Hürthle cell carcinoma: diagnostic and therapeutic implications

Abstract

Background: Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. It may present as a low-grade tumour or as a more aggressive type. Prognosis depends upon the age of the patient, tumour size, extent of invasion and initial nodal or distant metastasis.

Patient and methods: The case of Hürthle cell carcinoma is reported in a 79-year-old man who presented with a rapidly increasing lump on the left side of his neck, having had a right hemithyroidectomy for colloid goitre 24-years-ago. Fine needle aspiration cytology confirmed the presence of Hürthle cells, raising the possibility of a Hürthle cell neoplasm. The patient underwent staging and surgery. Histology showed Hürthle cell carcinoma and the patient underwent adjuvant therapy. The literature on Hürthle cell neoplasms is reviewed.

Conclusions: Fine needle aspiration cytology may recognise Hürthle cell lesion but final diagnosis of carcinoma depends upon histological confirmation of vascular or capsular invasion. Staging and surgery in Hürthle cell carcinoma are similar to follicular carcinoma of thyroid with favourable outcome despite the controversy regarding the histological classification and adjuvant therapy. Elderly patients with Hürthle cell carcinoma need to be made aware of their poorer prognosis and should be offered more radical treatment.

Figure 1

Superior extension of left goitre with 3 cm diameter complex mass deep to sternomastoid, posterior to carotid sheath. Note the displacement of larynx to the right.

Figure 2

Mediastinal extension of left goitre.

Figure 3

Photomicrograph showing capsular invasion (Haematoxylin and Eosin ×200)

Figure 4

photomicrograph showing Hürthle cell note the eosinophilic cytoplasm and prominent nucleoli (Haematoxylin and Eosin ×500).

Figure 5

Whole body scan on November 3, 2003 following ¹³¹I ablation therapy on 28^th October 2003, with 3060 MBq Sodium Iodine (¹³¹I). Increased uptake is seen in the region of the thyroid bed. No abnormal accumulation was noted elsewhere.

Figure 6

Whole body scan on 19^th April 2004 following ¹³¹I ablation therapy on 13^th April 2004 with 5911 MBq Sodium Iodine (¹³¹I). Two small focal area of uptake are seen in the thyroid bed. Low uptake focal area in the left lateral aspect of the neck, could possibly represent activity in a cervical node.