid16224162>{{Cite journal  | last1 = Choi | first1 = YL. | last2 = Kim | first2 = MK. | last3 = Suh | first3 = JW. | last4 = Han | first4 = J. | last5 = Kim | first5 = JH. | last6 = Yang | first6 = JH. | last7 = Nam | first7 = SJ. | title = Immunoexpression of HBME-1, high molecular weight cytokeratin, cytokeratin 19, thyroid transcription factor-1, and E-cadherin in thyroid carcinomas. | journal = J Korean Med Sci | volume = 20 | issue = 5 | pages = 853-9 | month = Oct | year = 2005 | doi =  | PMID = 16224162 }}</ref>).
*HCK -ve (6 of 6 cases<ref name=pmid16224162/>).
*CK19 +ve (focal in 4 of 6 cases<ref name=pmid16224162/>).
==See also==
*[[Thyroid gland]].
*[[Oncocytoma]].
*[[Follicular neoplasm]].
==References==
{{Reflist|1}}
[[Category:Thyroid gland]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

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.
Retrieved from "https://librepathology.org/w/index.php?title=Hürthle_cell_neoplasm&oldid=42649"