Hürthle Cell Carcinoma: Single Center Analysis and Considerations for Surgical Management Based on the Recent Literature

Abstract

BackgroundHürthle cell carcinoma (HCC) of the thyroid is rare. There are contrasting data on its clinical behavior. The aim of this study was to describe clinic-pathological features and outcomes of HCC patients at our institution, in order to adapt our surgical management.MethodsWe retrospectively studied 51 cases of HCC treated at the interdisciplinary endocrine center of the University Hospital of Cologne, Germany between 2005 and 2020.ResultsPatients median age was 63 years (range 29-78) with 64.7% of cases being female. Primary treatment included surgery and postoperative radioiodine therapy with 3.7 GBq in all patients. Surgery consisted of total thyroidectomy in all cases and additional central lymphadenectomy in 90.2% of cases. The median number of harvested lymph nodes was 11 (range 2-31). Lymph node involvement was found in two (4.3%) pT4a tumors. In all other cases (95.7%), central lymphadenectomy was prophylactic and lymph nodes were free of metastasis in final histopathology. Twelve (23.5%) patients with incomplete biochemical response to primary treatment were diagnosed with structural relapse during the course of disease, for which seven (58.4%) underwent resection of isolated cervical metastasis. Histopathology revealed soft tissue implants in all cases and cervical surgery led to biochemical and radiologic cure in only two (28.5%) cases. Five (41.6%) patients developed metastatic disease, followed by systemic therapy in two patients. Vascular invasion of the primary tumor was significantly associated with relapse (p<0.01).ConclusionsRecurrence of HCC was common in this study. Given the low rate of lymph node metastases both in this study and in recent literature and the nature of relapse (soft tissue instead of nodal metastasis), the benefit of routine prophylactic central lymph node dissection for HCC remains unclear, especially in the absence of vascular invasion from the primary tumor.

Thyroid Cancer Prevalence, Risk Exposure, and Clinical Features Among Transgender Female Veterans

“…Perhaps not surprisingly, given the historical marginalization of this population, approximately 33% of these veterans presented with at least minimal extrathyroidal extension, which is an increased proportion from previous estimates of approximately 9% [ 34 ]. We also demonstrate a higher proportion of the follicular variant of papillary thyroid carcinoma—18.5% of papillary thyroid carcinomas in our population, compared with 10% to 15% in previous estimates [ 35 ]—and of Hürthle cell carcinoma—11.8% of our population, compared with 3% to 4% of cancers in previous estimates [ 36 , 37 ]. It remains unknown whether these rates will hold on a larger scale if examined among all veterans.…”

Oncocytic carcinoma of the thyroid: Conclusions from a 20‐year patient cohort

“…Chiapponi et al reported US data for their OCA cohort of 51 patients, noting 85% had a solid composition, 55% were hypoechoic, and over 90% had smooth borders. 21 Similarly, the majority of OCA nodules in this cohort were solid and hypoechoic. However, a large number were reported as mixed cystic and solid.…”

“…The patient population evaluated in this study had a similar age average and range to previous single center and SEERdatabase studies. 18,21 This study population had a slightly higher proportion of males. The most common demographic risk factor appreciated was a family history of thyroid cancer, which was appreciated in nearly a quarter of this cohort.…”

Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma

“…Although total thyroidectomy facilitates the ability to follow thyroglobulin as a tumor marker, several reports have also suggested that thyroglobulin levels in OTC may be less reliable for monitoring for recurrent disease . Prophylactic central neck dissection has not been shown to improve outcomes . Overall, data quality regarding these important surgical perioperative issues are limited and most studies are retrospective.…”