A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent

Abstract

Background: Hürthle cell (HC) neoplasms are rare among pediatric thyroid cancers. HC adenomas (HCA) are typically benign and localized unilaterally without recurrence, and they are thus treated by hemithyroidectomy. HC carcinomas (HCC) can be bilateral and are more aggressive, necessitating total thyroidectomy. Diagnosis relies upon surgical histopathology demonstrating invasion for classification as HCC or lack of invasion in HCA, since fine needle aspiration fails to differentiate between the two. Methods: We report a case of a 14-year-old adolescent female with bilateral HCA. She had an initial left hemithyroidectomy for a large nodule measuring 2 × 1.5 × 1.2 cm³ in the left lobe, while smaller subcentimeter nodules remained under surveillance in the right. One year later, a nodule in the right lobe doubled in size, necessitating a right hemithyroidectomy which also revealed HCA. Conclusion: To our knowledge, this is the first reported case of bilateral HCA in pediatrics. It highlights the importance of close surveillance of persistent small nodules, even in patients with previously documented benign lesions such as HCA, which are typically thought to be unilateral and localized. Both HCA and HCC remain unpredictable in behavior, and treatment of HCA should be individualized.

Hurthle cell carcinoma in childhood: A retrospective analysis of five cases and review of pediatric literature

“…We report the largest cohort of pediatric patients with HCC, and a seven‐year‐old male included in the present series is the youngest patient with HCC described in the literature 1,5‐10 . We confirmed that the relative HCC prevalence of 5.8% detected in our study is very similar to those found in large populations of all ages 8,18 and to other, smaller pediatric cohorts 19‐22 …”

“…HCC differs from its benign counterpart (Hurthle cell adenoma) by the presence of capsular and/or vascular invasion, 8 which have been only sporadically described in young patients with thyroid nodules 1,9,10 . Therefore, Hurthle cell neoplasms are not generally included among the histotypes that may be associated with children's thyroid tumors 11,12 …”

Typical manifestations of Hürthle cell adenoma of the thyroid on contrast-enhanced CT

“…The Hürthle cell is characterized cytologically as a large cell with abundant eosinophilic, granular cytoplasm and a large hyperchromatic nucleus with a prominent nucleolus. [10] The histopathological diagnostic criteria for HCA of the thyroid are as follows: thyroid tumor cells consist entirely or predominantly (>75%) of follicular cells, characterized by eosinophils [3] and the thyroid tumor tissue has an intact capsule and no vascular invasion. [4]…”

“…But it is impossible to judge whether capsule or vascular invasion is present. [3] In addition, HCNs tend to undergo spontaneous necrosis or show extensive degenerative necrosis following fine-needle aspiration biopsy. In these situations, viable lesional cells are often not present, and it is difficult to fully evaluate the lesion pathologically.…”

“…Microscopically, the tumor capsule was intact, the tumor cells comprised numerous eosinophils and were arranged in a cord, beam, or interconnected network, showing a papillary structure, which meet the diagnostic criteria of HCA of the thyroid. [3,4] The patient was discharged 1 week after surgery. She was followed up for 12 months and was in good health without recurrence.…”