Hurthle cell carcinoma represents about 4-5% of differentiated thyroid carcinomas. The prognosis of the malignant type of the tumour is still under debate as some authors have reported that Hurthle cell adenoma very rarely behaves like Hurthle cell carcinoma. Aim of this present study is to evaluate previously reported data and experience on the clinical and pathological features of patients affected by Hurthle cell tumour that may predict disease progression and death. In the literature, the factors potentially associated with decreased survival are: age, disease stage, tumour size, extra-glandular invasion, lymph node invasion, distant metastases, surgery, radioiodine treatment. From 2005 to 2016, we identified 28 patients affected by Hurthle cell tumour, 9 with Hurthle cell adenoma and 19 with Hurthle cell carcinoma. Of these, 22 were females and 6 males. Mean age of patients affected by adenoma was 49.7 years (range 30-72) vs. 49.3 years (range 15-72) in Hurthle cell carcinoma patients. In all the patients, total thyroidectomy was performed. At histology, 9 adenomas, 5 “minimally invasive” and 14 invasive carcinomas were found. Post-operatively, in Hurthle cell carcinoma patients, TNM stage showed 9 patients with stage I, 5 stage II, 4 stage III and one stage IVa. All invasive carcinomas underwent I¹³¹therapy (91-585 mCi). One Hurthle cell carcinoma patient received external beam radiation. The mean follow-up period was 62 months (range 6-324). Relapse was not observed in the patients with adenoma. Only 1 Hurthle cell carcinoma patient showed distant lung metastases at 60 months’ follow-up. In the conclusion, Hurthle cell carcinoma was not found to present a more aggressive behaviour than follicular carcinoma, when risk factors, including extent of tumour invasion, were taken into account.Patients with Hurthle cell adenoma did not showed a relapse or death caused by the tumour.

Keywords: Thyroid • Hurthle cell adenoma • Hurthle cell carcinoma.

1. Chen H, Nicol TL, Zeiger MA, Dooley WC, Ladenson PW, Cooper DS, et al. Hurthle cell neoplasm of the thyroid: are there factors predictive of malignancy? Ann Surg 1998;227:542-6.
2. Sugino K, Itto K, Mimura T, Kameyama K, Iwasaki H, Ito K et al. Hurthle cell tumor of the thyroid: analysis of 188 cases. World J Surg 2004;25:1160-3.
3. Silverman ML, Sanders LE. Follicular and Hurthle cell carcinoma: predicting outcome and directing therapy. Surgery 1998;124:967-74.
4. Shaha AR, Loree TR, Shah JP. Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery 1995;118:1131-6.
5. McDonald MP, Sanders LE, Silverman ML, Chan HS, Buyske J. Hurthle cell carcinoma of the thyroid gland: prognostic factors and results of surgical treatment. Surgery 1997;120:1000-5.
6. Yutan E, Clark OH. Hurthle cell carcinoma. Curr Treat Opt Oncol 2004;2:331-6.
7. Tallini G, Carcangiu ML, Rosai J. Oncocytic neoplasms of the thyroid gland. Acta Pathol Jpn 2002;42:305-5.
8. LiVolsi VA , Bronner MP . Oxyphilic (Askanazy/Hurthle cell) tumors of the thyroid: microscopic features predict biologic behaviour. Surg Pathol 1988;1:137-50.
9. DeLellis RA Rosai J, Carcangiu ML,. Atlas of tumor pathology: tumors of the thyroid gland. Third series - Fascicle 5. Washington, DC; 2002.
10. Frassila KO, Ackerman LV, Brown CL, Hedinger CE.Follicular carcinoma. Semin Diagn Pathol 1985;2:101-5.
11. Sobin LH, Hedinger CE, Williams ED,. Histological typing of thyroid tumours. In: Hedinger CE, editor. International histological classification of tumors. Berlin: Springer- Verlag; 1998. p. 1-18.
12. Bhattacharyya N. Survival and prognosis in Hurthle cell carcinoma of the thyroid gland. Arch Otolaryngol 2005;127:207-10.
13. Langhans T. Uber die epithelialen Formen der malignen Struma. Virchows Arch (Pathol Anat) 1907;189:65-152.
14. Hadar T , Har-El G, Segal K, Levy R, Sidi J. Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy. Cancer 1985;57:1612-7.
15. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Database report on 53857 cases of thyroid carcinoma treated in the U.S., 1985-1994. Cancer 1994;83:2638-48.
16. McHenry CR, Sandoval BA. Management of follicular and Hurthle cell neoplasms of the thyroid gland. Surg OncolClin North Am 1998;7:893-910.
17. Maximo V, Sobrinho-Simoes M. Hurthle cell tunours of the thyroid. A review with emphasis on mitochondrial abnormalities with clinical relevance. Virchows Arch 2001;436:107-15.
18. Gerend PL , Clark OH. Thyrotropin receptor-adenylate cyclase system in Hurthle cell neoplasms. J Clin EndocrinolMetab 1985;61:773-8.
19. Hurthle K. Beitrage zur Kenntnis des Sekretionsvorgangs in der Schilddruse. Arch Gesamte Physiol 1984;56:1-44.
20. LiVolsi VA. Surgical pathology of the thyroid. Philadelphia: Ed. Saunders; 1990.
21. Hedinger CE, Williams ED, Sobin LH. The World Health Organization histological classification of thyroid tumours: acommentary on the second edition. Cancer 1989;63:908-11.
22. Giorgadze T, Rossi ED, Fadda G, Gupta PK, LiVolsi VA, Baloch Z. Does the fine-needle aspiration diagnosis of “Hurthle-cell neoplasm/follicular neoplasm with oncocytic features” denote increased risk of malignancy? Diagn Cytopathol 2004;31:307-12.
23. Dahl LD, Myssiorek D, Heller KS. Hurthle cell neoplasms of the thyroid. Laryngoscope 2002;112:2178-80.
24. Mijovi´c T, Rochon L, Gologan O, Hier MP, Black MJ, Young J, et al. Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions. Otolaryngol Head Neck Surg 2009;140:715-9.
25. Wegelin C. Die Schilddruse. In: Henke F, Lubarsch O, editors. Handbuch der speziellen pathologischen Anatomie und Histologie. Bd VIII. Berlin: Springer-Verlag; 1926.
26. Grant CS, Barr D, Goellner JR, Hay ID. Benign Hurthle cell tumors of the thyroid: a diagnosis to be trusted? World J Surg 1988;12:488-95.
27. Carcangiu ML, Bianchi S, Savino D, Voynick IM, Rosai J. Follicular Hurthle cell tumours of the thyroid gland. Cancer 1998;68:1944-53.
28. Stojadinovic A, Ghossein RA, Hoos A, Urist MJ, Spiro RH, Shah JP, et al. Hurthle cell carcinoma: a critical histopathologic appraisal. J Clin Oncol 2001;19:2616-25.
29. Mai KT, Thomas J, Yazdi J, Commons AS, Lamba M, Stinson AW. Pathologic study and clinical significance of Hurthle cell papillary thyroid carcinoma. Appl Immunohistochem Mol Morphol 2004;12:329-37.
30. Watson RG, Brennan MD, Goellner JR, van Heerden JA, McConahey WM, Taylor WF. Invasive Hurthle cell carcinoma of the thyroid: natural history and management. Mayo Clin Proc 1994;59:851-5.
31. Hasteh F, Lee J. Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto’s thyroiditis: a case report and review of the literature. Diagn Cytopathol 2009;37:600-6.
32. Brennan MD, Bergstralh EJ, van Heerden JA, McConahey WM. Follicular thyroid cancer treated at Mayo Clinic 1946 through 1970: initial manifestations, pathological findings, therapy and outcome. Mayo Clin Proc 1991;66:11-22.
33. Rogounovitch T, Saenko V, Yamashita S. Mitochondrial DNA and human thyroid disease. Endocr J 2004;51:265-77.
34. Harry NM. Hurthle cell tumours of the thyroid gland. Roy Melbourne Hosp Clin Rep 1941;12:18-22.
35. Warren S. The classification of tumours of the thyroid. Am J Roentgenol 1941;46:447-50.
36. Manual of Tumor Nomenclature and Coding: Prepared by the Subcommittee of the Statistics Committee, New York: American Cancer Society; 1951.
37. Thompson NW, Dunn EL, Batasakis JG, Nishiyanna RH. Hurthle cell lesions of the thyroid gland. Surg Gynecol Obstet 1974;139:155-60.
38. Hudson JL ,McLeod MK, Thompson NW, Gaglio JA, Lloyd RV, Harness JK, et al. Flow cytometric measurements of nulcear DNA and ploidy analysis in Hurthle cell neoplasms of the thyroid. Arch Surg 1988;123:849-54.
39. Maximo V, Soares P, Lima J, Cameselle-Teijeiro J, Sobrinho- Simoes M. Mitochondrial DNA somatic mutations (pointmutations and large deletions) and mitochondrial DNA variants in human thyroid pathology: a study with emphasis onHurthle cell tumors. Am J Pathol 2002;160:1857-65.
40. Erickson LA, Jalal SM, Goellner JR, Law ME, Harwood A, Jin L, et al. Analysis of Hurthle cell neoplasms of thyroid by interphase fluorescence in situ hybridization. Am J Surg Pathol 2001;25:911-7.
41. Musholt PB, Imkamp F, von Wasielewki R, Schmid KW, Musholt TJ. RET rearrangements in archival oxyphilic thyroid tumours: new insights in tumorigenesis and classification of Hurthle cell carcinomas? Surgery 2003;134:881-9.
42. Augustynowicz A, Dzieciol J, Barwijuk-Machala M, Dadan J, Puchalski Z, Sulkowski S. Assessment of proliferative activity of thyroid Hurthle cell tumours using PCNA, Ki-67 and AgNOR methods. Folia Histochem Cytobiol 2004;42:165-8
43. Shaha AR, Ferlito A, Rinaldo A. Distant metastases from thyroid and parathyroid cancer. J Otorhinolaryngol Relat Spec 2001;63:243-9.
44. Nishiyama RH. Overview of surgical pathology of the thyroid gland. World J Surg 2000;24:898-906.
45. Crile G, Pontius Kl, Howk WA. Factors influencing the survival of patients with follicular carcinoma of the thyroid gland. Surg Gynecol Obstet 1985;160:409-13.
46. Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am 1995;24:761-801.
47. Grant CS. Operative and postoperative management of the patient with follicular and Hurthle cell carcinoma. Do they differ? Surg Clin North Am 1995;75:395-403.
48. Mills SC, Haq M, Smellie WJ, Harmer C. Hurthle cell carcinoma of the thyroid: Retrospective review of 62patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol 2009;35:230-4.
49. DeGroot LJ, Kaplan EL, Shukla MS, Salti G, Straus FH. Morbidity and mortality in follicular thyroid cancer. J Clin Endocrinol Metab 1995;80:2946-53.
50. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordonez NG, et al. Prognostic factors inpatients with Hurthle cell neoplasms of the thyroid. Cancer2003;597:1186-94.
51. Zhang YW, Greenblatt DY, Repplinger D, Bargren A, Adler JT, Sippel RS, et al. Older age and larger tumor size predict malignancy in Hurthle cell neoplasms of the thyroid. Ann Surg Oncol 2008;15:2842-6.

Dr Nemalidinne Keerthi

Junior Resident, Department of General Surgery

Sri Devaraj Urs Medical College and Research Centre, Tamaka, Kolar