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Presented by George Netto, M.D. & Alcides Chaux, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 3: A 68 year old male underwent a a total thyroidectomy for 2 bilateral nodules.
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1. Question
Week 340: Case 3
A 68 year old male underwent a a total thyroidectomy for 2 bilateral nodules (9.2, and 7.4 cm). Sections of the larger nodule are shown.images/3A 2_18_08.jpg
images/3B 2_18_08.jpg
images/3C 2_18_08.jpg
images/3D 2_18_08.jpg
images/3E 2_18_08.jpgCorrect
Answer: Hurthle cell carcinoma, minimally invasive
Histology: none provided
Discussion: Follicular carcinomas of the thyroid gland, including their oncocytic variant (Hurthle cell carcinoma), are subdivided into the usually indolent encapsulated (“minimally invasive”) and the clinically aggressive widely invasive tumors. Minimally invasive Hurthle cell carcinomas, also termed encapsulated Hurthle cell carcinomas, are thyroid tumors with follicular to solid architecture, surrounded by a fibrous capsule that displays focal microscopic complete capsular invasion and/or intra/extracapsular vascular invasion.
Controversy exists over the ability of morphology to predict the biologic behavior of Hürthle cell carcinomas. A subset of minimally invasive Hurthle cell carcinoma has been associated with recurrences. In a recent study from Memorial Sloan Kettering Cancer Center, Ghossein et al. found that the presence of 4 or more foci of vascular invasion, tumor size >4 cm, increased mitotic activity, and the presence of a solid/trabecular growth pattern predict a lower recurrence free survival.
Reference(s):
– Ronald A. Ghossein, et al. Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland. A clinicopathologic study of 50 cases, Cancer. 2006 Apr 15;106(8):1669-76.
– Alexander Stojadinovic. Hürthle Cell Carcinoma: A Critical Histopathologic Appraisal. Journal of Clinical Oncology, Vol 19, Issue 10 (May), 2001: 2616-2625.Incorrect
Answer: Hurthle cell carcinoma, minimally invasive
Histology: none provided
Discussion: Follicular carcinomas of the thyroid gland, including their oncocytic variant (Hurthle cell carcinoma), are subdivided into the usually indolent encapsulated (“minimally invasive”) and the clinically aggressive widely invasive tumors. Minimally invasive Hurthle cell carcinomas, also termed encapsulated Hurthle cell carcinomas, are thyroid tumors with follicular to solid architecture, surrounded by a fibrous capsule that displays focal microscopic complete capsular invasion and/or intra/extracapsular vascular invasion.
Controversy exists over the ability of morphology to predict the biologic behavior of Hürthle cell carcinomas. A subset of minimally invasive Hurthle cell carcinoma has been associated with recurrences. In a recent study from Memorial Sloan Kettering Cancer Center, Ghossein et al. found that the presence of 4 or more foci of vascular invasion, tumor size >4 cm, increased mitotic activity, and the presence of a solid/trabecular growth pattern predict a lower recurrence free survival.
Reference(s):
– Ronald A. Ghossein, et al. Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland. A clinicopathologic study of 50 cases, Cancer. 2006 Apr 15;106(8):1669-76.
– Alexander Stojadinovic. Hürthle Cell Carcinoma: A Critical Histopathologic Appraisal. Journal of Clinical Oncology, Vol 19, Issue 10 (May), 2001: 2616-2625.
