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Sulaiman S, Chirukandath R, Krishnan SK, Rajesh N, Antony M, Mohan K, S S. Unraveling the Enigma: A Five-Year Comprehensive Analysis of Hurthle Cell Tumors in South India's Tertiary Care Center. Cureus 2024; 16:e57166. [PMID: 38681349 PMCID: PMC11056025 DOI: 10.7759/cureus.57166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Hurthle cell tumors of the thyroid gland constitute a rare and enigmatic group of neoplasms, characterized by the presence of Hurthle cells exhibiting abundant eosinophilic cytoplasm and numerous mitochondria. Despite their low incidence, they pose diagnostic challenges and display diverse clinical outcomes. This study aims to provide a comprehensive analysis of the clinicopathological profile of Hurthle cell tumors within a tertiary care center in South India. METHODS Through a retrospective approach, we analyzed cases of Hurthle cell tumors diagnosed and treated at a tertiary care center over a five-year period. Clinical, radiological, and histopathological data were meticulously collected and scrutinized. The study focused on examining demographic details, presenting symptoms, imaging features, cytological findings, surgical management, and postoperative outcomes of the patients. RESULTS A total of 32 cases of Hurthle cell tumors were identified during the study period. The majority of patients were female (84%), with a mean age of 49.6 years for Hurthle cell carcinoma. Thyroid enlargement and neck mass were the most common presenting complaints. Fine-needle aspiration cytology showed characteristic features suggestive of Hurthle cell tumors in 33% of cases. Total thyroidectomy remains the mainstay surgical approach. Histopathological evaluation confirmed 62.5% of cases as benign adenomas and 37.5% as malignant carcinomas. Among malignant cases, 67% showed capsular invasion and 33% demonstrated vascular invasion. Of the patients, 33.3% received adjuvant radiotherapy. The overall survival rate was 100%. In our study, we found that thyroid nodules larger than 3 cm demonstrated a higher propensity for Hurthle cell carcinoma. CONCLUSION Our findings support the multidisciplinary approach in managing Hurthle cell tumors, with a focus on tailored treatment plans for each patient based on individual characteristics. By recognizing the female predominance, assessing nodule size, and employing a combination of thyroidectomy and ablative therapy, clinicians can optimize patient care and contribute to better long-term prognosis and quality of life for those affected by Hurthle cell tumors. Continued research and collaborative efforts are necessary to advance our understanding and refine treatment strategies, paving the way for improved outcomes and enhanced patient management in the future.
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Affiliation(s)
- Sumin Sulaiman
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | | | | | | | - Manoj Antony
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | - Keerthana Mohan
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | - Sowndarya S
- General Surgery, Government Medical College Thrissur, Thrissur, IND
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Pałyga I, Rumian M, Kosel A, Albrzykowski M, Krawczyk P, Kalwat A, Gąsior-Perczak D, Walczyk A, Kuchareczko A, Kopczyński J, Chrapek M, Góźdź S, Kowalska A. The Frequency of Differentiated Thyroid Cancer Recurrence in 2302 Patients With Excellent Response to Primary Therapy. J Clin Endocrinol Metab 2024; 109:e569-e578. [PMID: 37768152 DOI: 10.1210/clinem/dgad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/18/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT Discrepant data on the recurrence rate of differentiated thyroid cancer (DTC) are reported. OBJECTIVE To evaluate the frequency and risk factors of true recurrence in DTC patients with excellent responses (ExR) to initial therapy. METHODS A retrospective analysis of the 2302 consecutive DTC patients with ExR to primary therapy, treated during 24 years at single center. The percentage of recurrence and cumulative recurrence rate (CRR) were analyzed. Risk factors for recurrence for patients with papillary thyroid cancer (PTC) were investigated and methods for establishing a diagnosis of recurrence were evaluated. RESULTS Of DTC patients, 32 (1.4%) experienced recurrence. PTC patients with recurrence were more likely to have younger age (P = .0182), larger tumor size (P = .0013), lymph node metastases (P = .0013), incomplete resection (P = .0446), higher ATA risk (P = .0002), and had more frequently been treated with 131I (P = .0203). CRRs at 5, 10, 15, 20, and 24 years after surgery were 1.2%, 1.9%, 2.5%, 2.9%, and 2.9%, respectively. The CRRs according to histological type were highest for poorly differentiated thyroid cancer (PDTC), lower for oncocytic (OTC) and follicular thyroid cancer (FTC), and lowest for PTC. Most recurrences occurred within the first 5 years of observation. The most effective method for detecting local recurrence was ultrasonography with fine needle aspiration cytology, and for distant metastases, 18F-FDG PET. CONCLUSION True recurrence is rare in DTC patients. PTC patients with ExR to primary therapy and N0/Nx can be dismissed from oncological follow-up. Despite ExR to primary therapy, DTC patients with N1, and PDTC, OTC, FTC should remain under oncological follow-up.
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Affiliation(s)
- Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Maciej Rumian
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Alicja Kosel
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | | | - Paulina Krawczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Agata Kalwat
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Artur Kuchareczko
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Janusz Kopczyński
- Department of Pathology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Magdalena Chrapek
- Department of Mathematics, Faculty of Natural Sciences, Jan Kochanowski University, Kielce 25-406, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
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Shi Y, Zheng Y, Zhang H, Dong W, Zhang P. Dynamic estimates of survival in oncocytic cell carcinoma of the thyroid. Discov Oncol 2023; 14:217. [PMID: 38030805 PMCID: PMC10686925 DOI: 10.1007/s12672-023-00839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/26/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Little is known about death hazard and conditional survival of oncocytic cell carcinoma of the thyroid (OCC). METHODS Patients diagnosed with OCC between 2004 to 2019 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method was used to estimate the actuarial disease-specific survival (DSS). The annual hazard rate of death was depicted employing the hazard function. Based on the life-table method, the conditional DSS was calculated. RESULTS In terms of DSS rates, there were statistically significant differences among the different stages (P < 0.01). Annual hazard curves for mortality from OCC in the entire study participants demonstrated an overall decreasing tendency with two peaks at 3 and 10 years. In patients with distant disease, the death risk curve was the steepest and decreased quickly and evidently. Conditional DSS tended to increase over time in the entire study population. Patients with distant disease showed more significant alterations than those patients with local or regional disease. CONCLUSIONS Prognosis improved over time in patients with OCC. The largest increase in conditional DSS was observed in patients with distant disease. Conditional survival may provide more relevant prognostic information than conventional survival estimates and allow personalized follow-up and counseling.
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Affiliation(s)
- Yang Shi
- Department of Thyroid Surgery, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning, People's Republic of China
| | - Yuenan Zheng
- Department of Thyroid Surgery, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning, People's Republic of China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning, People's Republic of China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning, People's Republic of China.
| | - Ping Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, 155 Nanjing Bei Street, Shenyang, Liaoning, People's Republic of China.
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Yeap ZH, Arman S, Stenhouse G, Isa A. Synchronous Hürthle cell and medullary thyroid carcinomas. BMJ Case Rep 2022; 15:e248879. [PMID: 35641084 PMCID: PMC9157358 DOI: 10.1136/bcr-2022-248879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/03/2022] Open
Abstract
Hürthle cell carcinoma (HCC) and medullary thyroid carcinomas (MTC) are uncommon histological subtypes of thyroid cancers, each accounting for around 3% of all thyroid cancers. A septuagenarian woman with a history of multiple primary cancer diagnoses presented with a growing left-sided neck lump. A diagnostic left thyroid lobectomy was performed, and pathological examination found two separate malignant foci: one HCC and an MTC. The patient developed left-sided HCC nodal metastasis, and following several multidisciplinary team discussions, a right completion lobectomy with left lateral neck dissection was performed, revealing further intrathyroidal MTC and extranodal extension of HCC. We present this as the first reported case of a collision tumour of HCC and MTC, and review the available literature regarding collision tumours and their management.
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Affiliation(s)
| | - Sam Arman
- Otolaryngology, NHS Highland, Inverness, UK
| | | | - Aidah Isa
- Otolaryngology, NHS Highland, Inverness, UK
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Chiapponi C, Hartmann MJ, Schmidt M, Faust M, Bruns CJ, Schultheis AM, Alakus H. Hürthle Cell Carcinoma: Single Center Analysis and Considerations for Surgical Management Based on the Recent Literature. Front Endocrinol (Lausanne) 2022; 13:904986. [PMID: 35846317 PMCID: PMC9276955 DOI: 10.3389/fendo.2022.904986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hürthle cell carcinoma (HCC) of the thyroid is rare. There are contrasting data on its clinical behavior. The aim of this study was to describe clinic-pathological features and outcomes of HCC patients at our institution, in order to adapt our surgical management. METHODS We retrospectively studied 51 cases of HCC treated at the interdisciplinary endocrine center of the University Hospital of Cologne, Germany between 2005 and 2020. RESULTS Patients median age was 63 years (range 29-78) with 64.7% of cases being female. Primary treatment included surgery and postoperative radioiodine therapy with 3.7 GBq in all patients. Surgery consisted of total thyroidectomy in all cases and additional central lymphadenectomy in 90.2% of cases. The median number of harvested lymph nodes was 11 (range 2-31). Lymph node involvement was found in two (4.3%) pT4a tumors. In all other cases (95.7%), central lymphadenectomy was prophylactic and lymph nodes were free of metastasis in final histopathology. Twelve (23.5%) patients with incomplete biochemical response to primary treatment were diagnosed with structural relapse during the course of disease, for which seven (58.4%) underwent resection of isolated cervical metastasis. Histopathology revealed soft tissue implants in all cases and cervical surgery led to biochemical and radiologic cure in only two (28.5%) cases. Five (41.6%) patients developed metastatic disease, followed by systemic therapy in two patients. Vascular invasion of the primary tumor was significantly associated with relapse (p<0.01). CONCLUSIONS Recurrence of HCC was common in this study. Given the low rate of lymph node metastases both in this study and in recent literature and the nature of relapse (soft tissue instead of nodal metastasis), the benefit of routine prophylactic central lymph node dissection for HCC remains unclear, especially in the absence of vascular invasion from the primary tumor.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany
- *Correspondence: Costanza Chiapponi,
| | - Milan J.M. Hartmann
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Cologne and University Hospital Cologne, Cologne, Germany
| | - Michael Faust
- Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University Hospital Cologne, Cologne, Germany
| | - Christiane J. Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany
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He H, Xu T, Li P, Jia G, Li X, Song Q. Anti-PD-1 Immunotherapy Combined With Stereotactic Body Radiation Therapy and GM-CSF as Salvage Therapy in a PD-L1-Positive Patient With Refractory Metastatic Thyroid Hürthle Cell Carcinoma: A Case Report and Literature Review. Front Oncol 2021; 11:782646. [PMID: 34888252 PMCID: PMC8650693 DOI: 10.3389/fonc.2021.782646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/03/2021] [Indexed: 12/21/2022] Open
Abstract
Thyroid Hürthle cell carcinoma, known as thyroid eosinophilic carcinoma, is a rare pathological type of differentiated thyroid cancer (DTC), representing 3-4% of all thyroid cancers. However, given the high risk of invasion and metastasis, thyroid Hürthle cell carcinoma has a relatively poor prognosis. Traditional treatment methods have limited effects on patients with metastatic thyroid cancers. Developing a valuable therapy for advanced thyroid carcinomas is an unfilled need, and immunotherapy could represent another choice for these tumors. We herein reported the case of a patient with recurrent advanced thyroid Hürthle cell cancer and positive programmed death-ligand 1 (PD-L1) expression, who suffered tumor progression after re-surgery, radiotherapy, and targeted therapy. It is encouraging that PD-1 inhibitors in combination with GM-CSF and stereotactic body irradiation (SBRT) on metastatic disease have a significant anti-tumor effect.
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Affiliation(s)
- Haihua He
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tangpeng Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guohua Jia
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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Hürthle Cell Carcinoma of the Thyroid Gland: Systematic Review and Meta-analysis. Adv Ther 2021; 38:5144-5164. [PMID: 34423400 DOI: 10.1007/s12325-021-01876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hürthle cell carcinoma (HCC) comprises about 5% of thyroid carcinoma cases. Partly because of its rarity there is much we still need to know about HCC as compared to other histological cancer subtypes. METHODS We conducted a systematic literature review following PRISMA guidelines and meta-analysis, from 2000 to 2020, to investigate the main characteristics of HCC and clarify information concerning tumor behavior and treatment. RESULTS Our review included data from 9638 patients reported in 27 articles over the past 20 years. This tumor occurred more frequently in women (67.5%). The mean age was 57.6 years, and the mean size of the neoplasm at diagnosis was 30 mm. Extrathyroidal extension was common (24%) but lymph node metastasis was not (9%). Total thyroidectomy was the most common surgical approach, with neck dissection usually performed in cases with clinically apparent positive neck nodes. Radioiodine therapy was frequently applied (54%), although there is no consensus about its benefits. The mean 5- and 10-year overall survival was 91% and 76%, respectively. CONCLUSION This review serves to further elucidate the main characteristics of this malignancy. HCC of the thyroid is rare and most often presents with a relatively large nodule, whereas lymph node metastases are rare. Given the rarity of HCC, a consensus on their treatment is needed, as doubts remain concerning the role of specific tumor findings and their influence on management.
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Jin M, Kim ES, Kim BH, Kim HK, Kang YE, Jeon MJ, Kim TY, Kang HC, Kim WB, Shong YK, Kim M, Kim WG. Clinicopathological Characteristics and Disease-Free Survival in Patients with Hürthle Cell Carcinoma: A Multicenter Cohort Study in South Korea. Endocrinol Metab (Seoul) 2021; 36:1078-1085. [PMID: 34731935 PMCID: PMC8566133 DOI: 10.3803/enm.2021.1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hürthle cell carcinoma (HCC), a type of thyroid carcinoma, is rare in South Korea, and few studies have investigated its prognosis. METHODS This long-term multicenter retrospective cohort study evaluated the clinicopathological features and clinical outcomes in patients with HCC who underwent thyroid surgery between 1996 and 2009. RESULTS The mean age of the 97 patients included in the study was 50.3 years, and 26.8% were male. The mean size of the primary tumor was 3.2±1.8 cm, and three (3.1%) patients had distant metastasis at initial diagnosis. Ultrasonographic findings were available for 73 patients; the number of nodules with low-, intermediate-, and high suspicion was 28 (38.4%), 27 (37.0%), and 18 (24.7%), respectively, based on the Korean-Thyroid Imaging Reporting and Data System. Preoperatively, follicular neoplasm (FN) or suspicion for FN accounted for 65.2% of the cases according to the Bethesda category, and 13% had malignancy or suspicious for malignancy. During a median follow-up of 8.5 years, eight (8.2%) patients had persistent/recurrent disease, and none died of HCC. Older age, gross extrathyroidal extension (ETE), and widely invasive types of tumors were significantly associated with distant metastasis (all P<0.01). Gross ETE (hazard ratio [HR], 27.7; 95% confidence interval [CI], 2.2 to 346.4; P=0.01) and widely invasive classification (HR, 6.5; 95% CI, 1.1 to 39.4; P=0.04) were independent risk factors for poor disease-free survival (DFS). CONCLUSION The long-term prognosis of HCC is relatively favorable in South Korea from this study, although this is not a nation-wide data, and gross ETE and widely invasive cancer are significant prognostic factors for DFS. The diagnosis of HCC by ultrasonography and cytopathology remains challenging.
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Affiliation(s)
- Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Mijin Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeokro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7738, Fax: +82-51-254-3237, E-mail:
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding authors: Won Gu Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-5883, Fax: +82-2-3010-6962, E-mail:
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Correia M, Lima AR, Batista R, Máximo V, Sobrinho-Simões M. Inherited Thyroid Tumors With Oncocytic Change. Front Endocrinol (Lausanne) 2021; 12:691979. [PMID: 34177813 PMCID: PMC8220141 DOI: 10.3389/fendo.2021.691979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
Familial non-medullary thyroid carcinoma (FNMTC) corresponds to 5-10% of all follicular cell-derived carcinoma (FCDTC). Oncocytic thyroid tumors have an increased incidence in the familial context in comparison with sporadic FCDTC, encompassing benign and malignant tumors in the same family presenting with some extent of cell oxyphilia. This has triggered the interest of our and other groups to clarify the oncocytic change, looking for genetic markers that could explain the emergence of this phenotype in thyroid benign and malignant lesions, focusing on familial aggregation. Despite some advances regarding the identification of the gene associated with retinoic and interferon-induced mortality 19 (GRIM-19), as one of the key candidate genes affected in the "Tumor with Cell Oxyphilia" (TCO) locus, most of the mutations follow a pattern of "private mutations", almost exclusive to one family. Moreover, no causative genetic alterations were identified so far in most families. The incomplete penetrance of the disease, the diverse benign and malignant phenotypes in the affected familial members and the variable syndromic associations create an additional layer of complexity for studying the genetic alterations in oncocytic tumors. In the present review, we summarized the available evidence supporting genomic-based mechanisms for the oncocytic change, particularly in the context of FNMTC. We have also addressed the challenges and gaps in the aforementioned mechanisms, as well as molecular clues that can explain, at least partially, the phenotype of oncocytic tumors and the respective clinico-pathological behavior. Finally, we pointed to areas of further investigation in the field of oncocytic (F)NMTC with translational potential in terms of therapy.
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Affiliation(s)
- Marcelo Correia
- Cancer Signalling and Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Cancer Signalling and Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- *Correspondence: Marcelo Correia,
| | - Ana Rita Lima
- Cancer Signalling and Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Cancer Signalling and Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Rui Batista
- Cancer Signalling and Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Cancer Signalling and Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Valdemar Máximo
- Cancer Signalling and Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Cancer Signalling and Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Department of Pathology, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Manuel Sobrinho-Simões
- Cancer Signalling and Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Porto, Portugal
- Cancer Signalling and Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Department of Pathology, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Department of Pathology, Centro Hospitalar e Universitário São João (CHUSJ), Porto, Portugal
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Canberk S, Lima AR, Pinto M, Soares P, Máximo V. Epigenomics in Hurthle Cell Neoplasms: Filling in the Gaps Towards Clinical Application. Front Endocrinol (Lausanne) 2021; 12:674666. [PMID: 34108939 PMCID: PMC8181423 DOI: 10.3389/fendo.2021.674666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
It has been widely described that cancer genomes have frequent alterations to the epigenome, including epigenetic silencing of various tumor suppressor genes with functions in almost all cancer-relevant signalling pathways, such as apoptosis, cell proliferation, cell migration and DNA repair. Epigenetic alterations comprise DNA methylation, histone modification, and microRNAs dysregulated expression and they play a significant role in the differentiation and proliferation properties of TC. In this review, our group assessed the published evidence on the tumorigenic role of epigenomics in Hurthle cell neoplasms (HCN), highlighting the yet limited, heteregeneous and non-validated data preventing its current use in clinical practice, despite the well developed assessment techniques available. The identified evidence gaps call for a joint endeavour by the medical community towards a deeper and more systematic study of HCN, aiming at defining epigenetic markers in early diagnose, allowing for accurate stratification of maligancy and disease risk and for effective systemic treatment.
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Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Ana Rita Lima
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Mafalda Pinto
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
| | - Paula Soares
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Valdemar Máximo
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- *Correspondence: Valdemar Máximo,
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Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features. Cancers (Basel) 2020; 13:cancers13010026. [PMID: 33374707 PMCID: PMC7793513 DOI: 10.3390/cancers13010026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Hürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is characterized by its large, granular and eosinophilic cytoplasm, due to an excessive number of mitochondria. Hürthle cells can be identified only after fine needle aspiration cytology biopsy or by histological diagnosis after the surgical operation. Published studies on HCC indicate its putative high aggressiveness. In this article, current knowledge of HCC focusing on clinical features, cytopathological features, genetic changes, as well as pitfalls in diagnosis are reviewed in order to improve clinical management. Abstract Hürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is considered to be more aggressive than non-oncocytic thyroid carcinomas. However, due to its rarity, the pathological characteristics and biological behavior of HCC remain to be elucidated. The Hürthle cell is characterized cytologically as a large cell with abundant eosinophilic, granular cytoplasm, and a large hyperchromatic nucleus with a prominent nucleolus. Cytoplasmic granularity is due to the presence of numerous mitochondria. These mitochondria display packed stacking cristae and are arranged in the center. HCC is more often observed in females in their 50–60s. Preoperative diagnosis is challenging, but indicators of malignancy are male, older age, tumor size > 4 cm, a solid nodule with an irregular border, or the presence of psammoma calcifications according to ultrasound. Thyroid lobectomy alone is sufficient treatment for small, unifocal, intrathyroidal carcinomas, or clinically detectable cervical nodal metastases, but total thyroidectomy is recommended for tumors larger than 4 cm. The effectiveness of radioactive iodine is still debated. Molecular changes involve cellular signaling pathways and mitochondria-related DNA. Current knowledge of Hürthle cell carcinoma, including clinical, pathological, and molecular features, with the aim of improving clinical management, is reviewed.
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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; 44:469-478. [PMID: 31863140 DOI: 10.1007/s00268-019-05264-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compares survival in patients with the rare subtypes of follicular (FTmC) and Hurthle cell (HCmC) microcarcinoma compared to that of papillary thyroid (PTmC) microcarcinoma. METHODS Patients with FTmC and HCmC were selected from the National Cancer Database 2004-2015 and compared with PTmC. Patient clinicopathological characteristics and overall survival (OS) were analyzed. Multivariable logistic and Cox regression analysis evaluated binary outcomes and predictors of survival. A propensity score matched analysis using age, gender, race, extrathyroidal extension (ETE), nodal status, distant metastasis, radiation, and operation was performed to evaluate the difference in OS with FTmC, HCmC, and PTmC. RESULTS We identified 858 FTmC, 476 HCmC, and 82,056 PTmC. FTmC was less likely to have macroscopic ETE compared to PTmC (2.6% vs. 3.1% p = 0.03), but more likely to have distant metastasis (2.3% vs. 0.2%, p < 0.01). FTmC and HCmC were less likely to have nodal metastasis (2.7%, 2.5% vs. 10.9%, p < 0.01). Ten-year OS was decreased in patients with FTmC (91.4%, p = 0.04) and HCmC (89.8%, p < 0.01) compared to PTmC (93.5%). On multivariable analysis, histology was not associated with OS. With HCmC, older age (OR 1.13, p < 0.01) and male gender (OR 2.72, p = 0.03) were associated with decreased OS. In propensity matched analysis, there was no difference in 10-year OS with FTmC and PTmC (91.4% vs. 93.7%, p = 0.54), but HCmC had decreased OS compared to PTmC (89.8% vs. 94.3%, p = 0.04). CONCLUSIONS Patients with FTmC have comparable OS to those with PTmC, but HCmC has decreased OS especially in older and male patients.
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Affiliation(s)
- Amna M Khokar
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA.,Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Simon A Holoubek
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA
| | - Kristine M Kuchta
- Bioinformatics and Research Core, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA
| | - David J Winchester
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA.,Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Richard A Prinz
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA.,Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Tricia A Moo-Young
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL, 60201, USA. .,Department of Surgery, University of Chicago, Chicago, IL, USA.
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13
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Clinical impact of follicular oncocytic (Hürthle cell) carcinoma in comparison with corresponding classical follicular thyroid carcinoma. Eur J Nucl Med Mol Imaging 2020; 48:449-460. [PMID: 32683470 PMCID: PMC7835150 DOI: 10.1007/s00259-020-04952-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/05/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE There are controversial debates if patients with Hürthle cell carcinoma, also known as oxyphilic or oncocytic cell follicular thyroid carcinoma, have a poorer outcome. In this study, we systematically evaluated the clinical outcome in a large patient cohort following thyroidectomy and initial I-131 radioactive iodine therapy (RIT). METHODS We retrospectively evaluated a total of 378 patients with diagnosed oncocytic follicular Hürthle cell carcinoma (OFTC) (N = 126) or with classical follicular thyroid carcinoma (FTC) (N = 252). Patients received thyroidectomy and complementary I-131 RIT. Clinical data regarding basic demographic characteristics, tumor grade, persistent disease and recurrence during follow-up, and disease-free, disease-specific, and overall survival were collected during follow-up of 6.9 years (interquartile range 3.7; 11.7 years). Univariate and multivariate analyses were used to identify factors associated with disease-related and overall survival. RESULTS Before and after matching for risk factors, recurrence was significantly more frequently diagnosed in OFTC patients during follow-up (17% vs. 8%; p value 0.037). Likewise, OFTC patients presented with a reduced mean disease-free survival of 17.9 years (95% CI 16.0-19.8) vs. 20.1 years (95% CI 19.0-21.1) in FTC patients (p value 0.027). Multivariate analysis revealed OFTC (HR 0.502; 95% CI 0.309-0.816) as the only independent prognostic factor for disease-free survival. Distant metastases of OFTC patients were significantly less iodine-avid (p value 0.014). Mean disease-specific and overall survival did not differ significantly (p value 0.671 and 0.687) during follow-up of median 6.9 years (3.7; 11.7 years). CONCLUSIONS Our study suggests that recurrence is more often seen in OFTC patients. OFTC patients have a poorer prognosis for disease-free survival. Thus, OFTC and FTC behave differently and should be categorized separately. However, patients suffering from OFTC present with the same overall and disease-specific survival at the end of follow-up indifferent to FTC patients after initial RIT.
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14
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Yang Q, Zhao Z, Zhong G, Jin A, Yu K. Effect of adjuvant radioactive iodine therapy on survival in rare oxyphilic subtype of thyroid cancer (Hürthle cell carcinoma). PeerJ 2019; 7:e7458. [PMID: 31523497 PMCID: PMC6716497 DOI: 10.7717/peerj.7458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Radioactive iodine (RAI) is widely used for adjuvant therapy after thyroidectomy, while its value for thyroid cancer has been controversial recently. The primary objectives of this study were to clarify the influence of Radioactive iodine (RAI) on the survival in rare oxyphilic subtype of thyroid cancer (Hürthle cell carcinoma, HCC). Methods Patients diagnosed with oxyphilic thyroid carcinoma from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results Program database. The Kaplan-Meier method was used to compare overall survival (OS) and cancer-specific survival (CSS) among patients who had adjuvant RAI use or not. Univariate and multivariate Cox proportional hazard models were performed for survival analysis, and subsequently visualized by nomogram. Results In all, 2,799 patients were identified, of which 1529 patients had adjuvant RAI use while 1,270 patients had not. Based on multivariate Cox analysis, the RAI therapy confers an improved OS for HCC patients (HR = 0.57, 95% CI [0.44–0.72], P < 0.001), whereas it has no significant benefit in the survival analysis regarding CSS (HR = 0.79, 95% CI [[0.47–1.34], P = 0.382). In a subgroup analysis, the same survival benefit of RAI treatment on OS, but not CSS was observed among patients stratified by AJCC stage and tumor extension. Nevertheless, patients with regional lymph node metastasis benefited from RAI therapy both in OS and CSS (P < 0.001, respectively). Furthermore, nomograms used for predicting long term survival of HCC patients exhibited a better prediction power for OS compared with traditional tumor, nodal and metastatic (TNM) stage made by American Joint Committee on Cancer (AJCC) (C-index = 0.833 of the nomogram model vs. 0.696 of the AJCC system). Conclusions This study suggests that RAI therapy is significantly associated with improved OS in patients with Hürthle cell carcinoma. However, there was no association between treatment with radioiodine and CSS, possibly due to small number of deaths that were related to HCC.
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Affiliation(s)
- Qiong Yang
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, P.R.China
| | - Zhongsheng Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, P.R.China
| | - Guansheng Zhong
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, P.R.China
| | - Aixiang Jin
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, P.R.China
| | - Kun Yu
- Department of Head, Neck & Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, P.R.China
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15
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Aydemirli MD, Corver W, Beuk R, Roepman P, Solleveld-Westerink N, van Wezel T, Kapiteijn E, Morreau H. Targeted Treatment Options of Recurrent Radioactive Iodine Refractory Hürthle Cell Cancer. Cancers (Basel) 2019; 11:E1185. [PMID: 31443247 PMCID: PMC6721552 DOI: 10.3390/cancers11081185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 01/29/2023] Open
Abstract
Objective: To evaluate the efficacy and treatment rationale of Hürthle cell carcinoma (HCC) following a patient with progressive and metastatic HCC. HCC was recently shown to harbor a distinct genetic make-up and the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kiase (PI3K)/AKT signaling pathways are potential targets for anti-cancer agents in the management of recurrent HCC. The presence or absence of gene variants can give a rationale for targeted therapies that could be made available in the context of drug repurposing trials. Methods: Treatment included everolimus, sorafenib, nintedanib, lenvatinib, and panitumumab. Whole genome sequencing (WGS) of metastatic tumor material obtained before administration of the last drug, was performed. We subsequently evaluated the rationale and efficacy of panitumumab in thyroid cancer and control cell lines after epidermal growth factor (EGF) stimulation and treatment with panitumumab using immunofluorescent Western blot analysis. EGF receptor (EGFR) quantification was performed using flow cytometry. Results: WGS revealed a near-homozygous genome (NHG) and a somatic homozygous TSC1 variant, that was absent in the primary tumor. In the absence of RAS variants, panitumumab showed no real-life efficacy. This might be explained by high constitutive AKT signaling in the two thyroid cancer cell lines with NHG, with panitumumab only being a potent inhibitor of pEGFR in all cancer cell lines tested. Conclusions: In progressive HCC, several treatment options outside or inside clinical trials are available. WGS of metastatic tumors might direct the timing of therapy. Unlike other cancers, the absence of RAS variants seems to provide insufficient justification of single-agent panitumumab administration in HCC cases harboring a near-homozygous genome.
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Affiliation(s)
- Mehtap Derya Aydemirli
- Department of Medical Oncolosgy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Willem Corver
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ruben Beuk
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul Roepman
- Hartwig Medical Foundation, 1098 XH Amsterdam, The Netherlands
| | | | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncolosgy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
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16
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Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy. Eur J Nucl Med Mol Imaging 2019; 46:2526-2535. [PMID: 31410542 DOI: 10.1007/s00259-019-04456-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Oncocytic (Hürthle cell) papillary thyroid carcinoma (OPTC) is a rare variant of the papillary thyroid carcinoma (PTC) which comprises approximately 1 to 11 % of PTC cases. Its clinical course and prognosis have not been comprehensively documented and the clinical outcome remains a controversial issue. Therefore, we investigated the long-term prognosis after thyroidectomy and (adjuvant) initial radioactive iodine therapy (RIT) of OPTC compared to PTC. METHODS A total of 563 patients (47 with OPTC and 516 with PTC) with a median follow-up of 9.9 (0.3; 23.5) years were studied. All patients underwent thyroidectomy followed by (adjuvant) initial RIT. Data on the patients' demographics, pathology, laboratory findings, imaging studies, treatment, and follow-up including recurrence, and disease-specific survival were collected. Cox's multivariate regression model was used to identify independent prognostic factors for survival. RESULTS OPTC patients were significantly older (55.2 ± 12.3 years) than PTC patients (50.3 ± 13.5) at the time of initial diagnosis (p value 0.016). Initial tumor size was larger in the OPTC group (2.8 ± 1.8 cm for OPTC patients, 1.5 ± 1.2 cm for PTC patients, p value < 0.001). Before matching, OPTC patients presented more often with evidence of disease at the last visit of follow-up (p value 0.046). However, this difference was not observed anymore after matching for risk factors (p value 0.637). Disease-specific survival did not differ significantly. Age (HR, 1.183; 95% CI, 1.097-1.276) was identified as an independent prognostic factor for disease-specific survival. OPTC patients predominantly showed a recurrence of distant metastasis within a shorter time despite being not statistically significant. CONCLUSION At initial diagnosis, OPTC shows significant differences in terms of age and initial tumor size compared to PTC. Patients suffering from OPTC present with the same clinical long-term outcome indifferent to PTC after (adjuvant) initial RIT after matching.
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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18
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Ernaga Lorea A, Migueliz Bermejo I, Anda Apiñániz E, Pineda Arribas J, Toni García M, Martínez de Esteban JP, Insausti Serrano AM. Comparison of clinical characteristics of patients with follicular thyroid carcinoma and Hürthle cell carcinoma. ACTA ACUST UNITED AC 2018; 65:136-142. [PMID: 29433918 DOI: 10.1016/j.endinu.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/28/2017] [Accepted: 12/01/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hürthle cell carcinoma (HCC) is an uncommon thyroid cancer historically considered to be a variant of follicular thyroid carcinoma (FTC). The aim of this study was to assess the differences between these groups in terms of clinical factors and prognoses. PATIENTS AND METHODS A total of 230 patients (153 with FTC and 77 with HCC) with a median follow-up of 13.4 years were studied. The different characteristics were compared using SPSS version 20 statistical software. RESULTS Patients with HCC were older (57.3±13.8 years vs. 44.6±15.2 years; P<.001). More advanced TNM stages were also seen in patients with HCC and a greater trend to distant metastases were also seen in patients with HCC (7.8% vs. 2.7%, P=.078). The persistence/recurrence rate at the end of follow-up was higher in patients with HCC (13% vs. 3.9%, P=.011). However, in a multivariate analysis, only age (hazard ratio [HR] 1.10, confidence interval [CI] 1.04-1.17; P=.001), size (HR 1.43, CI 1.05-1.94; P=.021), and histological subtype (HR 9.79, CI 2.35-40.81; P=.002), but not presence of HCC, were significantly associated to prognosis. CONCLUSION HCC is diagnosed in older patients and in more advanced stages as compared to FTC. However, when age, size, and histological subtype are similar, disease-free survival is also similar in both groups.
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Affiliation(s)
- Ander Ernaga Lorea
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - Iranzu Migueliz Bermejo
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Emma Anda Apiñániz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Javier Pineda Arribas
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Marta Toni García
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Zavitsanos P, Amdur RJ, Drew PA, Cusi K, Werning JW, Morris CG. Favorable Outcome of Hurthle Cell Carcinoma of the Thyroid Treated With Total Thyroidectomy, Radioiodine, and Selective Use of External-Beam Radiotherapy. Am J Clin Oncol 2017; 40:433-437. [DOI: 10.1097/coc.0000000000000180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Differential Expression of Glycolysis-Related Proteins in Follicular Neoplasms versus Hürthle Cell Neoplasms: A Retrospective Analysis. DISEASE MARKERS 2017; 2017:6230294. [PMID: 28790533 PMCID: PMC5534281 DOI: 10.1155/2017/6230294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/15/2017] [Indexed: 01/08/2023]
Abstract
Purpose Although currently classified as variants of follicular neoplasms (FNs), Hürthle cell neoplasms (HCNs) exhibit distinct biological characteristics. Hence, the metabolism of both neoplasms may also be different. The aims of this study were to investigate and compare the expression of glycolysis-related proteins in HCNs and FNs and to determine the clinical implications of such expression. Methods Tissue microarrays were constructed with 265 samples of FNs (112 follicular carcinomas (FCs) and 153 follicular adenomas (FAs)) as well as 108 samples of HCNs (27 Hürthle cell carcinomas (HCCs) and 81 Hürthle cell adenomas (HCAs)). Immunohistochemical staining for the glycolysis-related molecules Glut-1, hexokinase II, CAIX, and MCT4 was performed. Results The expression levels of Glut-1, hexokinase II, CAIX, and MCT4 were significantly higher in HCNs than in FNs (p < 0.001). Glut-1, hexokinase II, CAIX, and MCT4 expression levels were highest in HCC, followed by HCA, FC, and FA (all p < 0.001). In HCC, hexokinase II positivity was associated with large tumor size (>4 cm) (p = 0.046), CAIX positivity with vascular invasion (p = 0.005), and MCT4 positivity with extrathyroidal extension (p = 0.030). Conclusion The expression levels of the glycolysis-related proteins Glut-1, hexokinase II, CAIX, and MCT4 were higher in HCNs than in FNs and in HCCs than in HCAs.
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Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, Garabinovic Z, Slijepcevic N, Rovcanin B, Micic D, Filipovic A, Zivaljevic V. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer 2017; 17:371. [PMID: 28545571 PMCID: PMC5445517 DOI: 10.1186/s12885-017-3370-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hurthle cell carcinoma makes up 3 to 5% of all thyroid cancers and is considered to be a true rarity. The aim of our study was to analyze clinical characteristics and survival rates of patients with Hurthle cell carcinoma. METHODS Clinical data regarding basic demographic characteristics, tumor grade, type of surgical treatment and vital status were collected. Methods of descriptive statistics and Kaplan-Meier survival curves were used for statistical analysis. Cox proportional hazards regression was used to identify independent predictors. RESULTS During the period from 1995 to 2014, 239 patients with Hurthle cell carcinoma were treated at our Institution. The average age of the patients was 54.3, with female to male ratio of 3.6:1 and average tumor size was 41.8 mm. The overall recurrence rate was 12.1%, with average time for relapse of 90.74 months and average time without any signs of the disease of 222.4 months. Overall 5-year, 10-year and 20-year survival rates were 89.4%, 77.2%, 61.9% respectively. The 5-year, 10-year and 20-year cancer specific survival rates were 94.6%, 92.5%, 87.4%, respectively. When disease free interval was observed, 5-year, 10-year and 20-year rates were 91.1%, 86.2%, 68.5%, respectively. The affection of both thyroid lobes and the need for reoperation due to local relapse were unfavorable independent prognostic factors, while total thyroidectomy as primary procedure was favorable predictive factor for cancer specific survival. CONCLUSION Hurthle cell carcinoma is a rare tumor with an encouraging prognosis and after adequate surgical treatment recurrences are rare.
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Affiliation(s)
- Branisav Oluic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Zlatibor Loncar
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Vladimir Djukic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Aleksandar Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
| | - Milan Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Zeljko Garabinovic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nikola Slijepcevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Dusan Micic
- Emergency Center, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Aleksandar Filipovic
- Clinical Center of Montenegro, Department of Endocrine Surgery, University of Montenegro, Podgorica, Montenegro
| | - Vladan Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia
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Vogrin A, Besic H, Besic N, Music MM. Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms. Radiol Oncol 2016; 50:269-73. [PMID: 27679542 PMCID: PMC5024656 DOI: 10.1515/raon-2016-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/07/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm. PATIENTS AND METHODS Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma. RESULTS Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm. CONCLUSIONS Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.
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Affiliation(s)
- Andrej Vogrin
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Hana Besic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Nikola Besic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Marolt Music
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Besic N, Schwarzbartl-Pevec A, Vidergar-Kralj B, Crnic T, Gazic B, Marolt Music M. Treatment and outcome of 32 patients with distant metastases of Hürthle cell thyroid carcinoma: a single-institution experience. BMC Cancer 2016; 16:162. [PMID: 26921186 PMCID: PMC4768323 DOI: 10.1186/s12885-016-2179-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 02/15/2016] [Indexed: 12/03/2022] Open
Abstract
Background It is generally believed that patients with Hürthle cell thyroid carcinoma (HCTC) have a poor prognosis. Furthermore, distant metastases represent the most frequent cause of thyroid cancer-related death of patients with HCTC. The aim of this study was to report the treatment and outcomes of patients with distant metastases. Methods Altogether 108 patients were treated for HCTC from 1972 to 2011 in our tertiary center and 32 patients (19 females, 13 males; median age 64.5 years) had either initially proven metastatic disease (N = 12) or distant progression of HCTC after initial treatment (N = 20). Patients with metastases were followed for 1–226 (median 77) months. Data were collected on the patients’ gender and age, extent of their disease, morphologic characteristics, therapy, outcome, and survival rate. Statistical correlation between possible prognostic factors and cause-specific survival from time of detection of metastases was analyzed by univariate analysis and log-rank test. Results The most common were lung metastases, followed by bone, mediastinum, kidney, and liver in 24, 8, 2, 1, and 1 case, respectively. Total thyroidectomy, lobectomy, subtotal thyroidectomy and neck dissection were performed in 19, 10, 3, and 7 patients, respectively. Radioiodine (RAI) ablation of thyroid remnant was performed in 30 patients, while 20 of them had RAI therapy (median 4 times). RAI uptake in metastases was present in 16 patients and ranged from 0.05 % to 12 %. Chemotherapy was used in 13 patients and external beam radiotherapy in 19 patients. Locoregional control of disease was achieved in 19/21 (90 %) cases who succumbed due to HCTC. Estimated 10-year disease-specific survival for all patients was 60 %. 10-year disease-specific survival for patients with pulmonary metastases and other sites metastases was 60 % and 62 %, respectively. 10-year disease-specific survival for patients with single organ and multiple organ metastases was 52 %, and 100 %, respectively. Estimated median disease-specific survival after the diagnosis of metastatic disease for all patients was 77 months. The median disease-specific survival after the diagnosis of metastatic disease for patients with pulmonary metastases and other sites metastases was 72 and 138 months, respectively. Conclusions Ten-year disease-specific survival for all patients with metastatic Hürthle cell thyroid carcinoma, patients with pulmonary metastases and bone metastases was 60 %, 60 % and 68 %, respectively.
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Affiliation(s)
- Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia.
| | | | - Barbara Vidergar-Kralj
- Department of Nuclear Medicine, Institute of Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia.
| | - Tea Crnic
- Department of Nuclear Medicine, Institute of Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia.
| | - Barbara Gazic
- Department of Pathology, Institute of Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia.
| | - Maja Marolt Music
- Department of Radiology, Institute of Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia.
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Shawky M, Sakr M. Hurthle Cell Lesion: Controversies, Challenges, and Debates. Indian J Surg 2016; 78:41-8. [PMID: 27186039 PMCID: PMC4848220 DOI: 10.1007/s12262-015-1381-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
Abstract
Hurthle cell lesion is one of the most questionable clinico-pathological entities in most of its aspects. Literature has used the terms oncocytic, oxyphilic, Hurthle, and Ashkanazy interchangeably; what does each term denote? Who first described these cells? What is the cell of origin? How much Hurthle cells should be present to define the lesion as Hurthle cell one? Is it possible to differentiate hyperplastic from neoplastic and benign from malignant Hurthle cell lesion on a non-histopathologic ground? Does it belong to follicular or to papillary neoplasms or should it be classified separately? Can we anticipate its clinical behavior or predict its outcome? How can we manage? We will try to answer these questions in light of the ongoing relevant arguments with the aim of resolving some uncertainties and suggesting how to solve others.
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Affiliation(s)
- Michael Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
| | - Mahmoud Sakr
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
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Donatini G, Beaulieu A, Castagnet M, Kraimps JL, Levillain P, Fromont G. Thyroid Hürthle cell tumors: research of potential markers of malignancy. J Endocrinol Invest 2016; 39:153-8. [PMID: 26188382 DOI: 10.1007/s40618-015-0356-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hurthle cell tumors (HCTs) are rare thyroid neoplasia. To date, capsular and/or vascular invasion are the only findings predicting malignancy. Recently, mutation of 19p13, encoding two proteins involved in cell proliferation and apoptosis (GRIM-19 and p19), has been described. The aim of our study is to evaluate the cellular proliferation index (Ki67), GRIM-19 and p19 expression as diagnostic markers of malignancy in HCT. MATERIALS AND METHODS Eighty patients with HCT (32 carcinomas, 48 adenomas) whom underwent surgery in our center were included. Samples of both neoplastic lesions and adjacent normal thyroid tissue were analyzed by means of tissue micro-arrays. Correlations between expressions of Ki67, GRIM-19 and p19 and final histology were analyzed. RESULTS Mean size of the lesion was higher in carcinomas than in adenomas (p = 0.01). GRIM-19 and p19 were significantly underexpressed in Hurthle cells tumors compared to normal tissue (p = 0.0004 and p = 0.0001, respectively). Ki67 and GRIM-19 were, respectively, higher and down-expressed in carcinomas compared to adenomas (p = 0.0004 and p = 0.005, respectively). On multivariate analysis, size correlates with carcinoma diagnosis. Neither GRIM-19 nor Ki67 index was related to size. The expression of p19 was reduced in both adenoma and carcinoma but differences were not statistically significant (p = 0.13). CONCLUSIONS Our study suggest that Ki67 and GRIM-19 correlate with malignancy in HCT. The expression of p19 is down-regulated in HCT, but it is not diagnostic of carcinoma. Ki67 and GRIM-19 may potentially help as cytological markers of malignancy in HCT.
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Affiliation(s)
- G Donatini
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France.
| | - A Beaulieu
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
| | - M Castagnet
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
| | - J-L Kraimps
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
| | - P Levillain
- Department of Pathology, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
| | - G Fromont
- Department of Pathology, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
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Truran P, Harrison B. Central neck dissection in the treatment of well-differentiated thyroid cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Therapeutic central compartment neck dissection (CCND) is required for confirmed nodal metastasis in patients with differentiated thyroid cancer. The need for routine prophylactic CCND in patients with papillary thyroid cancer is controversial. This article presents the current evidence to inform the debate against the background of the recommendations of US and British thyroid cancer guidelines. Potential advantages of pCCND include reduced local recurrence, preventing the need for further central compartment surgery and improved staging. Opponents claim that there is no proven patient benefit and that there is increased risk of recurrent laryngeal nerve injury and hypocalcemia.
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Affiliation(s)
- Peter Truran
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, South Yorkshire S10 2JF, UK
| | - Barney Harrison
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, South Yorkshire S10 2JF, UK
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Chindris AM, Casler JD, Bernet VJ, Rivera M, Thomas C, Kachergus JM, Necela BM, Hay ID, Westphal SA, Grant CS, Thompson GB, Schlinkert RT, Thompson EA, Smallridge RC. Clinical and molecular features of Hürthle cell carcinoma of the thyroid. J Clin Endocrinol Metab 2015; 100:55-62. [PMID: 25259908 DOI: 10.1210/jc.2014-1634] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
CONTEXT Hürthle cell cancer (HCC) of the thyroid remains the subject of controversy with respect to natural course, treatment, and follow-up. OBJECTIVE The objective of the study was to evaluate the clinical and molecular features associated with outcome in HCC. DESIGN The study was a review of 173 HCC cases treated at Mayo Clinic over 11 years with a median 5.8-year follow-up. RESULTS None of the patients with minimally invasive histology had persistent disease, clinical recurrence, or disease-related death. Male gender and TNM stage were independently associated with increased risk of clinical recurrence or death in widely invasive patients. The 5-year cumulative probability of clinical recurrence or death was higher in patients with TNM stage III-IV (females, 74%; males, 91%) compared with patients with TNM stage I-II (females, 0%; males, 17%). Pulmonary metastases were best identified by computed tomography, whereas radioactive iodine scans were positive in only two of 27 cases. Thyroglobulin was detectable in patients with clinical disease, with the notable exception of five patients with distant metastases. The common TERT C228T promoter mutation was detected in both widely invasive and minimally invasive tumors. TERT mRNA was below the limit of detection in all samples. CONCLUSION Widely invasive HCC with TNM stage III-IV is aggressive, with low probability of recurrence-free survival. Males have worse outcomes than females. Minimally invasive HCC appears to be considerably less aggressive. Radioactive iodine scan performs poorly in detecting distant disease. Although the TERT gene is mutated in HCC, the role of this mutation remains to be demonstrated.
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Affiliation(s)
- Ana-Maria Chindris
- Department of Otorhinolaryngology (A.-M.C., J.D.C.) and Division of Endocrinology and Metabolism (V.J.B., R.C.S.), Mayo Clinic, Jacksonville, Florida 32224; Department of Anatomic Pathology (M.R.), Mayo Clinic, Rochester, Minnesota 55905; Departments of Health Sciences Research (C.T.) and Cancer Biology (J.M.K., B.M.N., E.A.T.), Mayo Clinic, Jacksonville, Florida 32224; Division of Endocrinology and Metabolism (I.D.H.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology and Metabolism (S.A.W.), Mayo Clinic, Scottsdale, Arizona 85259; Department of Surgery (C.S.G., G.B.T.), Mayo Clinic, Rochester, Minnesota 55905; and Department of Surgery (R.T.S.), Mayo Clinic, Scottsdale, Arizona 85259
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Petric R, Gazic B, Besic N. Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience. BMC Cancer 2014; 14:777. [PMID: 25338674 PMCID: PMC4213470 DOI: 10.1186/1471-2407-14-777] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hürthle cell thyroid carcinoma (HCTC) is a rare disease. It is believed that it is more aggressive than follicular thyroid carcinoma. The aim of our study was to identify factors associated with disease-specific and disease-free survival. METHODS Altogether, 108 patients with HCTC (26 male, 82 female; median age 62 years; range 19-87 years) treated at our Institute from 1972 to 2011 were included in the present retrospective study. Data on age, clinical and histopathological factors, tumor stage, recurrence, disease-free and disease-specific survival were collected. Univariate analysis was used to identify factors associated with disease-specific survival. Cox's multivariate regression model was used to identify independent prognostic factors for disease-specific survival. RESULTS The follow-up period was 1 to 337 (median 105) months. Of 108 patients, 12 (11%) had distant and 8 (7%) had locoregional metastases before primary treatment. Recurrence was diagnosed in 26 cases (24%): locoregional, distant, and both locoregional and distant in 12, 11, and 3 cases, respectively. The 5-year, 10-year, and 20-year disease-specific survival were 96%, 88%, and 67%, respectively. Independent prognostic factors for disease-specific survival were: age of patients at diagnosis, distant metastases and residual tumor after surgery. CONCLUSION Long disease-specific survival was found in patients with HCTC younger than 45 years of age without distant metastases and without residual tumor after surgery.
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Affiliation(s)
| | | | - Nikola Besic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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Samulski TD, Bai S, LiVolsi VA, Montone K, Baloch Z. Malignant potential of small oncocytic follicular carcinoma/Hürthle cell carcinoma: an institutional experience. Histopathology 2013; 63:568-73. [DOI: 10.1111/his.12206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Shuting Bai
- Department of Pathology; New York University; New York; NY; USA
| | - Virginia A LiVolsi
- Department of Pathology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - Kathleen Montone
- Department of Pathology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - Zubair Baloch
- Department of Pathology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
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Sugino K, Kameyama K, Ito K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, Uruno T, Akaishi J, Suzuki A, Masaki C, Ito K. Does Hürthle cell carcinoma of the thyroid have a poorer prognosis than ordinary follicular thyroid carcinoma? Ann Surg Oncol 2013; 20:2944-50. [PMID: 23616135 DOI: 10.1245/s10434-013-2965-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hürthle cell carcinoma (HCC) is a rare form of thyroid carcinoma and is considered an oxyphilic variant of follicular thyroid carcinoma. However, little is known about its biological characteristics or clinical behavior. We conducted a retrospective study to determine whether the prognosis of HCC differs from that of ordinary follicular thyroid carcinoma (OFC). METHODS The subjects were the 558 patients with follicular thyroid carcinoma who underwent initial surgery at our institution between 1989 and 2010 and consisted of 73 patients with HCC and 485 patients with OFC. There were 410 females and 148 males, and their median age was 51 years. A univariate analysis was conducted in relation to cumulative cause-specific survival (CSS) according to the Kaplan-Meier method for the following variables: age at the time of initial surgery, gender, tumor size, invasiveness, distant metastasis at presentation, and histological type (HCC vs OFC). Differences between groups were analyzed for significance by the log-rank test. Multivariate analysis was performed by using the Cox proportional hazard model. RESULTS A total of 4 patients (5.5%) in the HCC group had distant metastasis compared with 106 patients (21.9%) in the OFC group. Significant factors in relation to CSS in the univariate analyses were age, tumor size, and invasiveness, but there were no significant differences between the HCC group and the OFC group. Multivariate analysis showed that age, tumor size, and distant metastasis at presentation were significant factors. CONCLUSIONS HCC does not have a poorer prognosis than OFC.
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Indications of external beam radiation therapy in non-anaplastic thyroid cancer and impact of innovative radiation techniques. Crit Rev Oncol Hematol 2013; 86:52-68. [DOI: 10.1016/j.critrevonc.2012.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/13/2012] [Accepted: 09/25/2012] [Indexed: 11/23/2022] Open
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Goffredo P, Roman SA, Sosa JA. Hurthle cell carcinoma: a population-level analysis of 3311 patients. Cancer 2012; 119:504-11. [PMID: 22893587 DOI: 10.1002/cncr.27770] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hurthle cell carcinoma (HCC) is an uncommon and more aggressive thyroid cancer. To date, there is a paucity of data at a population level. In this study, demographic, clinical, and pathologic characteristics of HCC were investigated and compared with other types of differentiated thyroid cancers (ODTCs). The authors also evaluated disease-specific survival and compliance with American Thyroid Association (ATA) management guidelines from 2009. METHODS The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer. Data analyses were performed using chi-square tests, analysis of variance, Kaplan-Meier analysis, binary logistic regression, and Cox proportional hazards regression. RESULTS In total, 3311 patients with HCC and 59,585 patients with ODTC were identified. Compared with ODTC, HCC was more common among men (31.1% vs 23.0% for ODTC; P < .001) and among older patients (mean age, 57.6 years vs 48.9 years for ODTC; P < .001). Patients with HCC presented with higher SEER disease stage (P < .001), and their tumors were larger (36.1 mm vs 20.2 mm for ODTC; P < .001). Fewer patients underwent total thyroidectomy (P = .028). Both overall and disease-specific survival were lower for patients with HCC (P < .001), and neither improved over the last 2 decades (P = .689). After adjustment, age ≥45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio >3.0). Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged ≥65 years (odds ratio [OR], 1.43; P = .002) and among unmarried patients (OR, 1.29; P = .004). Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age ≥65 years (OR, 1.31; P = .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively; P < .001). CONCLUSIONS HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines.
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Stack BC, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012; 22:501-8. [PMID: 22435914 DOI: 10.1089/thy.2011.0312] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. METHODS A literature review followed by formulation of a consensus statement was performed. RESULTS Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient. CONCLUSIONS Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA.
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Kutun S, Turanli S, Kavlakoglu B, Cetin A. The predicting factors for clinical outcomes in patients with Hürthle cell carcinoma: how we do it. Clin Otolaryngol 2011; 36:73-7. [DOI: 10.1111/j.1749-4486.2011.02212.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cerutti JM, Oler G, Delcelo R, Gerardt R, Michaluart P, de Souza SJ, Galante PAF, Huang P, Riggins GJ. PVALB, a new Hürthle adenoma diagnostic marker identified through gene expression. J Clin Endocrinol Metab 2011; 96:E151-60. [PMID: 20926528 PMCID: PMC3038489 DOI: 10.1210/jc.2010-1318] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A better means to accurately identify malignant thyroid nodules and to distinguish them from benign tumors is needed. We previously identified markers for detecting thyroid malignancy, with sensitivity estimated at or close to 100%. One lingering problem with these markers was that false positives occurred with Hürthle cell adenomas (HCA) which lowered test specificity. METHODS To locate accurate diagnostic markers, we profiled in depth the transcripts of a HCA and a Hürthle cell carcinoma (HCC). From 1146 differentially expressed genes, 18 transcripts specifically expressed in HCA were tested by quantitative PCR in a wide range of thyroid tumors (n = 76). Sensibility and specificity were calculated using receiver operating characteristic (ROC). Selected markers were further validated in an independent set of thyroid tumors (n = 82) by immunohistochemistry. To define the panel that would yield best diagnostic accuracy, these markers were tested in combination with our previous identified markers. RESULTS Seventeen of the 18 genes showed statistical significance based on a mean relative level of expression (P < 0.05). KLK1 (sensitivity = 0.97) and PVALB (sensitivity = 0.94) were the best candidate markers. The combination of PVALB and C1orf24 increased specificity to >97% and maintained sensitivity for detection of carcinoma. CONCLUSION We identified tumor markers that can be used in combination for a more accurate preoperative diagnosis of thyroid nodules and for postoperative diagnosis of thyroid carcinoma in tumor sections. This improved test would help physicians rapidly focus treatment on true malignancies and avoid unnecessary treatment of benign tumors, simultaneously improving medical care and reducing costs.
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Affiliation(s)
- Janete M Cerutti
- Genetic Bases of Thyroid Tumor Laboratory, Federal University of São Paulo, São Paulo, SP, Brazil.
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Guerrero MA, Suh I, Vriens MR, Shen WT, Gosnell J, Kebebew E, Duh QY, Clark OH. Age and tumor size predicts lymph node involvement in Hürthle Cell Carcinoma. J Cancer 2010; 1:23-6. [PMID: 20842220 PMCID: PMC2931345 DOI: 10.7150/jca.1.23] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hürthle cell carcinoma (HCC) is a rare tumor that tends to metastasize to the lymph nodes. Some studies have correlated size of Hürthle cell tumors with the risk of malignancy. Whether the size of HCC correlates with the risk of lymph node (LN) metastases, to our knowledge has not been addressed. Methods: A retrospective analysis was performed on all patients diagnosed with HCC on final pathology between 1997 and 2008. The tumor size and lymph node status was obtained for each patient. The data were analyzed utilizing Student's t-test and the Fisher's exact test to calculate the two-tailed p-value. Results: Out of 39 patients diagnosed with HCC 3(8%) had LN metastases; 1 had ipsilateral central LN metastasis and 2 had ipsilateral central and lateral LN metastasis. LN dissection was performed in patients with known metastasis (2 were evident on preoperative ultrasound and 1 intraoperatively). Patients with LN metastasis were older than those without (mean age: 86.7 and 56.4 years, respectively), had larger tumors (mean size: 6 and 4 cm) and were commonly male (2 of 3). No tumor < 5cm presented with lymph node involvement (3/15 with >5cm cancer had node metastasis, 0/24 with <5cm cancer had node metastasis). Conclusions: Similar to what has been found in patients with papillary thyroid cancer, older male patients with Hürthle cell carcinomas greater than 5cm are more likely to have lymph node metastasis. Our data suggest that these patients may benefit from a prophylactic ipsilateral central neck dissection at the time of their initial operation.
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Affiliation(s)
- Marlon A Guerrero
- 1. Department of Surgery, University of Arizona, Tucson, AZ 85724-5131, USA
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