Clipboard, Search History, and several other advanced features are temporarily unavailable. Background: Hürthle cell features are frequently observed on the fine-needle aspiration (FNA) cytology of thyroid nodules and often pose a diagnostic challenge because of a significant overlap between cytomorphologic features seen in benign and malignant lesions. The diagnosis of an adequately sampled thyroid FNA is generally grouped into three categories: benign, malignant, and indeterminate. What is the most likely diagnosis of this thyroid aspirate? Hurthle cells can be seen in both non-neoplastic and neoplastic thyroid … Background. The oncocytic follicular cells of the thyroid continue to carry the name “Hürthle cells”, even though the cells that Karl Hürthle initially identified in 1894 ultimately proved to be the parafollicular C cells (Hürthle 1894). Ann Diagn Pathol. Fine-needle aspiration (FNA) can cause misdiagnosis of cytomorphological findings between parathyroid and thyroid lesions. 2014 Apr;122(4):241-9. doi: 10.1002/cncy.21391. Finely granular abundant cytoplasm. 34 These features may pose diagnostic challenges in differentiating a Hürthle-cell neoplasm … Published online 2020 Oct 7. doi: 10.1002/lio2.465 PMCID: PMC7752084 FOIA Bethesda, MD 20894, Copyright The … A variety of thyroid neoplasms are characterized as having oncocytic cytology. Hurthle cell cancer is a rare cancer that affects the thyroid gland.www.uwhealth.org/endocrine-surgery/thyroid-conditions/51430 Hürthle cells in fine-needle aspirates of the thyroid: a review of their diagnostic criteria and significance. Fine needle aspiration cytology … 26 The cytologic features mentioned most often in the literature as favoring a FNHCT include monomorphism (ie, absence of non‐Hürthle cells in addition to Hürthle cells) or predominance of Hürthle cells, microfollicular/syncytial/ nonmacrofollicular or trabecular arrangement (Fig. Hürthle cell nodule: thyroid nodule made of Hurthle cells, which are normal cells found in the thyroid together with the follicular cells. Hürthle cell predominant thyroid nodules often confound the diagnostic utility of fine needle aspiration biopsy (FNAB) with cytology often interpreted as a Hürthle cell lesion with an indeterminate risk of malignancy, Bethesda category (BC) III or IV. Prognosis depends upon the age of the patient, tumour size, extent of invasion and initial nodal or distant metastasis. Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. Specific criteria for the diagnosis of fine‐needle aspiration (FNA) of Hürthle Cell Carcinoma (HCC) have rarely been discussed in the literature. Home > FOLLICULAR NEOPLASM or SUSPICIOUS FOR A FOLLICULAR NEOPLASM > Hurthle Cell Neoplasm Laryngoscope Investig Otolaryngol. This site needs JavaScript to work properly. 2006 Apr 25;108(2):102-9. doi: 10.1002/cncr.21716. Molecular diagnostics for Hürthle cell predominant nodules has also been disappointing in further defining the risk of … Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland: A cytomorphologic study of 139 cases with statistical analysis. 1 In 1898, Askanazy was the first to describe the follicular-derived Hürthle cell as we know it today. The presence of colloid and … large, polygonal cells displaying uniform, rounded nuclei, often prominent nucleoli and abundant granular cytoplasm. nuclear enlargement, pale chromatin, grooves and intranuclear pseudoinclusions, A few Hürthle cell neoplasms exhibit some of the architectural and nuclear features of papillary carcinoma (diagnosed either as FNHCT/SFNHCT or “suspicious for malignancy”) (, Presence of salt and pepper chromatin, intranuclear pseudoinclusions but absence of prominent nucleolus; metachromasy on Romanowsky stains, Monomorphous cytoplasm with round nuclei and salt and pepper chromatin, GEC can recognize the expression profile of parathyroid lesions (, Calcitonin measurement using needle washout fluid, PTH value measurement using needle washout fluid. College of Pathologists, Academy of Medicine of Malaysia. Although the terms oncocyte, oxyphilic cel… The case of Hürthle cell carcinoma is reported in a 79-year-old man who presented with a rapidly … It may present as a low-grade tumour or as a more aggressive type. Since fine needle aspirations have sampling limitations, subsequent surgical excision is essential in determining the correct diagnosis in cases of cytologic Hürthle cell neoplasm which may harbor anaplastic thyroid carcinoma. National Library of Medicine In cytologic smears, they appear as polygonal cells, with large and finely granular cytoplasm, purple with MGG staining and orangeophilic with Papanicolaou staining. General. Pu RT, Yang J, Wasserman PG, Bhuiya T, Griffith KA, Michael CW. Hürthle cells (oncocytes) are altered follicular cells which are very rich in mitochondria. Highly cellular, 75% or more Hürthle cells (abundant granular cytoplasm, round nuclei, often prominent nucleoli), often discohesive cells, some enlarged and pleomorphic with intracytoplasmic lumens (empty vacuoles with magenta [Diff Quik], green [Pap] or no material); transgressing vessels (capillaries in clusters of Hürthle cells) (Arch Pathol Lab Med … Whether a FNA diagnosis of Hurthle cell lesion/neoplasm (HLN) denotes a worse clinical outcome than follicular lesion/neoplasm … Concentric calcifications of the luminal colloid resembling psammoma bodies can be seen in Hürthle-cell neoplasms. large, polygonal cells displaying uniform, rounded nuclei, often prominent nucleoli and abundant granular cytoplasm. with Hürthle cells 8 F inflammatory polyarthritis left lobe 5.8 9 3 3f colloid and cells of oncocytic type, an oncocytic follicular neoplasm refused surgery- surveillance 9 M diffuse large B cell lymphoma right lobe 7.3 36 3 3f thyrocytes with Hürthle cell change, follicular neoplasm with oncocytic change none 10 F neuroendo- Keywords: Cytology; FNA; … 2005 Oct;138(4):650-6; discussion 656-7. doi: 10.1016/j.surg.2005.06.047. Elliott DD, Pitman MB, Bloom L, Faquin WC. Epub 2014 Jan 16. This version is a relatively rare form of differentiated thyroid cancer, accounting for only 3-10% of all differentiated thyroid cancers. Hürthle cell cytology, genotype, and clinical behavior. 16, 17, 28, 32, 33 Furthermore, nuclear grooves and rarely poorly formed intranuclear pseudo-inclusions can also be seen in Hürthle cells, especially in cytology preparations. © Copyright PathologyOutlines.com, Inc. Click, Ali: The Bethesda System for Reporting Thyroid Cytopathology, 2nd Edition, 2018, American Registry of Pathology: Tumors of the Thyroid Glands, Atlas of Tumor Pathology, 1st Edition, 2016, atypia of undetermined significance or follicular lesion of undetermined significance, follicular neoplasm / suspicious for a follicular neoplasm, Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:111, Appl Immunohistochem Mol Morphol 2019;27:726, Bethesda category IV - Hürthle, “follicular neoplasm, Hürthle cell type / suspicious for a follicular neoplasm, Hürthle cell type (FNHCT/SFNHCT)” is used for cases with a cellular aspirate that consists exclusively of Hürthle cells (, Hürthle cells are thyroid follicular cells with oncocytic appearance characterized by large hyperchromatic nuclei with prominent nucleoli and abundant granular eosinophilic cytoplasm, Cases cytologically suspected for Hürthle cell adenoma and Hürthle cell carcinoma are included, The final diagnosis is made histologically because capsular or vascular invasion are the essential criteria of Hürthle cell carcinoma, Includes cases with most of the follicular cells showing abundant fine granular cytoplasm (Hürthle cells), Frequency 1.2 - 8.75%, resection rate 30.1%, risk of malignancy 10 - 40%, The most common histopathological diagnosis is Hürthle cell adenoma and Hürthle cell carcinoma, followed by multinodular goiter and Hashimoto thyroiditis, The term “suspicious for a follicular neoplasm, Hürthle cell type (SFNHCT)” may be more convenient than “follicular neoplasm, Hürthle cell type (FNHCT)” because some nodular goiter or Hashimoto thyroiditis (i.e. They are easily recognized by their distinct cytomorphology in cytological preparations, i.e. Statistically significant cytologic features that favored malignant (HCC) over benign lesions (HCA and BNHCL) included small cell dysplasia, large cell dysplasia, nuclear crowding, and cellular dyshesion. We describe a case of solitary thyroid nodule in a 46-year-old male, whose aspirates comprised predominantly of Hurthle cells exhibiting nuclear features suspicious of papillary carcinoma, which turned out to be Hurthle cell carcinoma on subsequent histological sections. Table 2 Distribution of cyto-histological diagnoses in the categories of 64 benign oncocytic/Hurthle lesions and 150 oncocytic/Hurthle cell neoplasms. Privacy, Help Follicular neoplasm (FN) or Hürthle cell neoplasm (HN) is a less well understood pitfall when evaluating thyroid nodule with fine-needle aspiration (FNA). Oncocytic perferred by WHO over Hurthle cell. Molecular alterations (MAs) associated with these lesions are not well described. 2 The Hürthle cell (also called Askanazy cell, oxyphilic cell, and oncocyte) is defined … Hurthle cells can be seen in both non-neoplastic and neoplastic thyroid lesions which can pose diagnostic dilemma to cytopathologists, especially when the lesions are focally sampled. While most thyroid nodules are non-cancerous (benign), 5-10% are cancerous (malignant). Case Presentation. Hürthle cell neoplasms (HCN) often show punctuated nuclear atypia, with scattered cells with large hyperchromatic nuclei (b). Hürthle cells (HC) are characterized by abundant granular eosinophilic cytoplasm and large nuclei with prominent nucleoli (a). Hürthle cell neoplasm, thyroid cancer, thyroid cytology/FNA, thyroid nodule evaluation, thyroidectomy 1 | INTRODUCTION Fine-needle aspiration (FNA) of the thyroid gland is a safe and effec-tive diagnostic tool in the evaluation of thyroid nodules.1-4 Diagnostic terminology and morphologic criteria for cytologic analysis are This … 2006 May;34(5):330-4. doi: 10.1002/dc.20440. Request PDF | Cytology of Hürthle cell neoplasms of thyroid gland | Hürthle cell neoplasms (HCN) are an uncommon group of tumors of the thyroid gland. nontumor) cases are included in this category, Hürthle cells are also known as oxyphilic, oncocytes or Askanazy cells (, In the Bethesda System for Reporting Thyroid Cytopathology, FNA specimens that are suspicious for a Hürthle cell neoplasm are distinguished from those suspicious for a non-Hürthle cell follicular neoplasm (, Striking morphologic difference between the cytologic patterns of follicular and Hürthle cell neoplasms, Follicular and Hürthle cell carcinomas may be genetically different neoplasms (, Rate of neoplastic lesion after resection: 75 - 84% (, The most common histopathological diagnosis is Hürthle cell adenoma and Hürthle cell carcinoma (77.3%), followed by multinodular goiter (13.3%) and Hashimoto thyroiditis (6.6%) (, Distinction between Hürthle cell adenoma and Hürthle cell carcinoma is based upon histologic evidence of transcapsular or vascular invasion (, Hürthle cell carcinomas represent 15 - 20% of all follicular carcinomas (, Aspirates are at least moderately cellular and are composed exclusively of Hürthle cells, Aspirates composed entirely of Hürthle cells with abundant fine granular cytoplasm should be diagnosed as FNHCT/SFNHCT, Sparsely cellular aspirates composed entirely of oncocytes that could be interpreted as, Moderately or markedly cellular aspirates composed entirely of non-atypical Hürthle cells with abundant colloid; it is acceptable to interpret the sample as, Specimen with partial or minimal Hürthle cell differentiation should be diagnosed as, Aspirates with Hürthle cells showing nuclear features of papillary carcinoma should be classified as, 16 year old girl with Hürthle cell carcinoma in an autonomous thyroid nodule (, 36 year old woman with medullary carcinoma of thyroid mimicking Hürthle cell neoplasm on cytology (, 42 year old man with papillary Hürthle cell tumor (, 69 year old man with recurrent Hürthle cell carcinoma (, 82 year old man with Hürthle cell carcinoma with extensive tumor necrosis (, 85 year old woman with anaplastic thyroid carcinoma developing from a Hürthle cell tumor (, Blue or gray pink (Romanowsky), green (Papanicolaou), pink (H&E), Enlarged, central or eccentrically located, Small cells with high nuclear / cytoplasmic (N/C) ratio (small cell dysplasia) (, Large cells with more than two times anisonucleosis (large cell dysplasia) (, Predominantly isolated cells but sometimes arranged in crowded, syncytial-like clusters, Transgressing vessels (capillaries passing through clusters of Hürthle cells), seen occasionally (, Sometimes intracytoplasmic colloid inclusions (, Molecular testing with available gene panels is generally not helpful in identifying Hürthle cell carcinomas and distinguishing them from adenomas (, Patients with FNHCT/SFNHCT who have benign Afirma Gene Expression Classifier (GEC) result may be spared an unnecessary lobectomy (, Dx / category: follicular neoplasm, Hürthle cell (oncocytic) type, Cellular aspirate consisting of abundant isolated oncocytes in the absence of colloid, Dx / category: suspicious for a follicular neoplasm, Hürthle cell (oncocytic) type, Cellular aspirate of follicular cells with Hürthle cell features, in addition occasional nuclear grooves and focal papillary architecture are seen, The findings raise the possibility of a Hürthle cell neoplasm with mild nuclear irregularity but a papillary carcinoma cannot be excluded, Cellular aspirate composed of cells with abundant granular cytoplasm, The findings raise the possibility of a Hürthle cell neoplasm but a parathyroid tumor cannot be excluded, Correlation with clinical findings, imaging and biochemistry might be helpful, Flat, cohesive sheets of Hürthle cell admixed with normal follicular cells and a moderate to abundant amount of colloid (, Lymphocytes predominate over Hürthle cells, Data suggest that the criteria for FNHCT/SFNHCT have a lower predictive value for malignancy in the settings of chronic thyroiditis (, Nuclear features specific for papillary carcinoma, i.e. Careers. These terms are synonyms; a laboratory should choose the one it prefers and use it exclusively for this interpretation. However, accurate diagnosis can still be made with careful observation of the predominant cell population, nuclear features and whether there is abundant colloid or lymphocytes in the background. Features: Single cells or sheets of oncocytic cells. +/-Transgressing vessels - cluster of oncocytes surrounding vessels. Surgery. The potential diagnostic pitfalls of Hurthle cell lesions and associated conditions in thyroid FNA are discussed. Please enable it to take advantage of the complete set of features! Oncocytesin the thyroid are often called Hürthle cells. - "The cytologic category of oncocytic (Hurthle) cell neoplasm mostly includes low-risk … By histology, FNHCT is considered a variant of follicular neoplasm and is defined as a neoplasm composed of at least 75% Hürthle cells. In each case, there was a subsequent surgical excision. Hürthle cells are thyroid follicular cells with oncocytic appearance characterized by large hyperchromatic nuclei with prominent nucleoli and abundant granular eosinophilic cytoplasm Cases cytologically suspected for Hürthle cell adenoma and Hürthle cell … The presence of Hurthle cell change in a wide variety of thyroid lesions can be diagnostically challenging. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Cancer. Accessibility Molecular alterations (MAs) associated with these lesions are not well described. When diagnosed by FNA as either Hürthle cell neoplasm or Hürthle cell lesion, males were much more likely to have malignant tumors than females. 2008 Jun;12(3):222-30. doi: 10.1016/j.anndiagpath.2008.04.007. By definition, Hürthle cell neoplasms are composed of 75% or greater Hürthle cells. 8600 Rockville Pike Hürthle cell features are frequently observed on the fine‐needle aspiration (FNA) cytology of thyroid nodules and often pose a diagnostic challenge because of a significant overlap between cytomorphologic features seen in benign and malignant lesions. Hurthle cells … Oncocytic and oncocyte-like lesions of the head and neck. 2020 Dec; 5(6): 1254–1259. Hurthle cells (HC) or oncocytic cells, are thyroid follicular cells with oncocytic appearance characterized by large hyperchromatic nuclei with prominent nucleoli and abundant granular eosinophilic cytoplasm,,,,,,,,,. Hürthle cell neoplasm may have marked atypia, for which anaplastic thyroid carcinoma is important to exclude. A Hürthle cell is a cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as benign and malignant tumors (Hürthle cell adenoma and Hürthle cell carcinoma, formerly considered a subtype of follicular thyroid cancer). This result is associated with a significant risk of malignancy (10–40%). We welcome suggestions or questions about using the website. Unable to load your collection due to an error, Unable to load your delegates due to an error. Oncocytic cells: Well-defined cellular borders. Nucleoli, may be prominent. In such cases, the diagnosis “follicular neoplasm, Hürthle cell (oncocytic) type” or “suspicious for a follicular neoplasm, Hürthle cell (oncocytic) type” should be made. 3), presence of single/dyshesive Hürthle cells … A retrospective review of 35 FNA cases with the diagnosis of Hürthle cell lesion or Hürthle cell neoplasm was performed. The objective of the … encapsulated thyroid lesion comprising at least 75% Hürthle cells. Hürthle cells (HC) are characterized by abundant granular eosinophilic cytoplasm containing accumulated dysfunctional mitochondria and large nuclei with prominent nucleoli. AKA Hurthle cell neoplasm. The latter group usually includes follicular neoplasm, follicular lesion, and sometimes a more specific diagnosis such as Hurthle cell neoplasm or follicular lesion/neoplasm with Hurthle cell change. Hurthle cells are not uncommonly encountered in thyroid fine needle aspiration cytology (FNAC) smears. Cancer Cytopathol. They are easily recognized by their distinct cytomorphology in cytological preparations, i.e. Notes: Which finding is not helpful in distinguishing medullary carcinoma from a Hürthle cell neoplasm? This website is intended for pathologists and laboratory personnel but not for patients. A 31-year-old man Cytology. In aspirates where the predominant cell population comprises of Hurthle cells, a diagnosis of Hurthle cell neoplasm (HCN) is favoured.2 To date, Hurthle cell carcinoma (HCC) is separated from Hurthle cell adenoma (HCA) by the presence of capsular and/or vascular invasion on histological section. Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? The term has become entrenched in the thyroid lexicon, even though Hürthle’s original description is now believed to represent a parafollicular or C-cell of the thyroid gland. The FNA specimens were divided according to histologic … Prevention and treatment information (HHS). However, we cannot answer medical or research questions or give advice. Hürthle Cell Thyroid Nodules with Equivocal Cytology Dorota Słowinska-Klencka´ *,y, Kamila Wysocka-Konieczna y, Mariusz Klencki and Bozena˙ Popowicz Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213 Łódz,´ Poland; kamila.wysocka91@wp.pl (K.W.-K.); … A few diagnostic Hurthle cells are not uncommonly encountered in thyroid fine needle aspiration cytology (FNAC) smears. 3-D clusters. Would you like email updates of new search results? Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells: a dilemma in the management of nodular thyroid disease. Based on the distinct clinicopathologic and molecular characteristics of Hürthle cell neoplasms (HCN), the 2017 Endocrine World Health Organization (WHO) moved to categorizing HCN as a … Diagn Cytopathol.
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