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Hürthle Cell Carcinoma

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Endocrine Surgery Comprehensive Board Exam Guide

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Abstract

The content of this chapter includes a description of Hürthle cell carcinoma, traditionally considered a histopathological variant of follicular carcinoma, yet more recently defined as a separate entity based upon its unique biological behavior, genetic alterations, and differences in prognosis as compared to follicular carcinoma. The most current evidence-based literature and management guidelines from the American Thyroid Association (ATA) and the European perspectives are summarized. This chapter starts with a case study along with a series of multiple-choice questions and answers to further enhance learning.

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References

  1. Chindris AM, Casler JD, Bernet VJ, Rivera M, Thomas C, Kachergus JM, et al. Clinical and molecular features of Hurthle cell carcinoma of the thyroid. J Clin Endocrinol Metab. 2015;100(1):55–62.

    Article  CAS  PubMed  Google Scholar 

  2. DeLellis RA. Pathology and genetics of thyroid carcinoma. J Surg Oncol. 2006;94(8):662–9.

    Article  CAS  PubMed  Google Scholar 

  3. Martin JD, Elkin DC. Hurthle cell tumors of the thyroid. Ann Surg. 1939;110(2):169–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see comments]. Cancer. 1998;83(12):2638–48.

    Article  CAS  PubMed  Google Scholar 

  5. WHO. WHO classification of tumours of endocrine organs. 4th ed. Geneva: World Health Organization; 2017.

    Google Scholar 

  6. Ganly I, Makarov V, Deraje S, Dong Y, Reznik E, Seshan V, et al. Integrated genomic analysis of Hurthle cell cancer reveals oncogenic drivers, recurrent mitochondrial mutations, and unique chromosomal landscapes. Cancer Cell. 2018;34(2):256–70 e5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Nagar S, Aschebrook-Kilfoy B, Kaplan EL, Angelos P, Grogan RH. Hurthle cell carcinoma: an update on survival over the last 35 years. Surgery. 2013;154(6):1263–71; discussion 71.

    Article  PubMed  Google Scholar 

  8. Goffredo P, Roman SA, Sosa JA. Hurthle cell carcinoma: a population-level analysis of 3311 patients. Cancer. 2013;119(3):504–11.

    Article  PubMed  Google Scholar 

  9. Sugino K, Kameyama K, Ito K, Nagahama M, Kitagawa W, Shibuya H, et al. Does Hurthle cell carcinoma of the thyroid have a poorer prognosis than ordinary follicular thyroid carcinoma? Ann Surg Oncol. 2013;20(9):2944–50.

    Article  PubMed  Google Scholar 

  10. Zhou X, Zheng Z, Chen C, Zhao B, Cao H, Li T, et al. Clinical characteristics and prognostic factors of Hurthle cell carcinoma: a population based study. BMC Cancer. 2020;20(1):407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ernaga Lorea A, Migueliz Bermejo I, Anda Apinaniz E, Pineda Arribas J, Toni Garcia M, Martinez de Esteban JP, et al. Comparison of clinical characteristics of patients with follicular thyroid carcinoma and Hurthle cell carcinoma. Endocrinol Diabetes Nutr (Engl Ed). 2018;65(3):136–42.

    Google Scholar 

  12. Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hurthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol. 2018;6(6):500–14.

    Article  PubMed  Google Scholar 

  13. Stojadinovic A, Hoos A, Ghossein RA, Urist MJ, Leung DH, Spiro RH, et al. Hurthle cell carcinoma: a 60-year experience. Ann Surg Oncol. 2002;9(2):197–203.

    PubMed  Google Scholar 

  14. Wong CP, AuYong TK, Tong CM. Thyrotoxicosis: a rare presenting symptom of Hurthle cell carcinoma of the thyroid. Clin Nucl Med. 2003;28(10):803–6.

    Article  CAS  PubMed  Google Scholar 

  15. Russo D, Wong MG, Costante G, Chiefari E, Treseler PA, Arturi F, et al. A Val 677 activating mutation of the thyrotropin receptor in a Hurthle cell thyroid carcinoma associated with thyrotoxicosis. Thyroid. 1999;9(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  16. Yu R, Auerbach MS. FDG-avid Hurthle cell thyroid adenoma. Clin Nucl Med. 2019;44(9):752–3.

    Article  PubMed  Google Scholar 

  17. Nilsson IL, Arnberg F, Zedenius J, Sundin A. Thyroid incidentaloma detected by fluorodeoxyglucose positron emission tomography/computed tomography: practical management algorithm. World J Surg. 2011;35(12):2691–7.

    Article  PubMed  Google Scholar 

  18. Ahmadi S, Stang M, Jiang X, Sosa J. Hürthle cell carcinoma: current perspectives. Onco Targets Ther. 2016;9:6873–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Khokar AM, Holoubek SA, Kuchta KM, Winchester DJ, Prinz RA, Moo-Young TA. Survival with follicular and Hurthle cell microcarcinoma compared to papillary thyroid microcarcinoma: a population study of 84,532 patients. World J Surg. 2020;44(2):469–78.

    Article  PubMed  Google Scholar 

  20. Samaan NA, Schultz PN, Ordonez NG, Hickey RC, Johnston DA. A comparison of thyroid carcinoma in those who have and have not had head and neck irradiation in childhood. J Clin Endocrinol Metab. 1987;64(2):219–23.

    Article  CAS  PubMed  Google Scholar 

  21. Guerrero MA, Suh I, Vriens MR, Shen WT, Gosnell J, Kebebew E, et al. Age and tumor size predicts lymph node involvement in Hurthle cell carcinoma. J Cancer. 2010;1:23–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bishop JA, Wu G, Tufano RP, Westra WH. Histological patterns of locoregional recurrence in Hurthle cell carcinoma of the thyroid gland. Thyroid. 2012;22(7):690–4.

    Article  PubMed  Google Scholar 

  23. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Luster M, Aktolun C, Amendoeira I, Barczynski M, Bible KC, Duntas LH, et al. European perspective on 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: proceedings of an interactive international symposium. Thyroid. 2019;29(1):7–26.

    Article  PubMed  Google Scholar 

  25. Kuo EJ, Roman SA, Sosa JA. Patients with follicular and Hurthle cell microcarcinomas have compromised survival: a population level study of 22,738 patients. Surgery. 2013;154(6):1246–53; discussion 53-4.

    Article  PubMed  Google Scholar 

  26. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J. 2017;6(5):225–37.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim PH, Suh CH, Baek JH, Chung SR, Choi YJ, Lee JH. Diagnostic performance of four ultrasound risk stratification systems: a systematic review and meta-analysis. Thyroid. 2020;30(8):1159–68.

    Article  PubMed  Google Scholar 

  28. Bahl M, Sosa JA, Eastwood JD, Hobbs HA, Nelson RC, Hoang JK. Using the 3-tiered system for categorizing workup of incidental thyroid nodules detected on CT, MRI, or PET/CT: how many cancers would be missed? Thyroid. 2014;24(12):1772–8.

    Article  PubMed  Google Scholar 

  29. Santana NO, Freitas RMC, Marcos VN, Chammas MC, Camargo RYA, Schmerling CK, et al. Diagnostic performance of thyroid ultrasound in Hurthle cell carcinomas. Arch Endocrinol Metab. 2019;63(3):300–5.

    PubMed  Google Scholar 

  30. Noto B, Eveslage M, Pixberg M, Gonzalez Carvalho JM, Schafers M, Riemann B, et al. Prevalence of hyperfunctioning thyroid nodules among those in need of fine needle aspiration cytology according to ATA 2015, EU-TIRADS, and ACR-TIRADS. Eur J Nucl Med Mol Imaging. 2020;47(6):1518–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Nikiforova MN, Mercurio S, Wald AI, Barbi de Moura M, Callenberg K, Santana-Santos L, et al. Analytical performance of the ThyroSeq v3 genomic classifier for cancer diagnosis in thyroid nodules. Cancer. 2018;124(8):1682–90.

    Article  CAS  PubMed  Google Scholar 

  32. Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, et al. A meta-analytic review of the Bethesda system for reporting thyroid cytopathology: has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol. 2015;123(12):713–22.

    Article  PubMed  Google Scholar 

  33. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56(4):333–9.

    Article  PubMed  Google Scholar 

  34. Ren Y, Kyriazidis N, Faquin WC, Soylu S, Kamani D, Saade R, et al. The presence of Hurthle cells does not increase the risk of malignancy in most Bethesda categories in thyroid fine-needle aspirates. Thyroid. 2020;30(3):425–31.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Slowinska-Klencka D, Wysocka-Konieczna K, Wozniak-Osela E, Sporny S, Popowicz B, Sopinski J, et al. Thyroid nodules with Hurthle cells: the malignancy risk in relation to the FNA outcome category. J Endocrinol Investig. 2019;42(11):1319–27.

    Article  CAS  Google Scholar 

  36. Anila KR, Nayak N, George PS, Jayasree K. Cytomorphologic Spectrum of Hurthle cell lesions of thyroid: a study of 54 cases. Gulf J Oncolog. 2018;1(26):6–10.

    CAS  PubMed  Google Scholar 

  37. Wong KS, Jo VY, Lowe AC, Faquin WC, Renshaw AA, Shah AA, et al. Malignancy risk for solitary and multiple nodules in Hurthle cell-predominant thyroid fine-needle aspirations: a multi-institutional study. Cancer Cytopathol. 2020;128(1):68–75.

    Article  PubMed  Google Scholar 

  38. Gopal RK, Kubler K, Calvo SE, Polak P, Livitz D, Rosebrock D, et al. Widespread chromosomal losses and mitochondrial DNA alterations as genetic drivers in Hurthle cell carcinoma. Cancer Cell. 2018;34(2):242–55 e5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Endo M, Nabhan F, Angell TE, Harrell RM, Nasr C, Wei S, et al. Use of molecular diagnostic tests in thyroid nodules with Hurthle cell-dominant cytology. Thyroid. 2020;30(9):1390–2.

    Article  PubMed  Google Scholar 

  40. Melo M, da Rocha AG, Vinagre J, Batista R, Peixoto J, Tavares C, et al. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2014;99(5):E754–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Melo M, Gaspar da Rocha A, Batista R, Vinagre J, Martins MJ, Costa G, et al. TERT, BRAF, and NRAS in primary thyroid cancer and metastatic disease. J Clin Endocrinol Metab. 2017;102(6):1898–907.

    Article  PubMed  Google Scholar 

  42. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16(12):1229–42.

    Article  PubMed  Google Scholar 

  43. Yang Q, Zhao Z, Zhong G, ** A, Yu K. Effect of adjuvant radioactive iodine therapy on survival in rare oxyphilic subtype of thyroid cancer (Hurthle cell carcinoma). PeerJ. 2019;7:e7458.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Chen H, Nicol TL, Zeiger MA, Dooley WC, Ladenson PW, Cooper DS, et al. Hurthle cell neoplasms of the thyroid: are there factors predictive of malignancy? Ann Surg. 1998;227(4):542–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Samaan NA, Schultz PN, Haynie TP, Ordonez NG. Pulmonary metastasis of differentiated thyroid carcinoma: treatment results in 101 patients. J Clin Endocrinol Metab. 1985;60(2):376–80.

    Article  CAS  PubMed  Google Scholar 

  46. Schlumberger M, Challeton C, De Vathaire F, Travagli JP, Gardet P, Lumbroso JD, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996;37(4):598–605.

    CAS  PubMed  Google Scholar 

  47. Farooki A, Leung V, Tala H, Tuttle RM. Skeletal-related events due to bone metastases from differentiated thyroid cancer. J Clin Endocrinol Metab. 2012;97(7):2433–9.

    Article  CAS  PubMed  Google Scholar 

  48. Udelsman R, Westra WH, Donovan PI, Sohn TA, Cameron JL. Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid. Ann Surg. 2001;233(5):716–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Mai KT, Khanna P, Yazdi HM, Perkins DG, Veinot JP, Thomas J, et al. Differentiated thyroid carcinomas with vascular invasion: a comparative study of follicular, Hurthle cell and papillary thyroid carcinoma. Pathology. 2002;34(3):239–44.

    Article  PubMed  Google Scholar 

  50. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordonez NG, et al. Prognostic factors in patients with Hurthle cell neoplasms of the thyroid. Cancer. 2003;97(5):1186–94.

    Article  PubMed  Google Scholar 

  51. Petric R, Gazic B, Besic N. Prognostic factors for disease-specific survival in 108 patients with Hurthle cell thyroid carcinoma: a single-institution experience. BMC Cancer. 2014;14:777.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kelders A, Kennes LN, Krohn T, Behrendt FF, Mottaghy FM, Verburg FA. Relationship between positive thyroglobulin doubling time and 18F-FDG PET/CT-positive, 131I-negative lesions. Nucl Med Commun. 2014;35(2):176–81.

    Article  PubMed  Google Scholar 

  53. Robbins RJ, Wan Q, Grewal RK, Reibke R, Gonen M, Strauss HW, et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006;91(2):498–505.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Molecular Medicine and Surgery, Endocrine Tumors and Sarcoma Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Inga-Lena Nilsson

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  1. Inga-Lena Nilsson
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Correspondence to Inga-Lena Nilsson .

Editor information

Editors and Affiliations

  1. Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA

    Alexander L. Shifrin

  2. Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Marco Raffaelli

  3. The Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph

  4. Department of Surgery, Linkö** University, Linkö**, Sweden

    Oliver Gimm

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Nilsson, IL. (2021). Hürthle Cell Carcinoma. In: Shifrin, A.L., Raffaelli, M., Randolph, G.W., Gimm, O. (eds) Endocrine Surgery Comprehensive Board Exam Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-84737-1_7

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  • DOI: https://doi.org/10.1007/978-3-030-84737-1_7

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  • Online ISBN: 978-3-030-84737-1

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