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Presented by George Netto, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 3: A 57 year old man presented with a 3.3 cm left thyroid mass.
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1. Question
Week 369: Case 3
A 57 year old man presented with a 3.3 cm left thyroid mass. An FNA procedure yielded a diagnosis of Hurthle Cell Neoplasm, and a left lobectomy was performed.images/10_20_2008 3A.jpg
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images/10_20_2008 3E.jpgCorrect
Answer: Pseudopapillary Hurthle cell adenoma
Histology: none provided
Discussion: Hürthle cells can be found in a variety of neoplastic and non-neoplastic conditions of thyroid. Hürthle cell metaplasia occurs in non-neoplastic conditions such as autoimmune thyroiditis and multinodular goiter among others.
To classify a neoplasm as a Hürthle cell neoplasm, it should be composed of at least 75% Hürthle cells. Hurthle Cell Neoplasms can display different architectural growth patterns including: follicular, trabecular, solid, and pseudopapillary patterns.
As in the current example, Hürthle cell neoplasms, both benign and malignant, have a peculiar tendency to show pseudopapillary change, which is thought to be the result of fixation artifact rather than true papillary frond formation.
In determining the biologic behavior of a Hurthle Cell Neoplasm, neither nuclear atypia, nuclear pleomorphism, mitotic activity, nor architectural pattern (including pseupapillary) is a determinant of malignancy. As in follicular carcinomas, Hürthle cell carcinomas are classified as minimally invasive, angioinvasive, or widely invasive.
Pseudopapillary Hurthle Cell Adenoma should be distinguished from Hürthle cell variant of Papillary Thyroid Carcinoma (PTC). The latter contains true papillary fronds with distinct fibrovascular cores. Classic nuclear features of PTC should be identified prior to classifying a neoplasm as Hürthle cell variant of PTC. At the genetic level, Hurthle cell variant of PTC shows RET/PTC gene rearrangements. BRAF mutations have also been demonstrated in a subset of these lesions.
Reference(s):
– Montone KT, Baloch ZW, LiVolsi VA. The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review. Arch Pathol Lab Med. 2008 Aug;132(8):1241-50.Incorrect
Answer: Pseudopapillary Hurthle cell adenoma
Histology: none provided
Discussion: Hürthle cells can be found in a variety of neoplastic and non-neoplastic conditions of thyroid. Hürthle cell metaplasia occurs in non-neoplastic conditions such as autoimmune thyroiditis and multinodular goiter among others.
To classify a neoplasm as a Hürthle cell neoplasm, it should be composed of at least 75% Hürthle cells. Hurthle Cell Neoplasms can display different architectural growth patterns including: follicular, trabecular, solid, and pseudopapillary patterns.
As in the current example, Hürthle cell neoplasms, both benign and malignant, have a peculiar tendency to show pseudopapillary change, which is thought to be the result of fixation artifact rather than true papillary frond formation.
In determining the biologic behavior of a Hurthle Cell Neoplasm, neither nuclear atypia, nuclear pleomorphism, mitotic activity, nor architectural pattern (including pseupapillary) is a determinant of malignancy. As in follicular carcinomas, Hürthle cell carcinomas are classified as minimally invasive, angioinvasive, or widely invasive.
Pseudopapillary Hurthle Cell Adenoma should be distinguished from Hürthle cell variant of Papillary Thyroid Carcinoma (PTC). The latter contains true papillary fronds with distinct fibrovascular cores. Classic nuclear features of PTC should be identified prior to classifying a neoplasm as Hürthle cell variant of PTC. At the genetic level, Hurthle cell variant of PTC shows RET/PTC gene rearrangements. BRAF mutations have also been demonstrated in a subset of these lesions.
Reference(s):
– Montone KT, Baloch ZW, LiVolsi VA. The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review. Arch Pathol Lab Med. 2008 Aug;132(8):1241-50.
