Hürthle Cell Neoplasms of the Thyroid

Chen, Herbert; Nicol, Theresa L.; Zeiger, Martha A.; Dooley, William C.; Ladenson, Paul W.; Cooper, David S.; Ringel, Matthew D.; Parkerson, Sara; Allo, Maria D.; Udelsman, Robert

doi:10.1097/00000658-199804000-00015

Cited by 146 publications

(62 citation statements)

References 13 publications

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“…FNAB cytology does not distinguish between Hürthle cell lesion/neoplasm and Hürthle cell adenoma and carcinoma. The malignancy rate in Hürthle cell neoplasm is quite variable and rates as high as 35% and as low as 14% are reported [30,31]. Our rate was higher than in the literature (46.3%).…”

Section: Rago Et Al Had Combined Conventional and Color Dopplercontrasting

confidence: 61%

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings

Gül

Ersoy

Dirikoç

et al. 2009

Endocr

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Thyroid ultrasonography (US) and fine needle aspiration biopsy (FNAB) are the most important tools in evaluating thyroid nodules. A total of 3,404 nodules in 2,082 cases referred to our clinic between 2005 and 2008 were analyzed retrospectively. Considering US features of nodules, risk factors predicting malignancy were: margin irregularity as the most important predictor, hypoechoic pattern and microcalcification (Odds ratios: 63.2, 13.3, 7.03, respectively). Cytologic results of the patients were as follows: 1,718 (82.5%) benign, 196 (9.4%) suspicious, 68 (3.3%) nondiagnostic, and 100 (4.8%) malignant. In histopathologic examination, we determined a malignancy rate of 7.59% (158/2082). We calculated the sensitivity of FNAB as 89.16%, specificity as 98.77%, positive predictive value as 96.10%, negative predictive value as 96.39%, and accuracy as 96.32%. In cytologic examination, the malignancy rate of subcentimetric (≤1 cm) nodules was higher than supracentimetric (>1 cm) nodules (5.1% vs. 1.5%, P = 0.001). In postoperative histopathologic examination, although the malignancy rate of subcentimetric nodules was higher than that of supracentimetric nodules, the difference was statistically insignificant (5.5%, 4.4%, respectively; P > 0.05). Cytologically diagnosed malignancy was detected in 4.5% of patients with multiple nodules, while it was present in 6% of patients with solitary nodule indicating no significant difference. However, postoperative histopathologic examination revealed a significantly higher malignancy rate in patients with solitary nodule compared to in patients with multiple nodules (11.7%, 6.5%; respectively, P < 0.001). The malignancy rate of patients operated for suspicious cytology was found to be 46.15%; for nondiagnostic cytology, it was 64.29%. In conclusion, ultrasonographically, hypoechoic pattern, microcalcification and margin irregularity of thyroid nodules are important features in determining the malignancy risk. The nodule size alone still remains inadequate to exclude malignancy risk.

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Section: Rago Et Al Had Combined Conventional and Color Dopplercontrasting

confidence: 61%

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings

Gül

Ersoy

Dirikoç

et al. 2009

Endocr

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“…Some have suggested that large tumor size, older age, and/or male sex are associated with an increased risk of HCC [10,11,20,21,22,23,24,25,26,27], while others found no difference with respect to size, age, or gender [28,29,30,31,32,33]. Thompson et al [32] in 1974 strongly advocated total thyroidectomy of all HCN, irrespective of size, based on his experience that even lesions <2 cm were found to be malignant.…”

Section: Discussionmentioning

confidence: 99%

“…Complete thyroidectomy is recommended for an indeterminate nodule subsequently found to be malignant following hemithyroidectomy [13]. The treatment of choice for HCA is hemithyroidectomy since HCA rarely presents bilaterally [10,24,30,56,57]. Complications after thyroidectomy can include transient or permanent hypoparathyroidism, recurrent laryngeal nerve damage, spinal accessory nerve injury, or Horner syndrome [5].…”

Section: Discussionmentioning

confidence: 99%

“…Another retrospective study in adults concluded that none of the HCA cases were bilateral (0/37), while 16% (3/20) of their HCC cases had bilateral foci [24]. Prior to the current practice of hemithyroidectomy for HCA, aggressive treatment with total thyroidectomy for all HCN was recommended based on adult cases where the initial HCA nodule later metastasized to regional lymph nodes or recurred as HCC [25,32,57,59].…”

Section: Discussionmentioning

confidence: 99%

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A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent

Kochummen

Tong²,

Umpaichitra³

et al. 2016

Horm Res Paediatr

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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.

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“…Carcangiu et al (18,19) have shown that local recurrence of Hürthle cell carcinomas is correlated with the extent of surgery, with recurrence rates for nodulectomy, thyroid lobectomy, and total thyroidectomy of 75%, 40%, and 15%, respectively. Additionally, 65% of Hürthle cell neoplasm larger that 4 cm will prove to be malignant (20). Thus, we recommend performing total thyroidectomy rather than a thyroid lobectomy for patients with a Hürthle cell neoplasm larger that 4 cm.…”

Section: Operative Treatmentmentioning

confidence: 99%

Follicular Neoplasms of the Thyroid: What to Recommend

Carling

Udelsman

2005

Thyroid

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Follicular neoplasms of the thyroid are usually diagnosed following fine-needle aspiration (FNA) biopsy of a dominant thyroid nodule. An FNA diagnosis of a follicular neoplasm represents a heterogeneous group of lesions including benign follicular hyperplasia, follicular adenomas, follicular carcinomas, and the follicular variant of papillary carcinoma. Hürthle cell neoplasms are also often included in this group. Because the criteria for malignancy in both follicular and Hürthle cell neoplasms requires vascular or capsular invasion seen on permanent histology, the majority of these patients undergo surgical resection. Intraoperative frozen section analysis of follicular neoplasms rarely renders informative information. Approximately 20% of these lesions prove to be malignant and for lesions greater than 1.0 cm in size, the majority of surgeons and endocrinologists recommend a total thyroidectomy. Postoperative treatment generally includes therapeutic doses of 131I for follicular carcinomas.

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Hürthle Cell Neoplasms of the Thyroid

Cited by 146 publications

References 13 publications

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings

A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent

Follicular Neoplasms of the Thyroid: What to Recommend

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