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Appearance of Hürthle cell carcinoma soon after surgical extirpation of Hürthle cell adenoma and follicular adenoma of the thyroid gland.

Ristevska N, Stojanoski S, Gjorceva DP - Radiol Oncol (2015)

Bottom Line: One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on (99m)Tc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB.No signs of metastatic disease are present up to date.The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation.

View Article: PubMed Central - PubMed

Affiliation: Institute of Pathophysiology and Nuclear Medicine, Acad. "Isak S. Tadzer", Skopje, Macedonia.

ABSTRACT

Background: Hürthle cell neoplasms could be benign (Hürthle cell adenoma) or malignant (Hürthle cell carcinoma). Hürthle cell carcinoma is a rare tumour, representing 5% of all differentiated thyroid carcinomas. The cytological evaluation of Hürthle cell neoplasms by fine needle aspiration biopsy (FNAB) is complicated because of the presence of Hürthle cells in both Hürthle cell adenoma and Hürthle cell carcinoma. Thus, the preoperative distinction between these two entities is very difficult and possible only with pathohistological findings of the removed tumour.

Case report: A 57-year old female patient was admitted at our Department, for investigation of nodular thyroid gland. She was euthyroid and FNAB of the nodules in both thyroid lobes were consistent of Hürthle cell adenoma with cellular atypias. After thyroidectomy the histopathology revealed Hürthle cell adenoma with high cellular content and discrete cellular atypias in the left lobe and follicular thyroid adenoma without cellular atypias in the right lobe. One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on (99m)Tc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB. Tumorectomy was performed and well-differentiated Hürthle cell carcinoma detected. The patient received ablative dose of 100 mCi (131)I. No signs of metastatic disease are present up to date.

Conclusions: The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation. Patients with cytological diagnosis of Hürthle cell neoplasms should proceed to total thyroidectomy, especially if tumour size is > 1cm, FNAB findings comprise cellular atypias and/or multiple bilateral nodules are detected in the thyroid gland.

No MeSH data available.


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99mTcO4 scan showing “cold” nodules in the both thyroid lobes.
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f1-rado-49-01-26: 99mTcO4 scan showing “cold” nodules in the both thyroid lobes.

Mentions: The patient was euthyroid, had no local or systemic complains, with thyroid functional tests within normal range (FT4 = 17.7 mmol/L, TSH = 1.36 IU/l). Nodules in both thyroid lobes were detected by palpation - smaller one in the right lobe and bigger one in the left lobe. Ultrasound (US) revealed isoechoic, non-homogenic nodule with hypoechoic halo (10 × 12 × 16 mm) in the middle part of the right thyroid lobe and smaller hyperechoic zone above it (7 × 4 × 8 mm). The nodule located in the lower 2/3 of the left lobe was hypoechoic, non-homogenic with cystic degeneration (20 × 27 × 39 mm). A scintiscan was performed, 20 min after intravenous application of 74 MBq of 99mTcO4, that showed reduced uptake of 99mTcO4 in the nodule in the middle of the right lobe and a “cold” nodule in the lower 2/3 of the left lobe (Figure 1).


Appearance of Hürthle cell carcinoma soon after surgical extirpation of Hürthle cell adenoma and follicular adenoma of the thyroid gland.

Ristevska N, Stojanoski S, Gjorceva DP - Radiol Oncol (2015)

99mTcO4 scan showing “cold” nodules in the both thyroid lobes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4362603&req=5

f1-rado-49-01-26: 99mTcO4 scan showing “cold” nodules in the both thyroid lobes.
Mentions: The patient was euthyroid, had no local or systemic complains, with thyroid functional tests within normal range (FT4 = 17.7 mmol/L, TSH = 1.36 IU/l). Nodules in both thyroid lobes were detected by palpation - smaller one in the right lobe and bigger one in the left lobe. Ultrasound (US) revealed isoechoic, non-homogenic nodule with hypoechoic halo (10 × 12 × 16 mm) in the middle part of the right thyroid lobe and smaller hyperechoic zone above it (7 × 4 × 8 mm). The nodule located in the lower 2/3 of the left lobe was hypoechoic, non-homogenic with cystic degeneration (20 × 27 × 39 mm). A scintiscan was performed, 20 min after intravenous application of 74 MBq of 99mTcO4, that showed reduced uptake of 99mTcO4 in the nodule in the middle of the right lobe and a “cold” nodule in the lower 2/3 of the left lobe (Figure 1).

Bottom Line: One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on (99m)Tc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB.No signs of metastatic disease are present up to date.The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation.

View Article: PubMed Central - PubMed

Affiliation: Institute of Pathophysiology and Nuclear Medicine, Acad. "Isak S. Tadzer", Skopje, Macedonia.

ABSTRACT

Background: Hürthle cell neoplasms could be benign (Hürthle cell adenoma) or malignant (Hürthle cell carcinoma). Hürthle cell carcinoma is a rare tumour, representing 5% of all differentiated thyroid carcinomas. The cytological evaluation of Hürthle cell neoplasms by fine needle aspiration biopsy (FNAB) is complicated because of the presence of Hürthle cells in both Hürthle cell adenoma and Hürthle cell carcinoma. Thus, the preoperative distinction between these two entities is very difficult and possible only with pathohistological findings of the removed tumour.

Case report: A 57-year old female patient was admitted at our Department, for investigation of nodular thyroid gland. She was euthyroid and FNAB of the nodules in both thyroid lobes were consistent of Hürthle cell adenoma with cellular atypias. After thyroidectomy the histopathology revealed Hürthle cell adenoma with high cellular content and discrete cellular atypias in the left lobe and follicular thyroid adenoma without cellular atypias in the right lobe. One year after substitution therapy, a palpable tumour on the left side of the remnant tissue was found, significantly growing with time, presented as hot nodule on (99m)Tc-sestamibi scan and conclusive with Hürthle cell adenoma with marked cellularity on FNAB. Tumorectomy was performed and well-differentiated Hürthle cell carcinoma detected. The patient received ablative dose of 100 mCi (131)I. No signs of metastatic disease are present up to date.

Conclusions: The differences between Hürthle cell adenomas and Hürthle cell carcinomas could be clearly made only by histopathological evaluation. Patients with cytological diagnosis of Hürthle cell neoplasms should proceed to total thyroidectomy, especially if tumour size is > 1cm, FNAB findings comprise cellular atypias and/or multiple bilateral nodules are detected in the thyroid gland.

No MeSH data available.


Related in: MedlinePlus