Why Hurthle Cells Drive Cytopathologists Mad
Because HCs are found in all benign conditions such as Hashimoto’s thyroiditis CHT and simple goiter as well as papillary thyroid cancer and Hurthle cell neoplasms and cancer. The most common cause of HC on needle biopsies is CHT, and Goiter. HC neoplasm is less common and HC cancers is even more uncommon. HC cancers are hard to treat and is the cause of the over-concern for finding HC on FNA specimens. The finding of Atypia of undetermined significance AUS-HC has about a 10-12% chance of malignancy, while follicular neoplasm HC type has a higher rate of malignancy. Most HC findings ion CHT and goiter only confuse the issue for many pathologists leading to over- reading neoplasm risk. When second opinions are obtained AUS-HC is more often down graded to benign than ungraded to cancer.
Comment: If you are given a DX of possible Hurthle cell neoplasm and recommended to have surgery you have options. One see a thyroidologist for evaluation to see if you have Hashimoto’s thyroiditis, and get the slides for review, and if needed have the slides microdissected for molecular markers and classifier or repeat the biopsy and get markers and classifier. Save yourself an unnecessary surgery for benign HC in goiter and CHT. Call for my opinion. Ask for Matt at 310-393-8860
HC metaplasia in Hashimoto’s
A. Blood vessels in Hurthle Neoplasm B. Hurthle Cell Neoplasm single cell pattern