Endocrine Abstracts

Introduction: Hurthle cell carcinoma was considered to be a variant of follicular thyroid cancer. However, recent clinical and molecular studies clearly indicate that Hurthle cell cancer is a distinct tumor type. Histologically, it is characterized by the presence of a cell population of ‘oncocytes’, mostly eosinophilic oxyphilic cells and abundant cytoplasm,closely packed mitochondria, and round oval nuclei with prominent nucleoli. Unlike follicular thyroid cancer, Hurthle cell cancer has more of propensity to to spread to cervical lymph nodes. Hurthle cell cancer metastatic foci are often radioactive iodine refractory. This type of carcinoma accounts for only about 3–10% of all differentiated thyroid cancers.

Case: A 51-year-old women was presented in our policlinic with a visibile mass on the neck. She complains about difficulty swallowing and hoarseness. On physical examination we detect enlargement and stiffness of the right lobe ofthyroid gland. Thyroid ultrasonography revealed a 3 cm hypoechoic nodule with cystic degeneration on the right lobe. The left lobe and istmus were normal. Thyroid hormone tests showed normal thyroid-stimulating hormone (TSH) 2.28 uIU/ml (reference value 0.3–4.5uIU/ml), normal FT4 12.7 pg/ml (normal range 8.9–17.2 pg/ml) and normal FT3 2.1 pg/ml (normal range 1.21–4.18 pg/ml). Thyroid scintigraphy (technetium(TC)-99 m) showed enlarged right lobe,and acold nodule in the lower part of this lobe. The left lobe was non enlarged, with low homogeneous fixation, isthmusi non-homogenous. Thetotal uptake was in range. A Fine-needle aspiration (FNA) biopsy was performed and showed suspected neoplasia with Hurthle cells. The patient underwent surgical intervention. Total thyroidectomy was performed, No local lymph nodes resection. The postoperative biopsy conclude:Proliferative process of oxyphil carcinoma type. Further immunohistochemial test confirmatethe diagnosis. There were no evidence of invasion of the Hurthle cell cancer (metastasis) beyond the thyroid gland, so substitutive hormone therapy was started. Radioactive Iodine Treatment (RAI) was not performed. Periodic follow-ups every 6-months are done with ultrasound examination and hormone levels. She is free of metastases so far.

Conclusion: Hurthle cell carcinoma may be associated with poor prognosis than follicular cancer, related with the poor affinity for taking radioiodine. Hurthle cells has been shown to have an increased recurrence in local lymph nodes. Our case was a middle aged woman with a cold nodule nearly 3 cm, with no evidence of lymph node involvement.

Keywords: hurthle cell carcinoma, oxyphilic carcinoma, lymph nodes, radioactive iodine.