Hürthle cell carcinoma is a rare type of differentiated thyroid cancer.
Hürthle cell cancer comprises 3-10% of thyroid cancers to limit institutional experience with neoplasms.
Oncocytic cells or Hürthle cells exhibit enlargement and abundant eosinophilic granular cytoplasm due to altered mitochondria accumulation.
Hürthle cell neoplasms show hypercellularity dominated by oncocytes, with few lymphocytes and minimal or absent colloid in nodules.
Hürthle cells, first described by Askanasy in 1898, were wrongly named after German physiologist Karl Hürthle.
Hürthle cells are large and polygonal with indistinct borders, hyperchromatic nuclei, prominent nucleoli, and granular pink cytoplasm after staining.
WHO defines Hürthle cell carcinoma as minimally invasive capsular and widely invasive vascular invasions.
Hürthle cell cancer is more aggressive than other thyroid cancers, with increased metastasis and decreased survival rates.
Epidemiology
Thyroid cancer is the seventh most common cancer in women. Hürthle cell carcinoma is a rare thyroid cancer type.
In 2023, there are 43720 new thyroid cancer cases are expected as 31180 in women, 12540 in men.
All races affected equally as typical patient age range is 20 to 85 years. Mean age is typically 50 to 60 years, about 10 years older than others.
Lithuania leads incidence rates followed by Italy, Austria, Croatia, and Luxembourg.
Anatomy
Pathophysiology
Evidence indicates a multistep adenoma-to-carcinoma pathway but inconsistently accepted.
Cells likely arise from adenomas, but follicular carcinoma in situ undetected. Cytogenetic abnormalities and genetic loss are more common in follicular cancer.
Somatic mutations in growth control genes drive follicular thyroid cancer development. Low iodide intake influences incidence of follicular and papillary cancers.
Mutations or translocations of the ras oncogene are common in follicular adenomas and carcinomas that indicates early tumorigenesis.
Overexpression of p53 correlates with certain Hürthle cell carcinomas, while decreased E-cadherin immunoexpression trends towards a diffuse cytoplasmic pattern in both benign and malignant tumors.
Etiology
The causes of hurthle cell carcinoma are:
Radiation to the neck
Iodide deficiency
Overexpression of the p53noncogene
Somatic mutations of genes
Oncogene activation
Genetics
Prognostic Factors
Hürthle cell carcinomas are more aggressive than other thyroid cancers with increased metastasis and decreased survival.
Nuclear aneuploidy is found in 90% of Hürthle cell carcinoma patients and links to poor prognosis.
Mitosis and solid tumor pattern indicate increased recurrence risk. It has similar or worse survival rates than follicular carcinoma patients.
Median disease-specific survival was 72 months for pulmonary metastases and 138 months for other metastatic sites.
Clinical History
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Physical Examination
Neck Examination
Lymph Node Examination
Neurologic Examination
Respiratory Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Typical symptoms are:
Slowly enlarging neck mass over months to years, no systemic symptoms in early stages
Acute symptoms are:
Hoarseness or voice changes, Dysphagia, Neck discomfort
Differential Diagnoses
Anaplastic Thyroid Carcinoma
Diffuse Toxic Goiter
Hashimoto Thyroiditis
Follicular Thyroid Carcinoma
Goiter
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Hürthle cell carcinoma treatment involves surgical excision and postoperative iodine-131 scanning after 4-6 weeks.
No interim thyroid hormone treatment is given. If uptake is seen, a 131I treatment dose is given, followed by a total body scan after 4-7 days
Radioactive iodine-131 treats thyroid bed uptake after surgery.
Radioactive iodide eliminates normal thyroid tissue, improving sensitivity of 131I scans and specificity of serum thyroglobulin measurements for disease detection.
Radioactive iodide treatment is employed for Hürthle cell cancers post-surgery and for recurrent/metastatic cases.
Limited evidence suggests retinoic acid redifferentiation therapy may restore 131I uptake in certain thyroid carcinomas.
TSH controls thyroid tumor cell growth while levothyroxine (T4) inhibition reduces recurrence and enhances survival rates.
Patient should use elevated pillows to reduce neck strain after surgery also avoid heavy lifting or sudden neck movements.
Modify tasks for patients those experiencing fatigue or weakness due to metastatic disease.
Avoid extreme exertion in the post-surgical period. Start gentle neck exercises to improve flexibility and healing.
Radiation patients need skin protection and clothing adjustments for irritation.
Proper awareness about hurthle cell carcinoma should be provided and its related causes with management strategies.
Appointments with oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Use of Thyroid hormones
Levothyroxine:
Start this drug post-131 I treatment dose administration. It increases mobilization of glycogen stores to promote gluconeogenesis in growth development.
Intervention for hürthle cell carcinoma involves surgical procedures including thyroidectomy, lobectomy, neck dissection, and tracheostomy.
use-of-phases-in-managing-hurthle-cell-carcinoma
In the initial treatment phase, the goal is to remove primary tumor and prevent recurrence.
While in diagnostic phase, the goal is to confirm malignancy and assess disease.
Pharmacologic therapy is effective in the treatment phase as it includes the use of thyroid hormones.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the oncologist are scheduled to check the improvement of patients along with treatment response.
Hürthle cell carcinoma is a rare type of differentiated thyroid cancer.
Hürthle cell cancer comprises 3-10% of thyroid cancers to limit institutional experience with neoplasms.
Oncocytic cells or Hürthle cells exhibit enlargement and abundant eosinophilic granular cytoplasm due to altered mitochondria accumulation.
Hürthle cell neoplasms show hypercellularity dominated by oncocytes, with few lymphocytes and minimal or absent colloid in nodules.
Hürthle cells, first described by Askanasy in 1898, were wrongly named after German physiologist Karl Hürthle.
Hürthle cells are large and polygonal with indistinct borders, hyperchromatic nuclei, prominent nucleoli, and granular pink cytoplasm after staining.
WHO defines Hürthle cell carcinoma as minimally invasive capsular and widely invasive vascular invasions.
Hürthle cell cancer is more aggressive than other thyroid cancers, with increased metastasis and decreased survival rates.
Thyroid cancer is the seventh most common cancer in women. Hürthle cell carcinoma is a rare thyroid cancer type.
In 2023, there are 43720 new thyroid cancer cases are expected as 31180 in women, 12540 in men.
All races affected equally as typical patient age range is 20 to 85 years. Mean age is typically 50 to 60 years, about 10 years older than others.
Lithuania leads incidence rates followed by Italy, Austria, Croatia, and Luxembourg.
Evidence indicates a multistep adenoma-to-carcinoma pathway but inconsistently accepted.
Cells likely arise from adenomas, but follicular carcinoma in situ undetected. Cytogenetic abnormalities and genetic loss are more common in follicular cancer.
Somatic mutations in growth control genes drive follicular thyroid cancer development. Low iodide intake influences incidence of follicular and papillary cancers.
Mutations or translocations of the ras oncogene are common in follicular adenomas and carcinomas that indicates early tumorigenesis.
Overexpression of p53 correlates with certain Hürthle cell carcinomas, while decreased E-cadherin immunoexpression trends towards a diffuse cytoplasmic pattern in both benign and malignant tumors.
The causes of hurthle cell carcinoma are:
Radiation to the neck
Iodide deficiency
Overexpression of the p53noncogene
Somatic mutations of genes
Oncogene activation
Hürthle cell carcinomas are more aggressive than other thyroid cancers with increased metastasis and decreased survival.
Nuclear aneuploidy is found in 90% of Hürthle cell carcinoma patients and links to poor prognosis.
Mitosis and solid tumor pattern indicate increased recurrence risk. It has similar or worse survival rates than follicular carcinoma patients.
Median disease-specific survival was 72 months for pulmonary metastases and 138 months for other metastatic sites.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Neck Examination
Lymph Node Examination
Neurologic Examination
Respiratory Examination
Typical symptoms are:
Slowly enlarging neck mass over months to years, no systemic symptoms in early stages
Acute symptoms are:
Hoarseness or voice changes, Dysphagia, Neck discomfort
Anaplastic Thyroid Carcinoma
Diffuse Toxic Goiter
Hashimoto Thyroiditis
Follicular Thyroid Carcinoma
Goiter
Hürthle cell carcinoma treatment involves surgical excision and postoperative iodine-131 scanning after 4-6 weeks.
No interim thyroid hormone treatment is given. If uptake is seen, a 131I treatment dose is given, followed by a total body scan after 4-7 days
Radioactive iodine-131 treats thyroid bed uptake after surgery.
Radioactive iodide eliminates normal thyroid tissue, improving sensitivity of 131I scans and specificity of serum thyroglobulin measurements for disease detection.
Radioactive iodide treatment is employed for Hürthle cell cancers post-surgery and for recurrent/metastatic cases.
Limited evidence suggests retinoic acid redifferentiation therapy may restore 131I uptake in certain thyroid carcinomas.
TSH controls thyroid tumor cell growth while levothyroxine (T4) inhibition reduces recurrence and enhances survival rates.
Oncology, Other
Patient should use elevated pillows to reduce neck strain after surgery also avoid heavy lifting or sudden neck movements.
Modify tasks for patients those experiencing fatigue or weakness due to metastatic disease.
Avoid extreme exertion in the post-surgical period. Start gentle neck exercises to improve flexibility and healing.
Radiation patients need skin protection and clothing adjustments for irritation.
Proper awareness about hurthle cell carcinoma should be provided and its related causes with management strategies.
Appointments with oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Oncology, Other
Levothyroxine:
Start this drug post-131 I treatment dose administration. It increases mobilization of glycogen stores to promote gluconeogenesis in growth development.
Oncology, Other
Intervention for hürthle cell carcinoma involves surgical procedures including thyroidectomy, lobectomy, neck dissection, and tracheostomy.
Oncology, Other
In the initial treatment phase, the goal is to remove primary tumor and prevent recurrence.
While in diagnostic phase, the goal is to confirm malignancy and assess disease.
Pharmacologic therapy is effective in the treatment phase as it includes the use of thyroid hormones.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the oncologist are scheduled to check the improvement of patients along with treatment response.
Hürthle cell carcinoma is a rare type of differentiated thyroid cancer.
Hürthle cell cancer comprises 3-10% of thyroid cancers to limit institutional experience with neoplasms.
Oncocytic cells or Hürthle cells exhibit enlargement and abundant eosinophilic granular cytoplasm due to altered mitochondria accumulation.
Hürthle cell neoplasms show hypercellularity dominated by oncocytes, with few lymphocytes and minimal or absent colloid in nodules.
Hürthle cells, first described by Askanasy in 1898, were wrongly named after German physiologist Karl Hürthle.
Hürthle cells are large and polygonal with indistinct borders, hyperchromatic nuclei, prominent nucleoli, and granular pink cytoplasm after staining.
WHO defines Hürthle cell carcinoma as minimally invasive capsular and widely invasive vascular invasions.
Hürthle cell cancer is more aggressive than other thyroid cancers, with increased metastasis and decreased survival rates.
Thyroid cancer is the seventh most common cancer in women. Hürthle cell carcinoma is a rare thyroid cancer type.
In 2023, there are 43720 new thyroid cancer cases are expected as 31180 in women, 12540 in men.
All races affected equally as typical patient age range is 20 to 85 years. Mean age is typically 50 to 60 years, about 10 years older than others.
Lithuania leads incidence rates followed by Italy, Austria, Croatia, and Luxembourg.
Evidence indicates a multistep adenoma-to-carcinoma pathway but inconsistently accepted.
Cells likely arise from adenomas, but follicular carcinoma in situ undetected. Cytogenetic abnormalities and genetic loss are more common in follicular cancer.
Somatic mutations in growth control genes drive follicular thyroid cancer development. Low iodide intake influences incidence of follicular and papillary cancers.
Mutations or translocations of the ras oncogene are common in follicular adenomas and carcinomas that indicates early tumorigenesis.
Overexpression of p53 correlates with certain Hürthle cell carcinomas, while decreased E-cadherin immunoexpression trends towards a diffuse cytoplasmic pattern in both benign and malignant tumors.
The causes of hurthle cell carcinoma are:
Radiation to the neck
Iodide deficiency
Overexpression of the p53noncogene
Somatic mutations of genes
Oncogene activation
Hürthle cell carcinomas are more aggressive than other thyroid cancers with increased metastasis and decreased survival.
Nuclear aneuploidy is found in 90% of Hürthle cell carcinoma patients and links to poor prognosis.
Mitosis and solid tumor pattern indicate increased recurrence risk. It has similar or worse survival rates than follicular carcinoma patients.
Median disease-specific survival was 72 months for pulmonary metastases and 138 months for other metastatic sites.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Neck Examination
Lymph Node Examination
Neurologic Examination
Respiratory Examination
Typical symptoms are:
Slowly enlarging neck mass over months to years, no systemic symptoms in early stages
Acute symptoms are:
Hoarseness or voice changes, Dysphagia, Neck discomfort
Anaplastic Thyroid Carcinoma
Diffuse Toxic Goiter
Hashimoto Thyroiditis
Follicular Thyroid Carcinoma
Goiter
Hürthle cell carcinoma treatment involves surgical excision and postoperative iodine-131 scanning after 4-6 weeks.
No interim thyroid hormone treatment is given. If uptake is seen, a 131I treatment dose is given, followed by a total body scan after 4-7 days
Radioactive iodine-131 treats thyroid bed uptake after surgery.
Radioactive iodide eliminates normal thyroid tissue, improving sensitivity of 131I scans and specificity of serum thyroglobulin measurements for disease detection.
Radioactive iodide treatment is employed for Hürthle cell cancers post-surgery and for recurrent/metastatic cases.
Limited evidence suggests retinoic acid redifferentiation therapy may restore 131I uptake in certain thyroid carcinomas.
TSH controls thyroid tumor cell growth while levothyroxine (T4) inhibition reduces recurrence and enhances survival rates.
Oncology, Other
Patient should use elevated pillows to reduce neck strain after surgery also avoid heavy lifting or sudden neck movements.
Modify tasks for patients those experiencing fatigue or weakness due to metastatic disease.
Avoid extreme exertion in the post-surgical period. Start gentle neck exercises to improve flexibility and healing.
Radiation patients need skin protection and clothing adjustments for irritation.
Proper awareness about hurthle cell carcinoma should be provided and its related causes with management strategies.
Appointments with oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Oncology, Other
Levothyroxine:
Start this drug post-131 I treatment dose administration. It increases mobilization of glycogen stores to promote gluconeogenesis in growth development.
Oncology, Other
Intervention for hürthle cell carcinoma involves surgical procedures including thyroidectomy, lobectomy, neck dissection, and tracheostomy.
Oncology, Other
In the initial treatment phase, the goal is to remove primary tumor and prevent recurrence.
While in diagnostic phase, the goal is to confirm malignancy and assess disease.
Pharmacologic therapy is effective in the treatment phase as it includes the use of thyroid hormones.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the oncologist are scheduled to check the improvement of patients along with treatment response.
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