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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.


Related in: MedlinePlus

Whole-body scan (WBS) with 99mTc-MIBI showing normal distribution of the tracer in the body as well as the accumulation in the tumor in the left thyroid lobe.
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f4-rado-49-01-26: Whole-body scan (WBS) with 99mTc-MIBI showing normal distribution of the tracer in the body as well as the accumulation in the tumor in the left thyroid lobe.

Mentions: Considering the FNAB findings, 99mTc-MIBI scan and tumour size (increasing with time) the patient was suggested and underwent a second operation (August 2012) - tumourectomy and remnant tissue extirpation. Hystopatological examination of the extirpated tissue fragment - (comprising the newly detected nodule and the remnant thyroid tissue, sized 5.5 × 4.5 × 4 cm) revealed presence of well-differentiated HCC (stage III, pTNM = pT3 pNx pMx, G1 C1) with large malignant cells rich with eosinophilic cytoplasm, with hyperchromatic nucleuses, and well-differentiated grade 1 nucleus. Necrotic regions and capsular invasion were found as well. US postoperatively revealed only small remnant thyroid tissue on the left side, confirmed on the consecutive 99mTc-MIBI scintigraphy (January 2013) (Figure 4).


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)

Whole-body scan (WBS) with 99mTc-MIBI showing normal distribution of the tracer in the body as well as the accumulation in the tumor in the left thyroid lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-rado-49-01-26: Whole-body scan (WBS) with 99mTc-MIBI showing normal distribution of the tracer in the body as well as the accumulation in the tumor in the left thyroid lobe.
Mentions: Considering the FNAB findings, 99mTc-MIBI scan and tumour size (increasing with time) the patient was suggested and underwent a second operation (August 2012) - tumourectomy and remnant tissue extirpation. Hystopatological examination of the extirpated tissue fragment - (comprising the newly detected nodule and the remnant thyroid tissue, sized 5.5 × 4.5 × 4 cm) revealed presence of well-differentiated HCC (stage III, pTNM = pT3 pNx pMx, G1 C1) with large malignant cells rich with eosinophilic cytoplasm, with hyperchromatic nucleuses, and well-differentiated grade 1 nucleus. Necrotic regions and capsular invasion were found as well. US postoperatively revealed only small remnant thyroid tissue on the left side, confirmed on the consecutive 99mTc-MIBI scintigraphy (January 2013) (Figure 4).

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