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Abstract
In fine-needle aspirations (FNA) of thyroid, Hürthle cells can be found in a broad spectrum of lesions, ranging from non-neoplastic conditions to aggressive malignant tumors. Recognize them morphologically, frequently represents a challenging for an adequately diagnosis and are associated with a significant interobserver variability. Although the limitations of the morphologic diagnosis still exist, the interpretation of the context where the cells appear and the recent advances in the molecular knowledge of Hürthle cells tumors are contributing for a more precise diagnosis. This review aims to describe the cytology aspects of all Hürthle cells neoplastic and non-neoplastic thyroid lesions, focusing on the differential diagnosis and reporting according to The Bethesda System for Reporting Thyroid Cytology (TBSRTC). New entities according to the latest World Health Organization (WHO) classification are included, as well as an update of the current molecular data.
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Affiliation(s)
- Eleni Thodou
- Department of Pathology, Medical School, University of Thessaly, Larissa, Greece
| | - Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
- Medical Faculty, Porto University, Porto, Portugal
- CINTESIS@RISE, Porto, Portugal
- *Correspondence: Fernando Schmitt,
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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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de Salins V, Loganadane G, Joly C, Abulizi M, Nourieh M, Boussion H, Belkacemi Y, Tournigand C, Kempf E. Complete response in anaplastic lymphoma kinase–rearranged oncocytic thyroid cancer: A case report and review of literature. World J Clin Oncol 2020; 11:495-503. [PMID: 32821654 PMCID: PMC7407927 DOI: 10.5306/wjco.v11.i7.495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oncocytic carcinoma of the thyroid is a rare disease, characterized by a poor prognosis and low response rate to radioiodine therapy. Crizotinib is a specific anaplastic lymphoma kinase (ALK) inhibitor, which was initially developed in non-small cell lung cancer. Other solid tumors harboring a translocation in ALK have been described, such as renal carcinoma, thyroid, colorectal, ovarian cancers, and spitzoid melanoma. The research of ALK rearrangements in thyroid tumor is a promising therapeutic track, and treatments need to be explored.
CASE SUMMARY We report the case of a 76-year-old woman with a history of multinodular goiter, who was hospitalized for impairment of her general condition. She was diagnosed with metastatic oncocytic thyroid cancer. Synchrone metastases were found: Multiple mediastinal lymphadenopathies, lytic bone lesions and bilateral mammary lumps. Fluorescence in situ hybridization analysis revealed an ALK rearrangement in 61% of cells. No other mutation was found. A tumor board discussion based on molecular characteristics of the tumor suggested initiating a daily treatment by crizotinib, a specific ALK inhibitor. A positron emission tomography scan performed 4 mo after the initiation of crizotinib showed a complete metabolic response.
CONCLUSION This case highlights an unexpected efficacy of crizotinib in an ALK-rearranged thyroid tumor, and the need of further assessments.
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Affiliation(s)
- Victoire de Salins
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Gokoulakrichenane Loganadane
- Department of Radiation Oncology and Breast Center, Henri Mondor University Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil and IMRB-INSERM 955 Team 21, Creteil 94010, France
| | - Charlotte Joly
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Mukedaisi Abulizi
- Department of Nuclear Medicine, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Maya Nourieh
- Department of Pathology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Hélène Boussion
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Yazid Belkacemi
- Department of Radiation Oncology and Breast Center, Henri Mondor University Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil and IMRB-INSERM 955 Team 21, Creteil 94010, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Emmanuelle Kempf
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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