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Thyroid
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Hürthle-cell carcinoma was previously considered a variant of follicular cancer and is composed of cells that exhibit oncocytic changes (Figure 4.1c). However, it is now recognized as a distinct pathological entity because of its different oncogenic expression. The majority of Hürthle-cell tumors are benign, but malignancy is documented in local recurrence and distant metastases. Histopathological studies have shown that either capsular or vascular invasion is a reliable criterion of malignancy. Although they are usually well differentiated and produce thyroglobulin, these tumors rarely take up iodine. This is a contributory factor to their poorer prognosis than other follicular carcinomas.17
Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
If the final histology report confirms a follicular carcinoma, what further treatment will she need?She needs to be discussed at a thyroid MDT.If the tumour is small (<4 cm), capsular invasion is minimal and no angioinvasion is seen, a case can be made for no further surgery.If extracapsular extension and/or angioinvasion is present or a Hurthle cell variant is observed, completion thyroidectomy is advised.Hurthle cell tumours have poor uptake of radioactive iodine (RI), but do secrete thyroglobulin, which is why completion thyroidectomy is recommended.
Thyroid cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Gitta Madani, Polly S Richards
In 2017, the fourth edition of the WHO classification of thyroid tumours classified Hürthle cell tumours as a separate entity (19). These are follicular neoplasms with more than 75% oncocytic cells. Hürthle cell tumours are considered malignant if they exhibit capsular or vascular invasion, but mitoses and histological features of the tumour do not determine malignancy. Like follicular carcinoma, Hürthle cell carcinoma presents with haematogenous metastases, but lymph node metastases at the time of diagnosis are more frequent in Hürthle cell carcinoma (18%–34%) (42–44). Although Hürthle cell carcinomas appear to be more clinically more aggressive than conventional follicular carcinoma, with higher frequency of extrathyroidal extension and metastasis to lymph nodes, recurrence rates are similar (14%–44%) (36). Prognosis worsens with old age, wide invasiveness, and extrathyroidal invasion, which predict distant metastases (45).
The impact of concurrent Hashimoto thyroiditis on thyroid nodule cytopathology assessed by ultrasound-guided fine-needle aspiration cytology
Published in Postgraduate Medicine, 2020
Fengqiu Hu, Zhe Yan, Buyun Ma, Yong Jiang, Hui Huang
Many factors contribute to an uninformative FNAC outcome. It was recognized that Hürthle cells, which are commonly seen on smears of patients with Hashimoto thyroiditis, and follicular lesions are major difficulties hindering a definitive cytological diagnosis [4,5]. Patients with Hashimoto thyroiditis, clinically characterized by elevated serum anti-thyroid autoantibodies (TgAb and TPOAb) and pathologically characterized by Hürthle cell and diffuse lymphocyte infiltration, are often found with concurrent thyroid nodules (up to 30% of patients) [6,7]. Some studies found that the anti-thyroid autoantibodies were associated with FNAC diagnostic performance, describing a higher incidence of indeterminate FNAC in patients with positive autoantibodies [8]. Therefore, an indeterminate diagnosis has always been the biggest concern in the clinical application of FNAC. For an initial indeterminate FNAC, there are several recommendations, such as repeated FNAC, molecular testing, surveillance or diagnostic surgery. The choice varies depending on clinical evaluation and patient preference. However, if an HT nodule is bound to have a high risk of indeterminate FNAC, then repeated FNAC would hardly help. Whether concurrent HT or increased serum anti-thyroid autoantibodies prevent a thyroid nodule from a conclusive FNAC is uncertain. We hereby conducted this clinical research to analyze the impact of HT on FNAC outcome to provide evidence for the subsequent diagnostic choice when faced with an initial indeterminate FNAC.
Diagnosis and management of hurthle cell carcinoma, a rare case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Marlinda Adham, Ferucha Moulanda, Agnes Harahap, Krishna Pandu, Em Yunir
New cases of thyroid cancer diagnosed in 2010 are estimated to reach 45,000 cases and about 5–10% are proven malignant and have poor prognosis, yet it is a challenge to identify this 5–10% population with significant clinical manifestations [1]. Follicular thyroid carcinoma (FTC) is the second most common epithelial-derived malignancy of the thyroid, accounting for approximately 3–15% of total thyroid cancer incidence. The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion [1]. Since its description in nineteenth century to date, Hurthle cell lesion has been a subject of continuing and evolving conflicts in nearly all of its aspects, starting from its nomenclature to its management. The oncocytic follicular cells of the thyroid continue to carry the name ‘Hürthle cells’, even though the cells that Karl Hürthle initially identified in 1894 ultimately proved to be the parafollicular C cells (Hürthle 1894) [2].
Sorafenib: key lessons from over 10 years of experience
Published in Expert Review of Anticancer Therapy, 2019
Bernard Escudier, Francis Worden, Masatoshi Kudo
Ongoing clinical trials are evaluating sorafenib in combination with other therapies, such as the mammalian target of rapamycin (mTOR) inhibitor, everolimus. In a phase 2 study of patients who had progressed on sorafenib, the addition of everolimus to sorafenib resulted in a median PFS of 13.7 months with a clinical benefit rate of 58% (no complete response, 1/33 patients with partial response) and no increase in HFSR [101]. This combination also resulted in improved tumor response rates in the first-line treatment of DTC and medullary thyroid cancers (MTCs) in a phase 2 study [102]. Among nine patients in this study with Hürthle cell thyroid carcinoma, seven achieved a partial response and two stable disease [102]. Based on these results, a phase 2 study is underway investigating the combination of sorafenib and everolimus in patients with Hürthle cell thyroid carcinoma (NCT02143726). In addition, the combination of sorafenib with temsirolimus has shown promising results; in a phase 2 study in 36 patients with metastatic RaI-refractory follicular thyroid cancer, response rates were 10% and 38% in patients with (n = 20) or without (n = 16) prior systemic treatment, respectively [103]. Other therapies are under investigation in DTC, including a phase 2 study evaluating the combination of lenvatinib and pembrolizumab (NCT02973997).