Hurtle cell carcinoma of the thyroid

Are follicular carcinomas in which the cells have eosinophilic granular cytoplasm.

Presently known as oncocytic thyroid carcinoma.

Account for 20-40% of follicular carcinomas.

A genetically distinct thyroid cancer, with loss of one on of most chromosomes and duplication of chromosomes, 5 and seven.

Similar treatment and prognosis as follicular carcinomas of the thyroid.

Hürthle cell neoplasm is a rare tumor of the thyroid, typically seen in women between the ages of 70 and 80 years old. 

When benign, it is called a Hürthle cell adenoma, and when malignant it is called a Hürthle cell carcinoma. 

Hürthle cells are characterized as enlarged epithelial cells, when stained with hematoxylin-eosin show as pink. 

This is due to the abundant mitochondria and granular eosinophilic matter within the cells’ cytoplasm. 

These cells are often found in the thyroid. 

The thyroid is a butterfly-shaped organ, responsible for producing various hormones for metabolism. 

Hürthle cells are often benign, but they can be malignant and metastasize. 

Hürthle cells are resistant to radiation, but can be treated using radioactive iodine treatment.

This mass can be detected and removed before transformation and metastasis. 

Hürthle cell tumor is often detected by imaging such as ultrasound. 

Hürthle cell adenoma is the benign analogue of Hürthle cell carcinoma. 

This adenoma is extremely rare, and it usually occurs in women. 

Hürthle cell adenoma is harmless but is removed after detection because its future course is unknown.

Cytopathology cannot distinguish Hürthle cell adenoma from Hürthle cell carcinoma.

To distinguish the two requires histopathologic sections to see transcapsular or vascular invasion. 

Hürthle cell hyperplasia is seen in Hashimoto’s thyroiditis with moderate variation in nuclear sizes and prominent nucleoli, but further findings favoring Hürthle cell neoplasm include a large number of Hürthle cells, and discohesiveness.

There are three main treatments for Hürthle cell adenomas. 

Once the adenoma is detected most oftremoved to prevent the cells from later metastisizing.

A total thyroidectomy is often performed, this results in a complete removal of the thyroid. 

Pharmacological suppression of thyroid hormone is another treatment modality.

RAI ablation (radioactive iodine ablation), is an option to destroy thyroid cells after total thyroidectomy. 

Hürthle cells do not respond well to RAI, but this treatment to patients with Hürthle cell adenoma and Hürthle cell carcinoma because some Hürthle cells will respond and it will kill remaining tissue.

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