Hurthle Cells are Not Always a Sign of Thyroid Cancer

Hurthle Cells are Not Always a Sign of Thyroid Cancer

Hurthle Cells are Not Always a Sign of Thyroid Cancer
Hurthle Cells are Not Always a Sign of Thyroid Cancer. They are the cause of confusion among pathologists endocrinologists surgeons and patients. Always get outside opinions if Hurtle cells are seen in your biopsy as most are found in goiters and Hashimoto’s thyroiditis nodules and not in cancers.
Hashimoto’s thyroiditis with Hurthle cells
Image result for hurthle cells
Benign hurtle cell metaplasia not cancer neoplasia
Hurthle cells seen in a single cell pattern of neoplasm
with a 20% chance of Hurthle cell Cancer.
Richard Guttler MD,FACE,ECNU

Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology.

Yazgan A et al
Cytopathology. 2014 Jun;25(3):185-9.

  1. Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign,
  2. 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),
  3. 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),
  4. 12 (1.3%) as suspicious for malignancy (SFM)
  5. One (0.1%) as malignant.
  6. FNAs without Hürthle cells, 9707 (93.7%) were classified as benign.
  7. 412 (4.0%) as AUS/FLUS,
  8. 77 (0.7%) as FN/SFN,
  9. 93 (0.9%) as SFM and
  10. 70 (0.7%) as malignant.
  11. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001)
  12.  A decrease in benign and an increase in AUS/FLUS and FN/SFN categories.
  13. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher with Hurthle cells present.
  14. We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present.
  15. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.

The rule is do not panic when you here Hurthle cells are present in your biopsy  85% are found in benign goiter and thyroiditis nodules.

Delay surgery until you sort out if you really need it. Finding more Hurthle cells in atypical biopsy results can  lead to too many surgeries without molecular marker testing on the nodule.

Call Matt for details of my evaluation of the presence of Hurthle cells seen in your biopsy.



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