Hürthle Cells in Thyroid Disease: It is not all about Hurthle Cell Neoplasm or Cancer

Hürthle Cells in Thyroid Disease: It is not all about Hurthle Cell Neoplasm or Cancer

Hürthle Cells in Thyroid Disease: It is not all about Hurthle Cell Neoplasm or Cancer

Hürthle Cells HC in Thyroid Disease. It is not all about Hurthle Cell Neoplasm or Cancer.

Hürthle Cells in Thyroid Disease
The cytology above is of Hurthle cell metaplasia in a Hashimoto’s thyroiditis. This is not Hurthle cell neoplasm or cancer. HC are seen in all thyroid diseases.There is lymphoid tangles of lymphocytes and plasma cell in the lower left and a large cluster of Hurthle cells to the right.

  1. The Significance of Hürthle Cells in Thyroid Disease.
  2. Other names for HC are oncocytes/oncocytic change or oxyphils/oxyphilic change.
  3. HC are not infrequently described on fine-needle aspiration biopsy (FNAB) reports of thyroid lesions.
  4. The description of HCs on FNAB reports may cause significant concern to the clinician.
  5. However, placing the finding in the appropriate clinical context may alleviate some anxiety.
  6. Not all oxyphilic cells are true HCs and not every aspirate containing HCs is or should be considered equivalent to an HC neoplasm (HCN).
  7. pmc1184092_1742-6413-2-12-6
  8. Above slide shows Hurthle cell neoplasm.
  9. There are many benign thyroid lesions associated with HCs or HC change.
  10. For clinicians, it may be difficult to discern the significance of these findings and to determine an appropriate course of action.
  11. A skilled and experienced cytopathologist is invaluable in discriminating the subtle features that distinguish these lesions from those warranting a more aggressive approach.
  12. The diagnosis of HC carcinoma relies on histopathologic scrutiny and evidence of capsular and/or vascular invasion or metastasis to lymph nodes or distant organs.
  13. Many investigators have sought clinical, radiographic, cytological, genetic, and other factors to attempt to discriminate preoperatively between benign and malignant HCNs.
  14. To date, none have been definitively proven to be reliable.
  15. For now, because of the inability to determine the benign or malignant nature of such neoplasms based on cytology alone, a surgical approach is warranted.
  16. Molecular marker studies can help in some cases.
  17. FNABiopsy terms are Hürthle cell neoplasm (HCN), Hürthle cell (HC) change, and variations thereof.
  18. The dilemma facing the clinician is how to proceed from there.
  19. Despite the historical misnomer, the term Hürthle cell is used to describe follicular-derived epithelial cells with oncocytic cytology.
  20. HCs may be found in a wide variety of conditions affecting the thyroid gland.
  21. They are commonly found in older individuals, those who have undergone thyroid irradiation, and patients with long-standing nodular goiters, Graves’ disease, and Hashimoto’s thyroiditis. CHT.
  22. The classic definition of Hashimoto’s disease calls for the triad of lymphocytes, plasma cells, and HCs.
  23. Hashimoto’s thyroiditis is, in most cases, a diffuse process, but in some instances discrete nodules may be dominant.
  24. Follicular cell metaplasia, ranging from pale pink cells with abundant cytoplasm to true HCs with the characteristic granular, deeply eosinophilic cytoplasm, is commonly seen.
  25.  HC metaplasia is rarely seen in the juvenile form of CHT.
  26. HCs are also seen in neoplastic diseases of the thyroid, both benign and malignant, including HCA, HCC, variants of PTC, and the oncocytic variant of MTC, among others.
  27. Oncocytic/oxyphilic change, HC change, focal or diffuse, may be described.
  28. Oxyphilic cells may be seen in metastatic renal cell carcinoma to the thyroid; however, these are not true HCs because they are not derived from thyroid follicular epithelium.
  29. FNAB aspirates of non-neoplastic lesions are often comprised of HCs, benign follicular cells without oncocytic change, and colloid, as in the case of nodular goiter.
  30. HCs, aggregates of lymphocytes and dendritic cells, and benign follicular cells, as seen in CHT.
  31. In rare circumstances, FNAB of a thyroid nodule may reveal oxyphilic cells from an intrathyroidal parathyroid adenoma.
  32. The cells may be indistinguishable from HCs, with their true identity revealed only on final pathology and needle washout for PTH.
  33. The only cytomorphologic features associated more frequently with neoplastic disease were extensive overall cellularity, absent colloid, and extensive HC cellularity; no feature reliably excluded neoplasia.
  34. This underscores the difficulty in determining the proper course of action when “HC hyperplasia“ versus ”HCN” is reported on FNAB reports.
  35.  Ultrasound has become a widely recognized tool in the diagnosis and management of nodular thyroid disease.
  36.  There was no characteristic sonographic appearance that could readily distinguish a benign from a malignant tumor.
  37. Ultrasound may be most useful in HCN diagnosis when sonographically abnormal lymph nodes are identified, suggesting metastatic disease on Preoperative FNAB of these nodes accompanied by measurement of the thyroglobulin level of the specimen can increase the accuracy of a malignant diagnosis and greatly aid preoperative planning.
  38. Malignant HCNs do require aggressive surgery, because they are poorly responsive to chemotherapy, do not concentrate iodine, and are generally not radiosensitive.
  39. When metastases are present at the time of diagnosis, aggressive surgical approaches do not appear to have much influence on the long-term outcome and are chiefly palliative, underscoring the need to perform timely FNAB of solid thyroid nodules.
  40. Conclusions: HCs may be found in lesions across the spectrum of thyroid disease.
  41. The significance of HCs in thyroid pathology is currently uncertain.
  42.  Although the mere presence of HCs or HC change in an FNAB smear should not immediately trigger clinical worry and perhaps an unnecessary surgical referral, clinical context and an appreciation for the variety of findings associated with oncocytes may help guide the clinician to appropriate clinical follow-up.
  43. The safest course of action is for all patients with a diagnosis of HCN, made by a cytopathologist with adequate expertise and using accepted guidelines and criteria, to undergo surgical excision in order to obtain a definitive diagnosis.
  44. Do not go to surgery with a diagnosis of Hurthle cell neoplasm with a second outside opinion.Many benign thyroid conditions have Hurthle cells that are not cancer and do not need surgery.
  45. Call me for my opinion at 310-393-8860 or thyroid.manager@protonmail.com.
  46. Dr.G.

 

Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860