Skip to main content

Advertisement

SpringerLink
Log in

Poorly Differentiated Oncocytic (Hürthle Cell) Follicular Carcinoma: an Institutional Experience

  • Published:
Endocrine Pathology Aims and scope Submit manuscript

Abstract

The proposed diagnostic criteria for poorly differentiated thyroid carcinoma (known as the Turin classification) were defined based on growth pattern (solid, trabecular, or insular) and high-grade morphologic features (nuclear pleomorphism, mitoses including abnormal forms, and coagulative tumor necrosis). The development of this classification specifically did not include tumors with oncocytic or Hürthle cell cytology, and only sparse literature describing poorly differentiated oncocytic carcinomas is available. In this study, we examined a cohort of 284 cases of oncocytic follicular carcinoma/Hürthle cell carcinoma (OFC/HCC) and identified 17 cases of oncocytic variant of poorly differentiated carcinoma (OV-PDTC) based on Turin criteria. Compared to minimally invasive and angioinvasive OFC/HCC, these tumors arose in older patients (range 44–88 years; average 71 years), were larger (average size 4.5 cm), and all had extensive vascular invasion (5–15 foci), and coagulative tumor necrosis and the tumor cells were arranged in a trabecular or solid growth pattern. All showed an admixture of oncocytic follicular/Hürthle cells arranged in solid and trabecular growth pattern. Aggregates of small sized cells with minimal eosinophilic cytoplasm, comprising 10–20 % of the entire tumor mass were also seen in 16/17 cases. Clinical follow-up was available in 12 cases and ranged from 6 to 120 months (average 41 months). Distant metastases were seen in 10/12 (83 %) patients; two had lung and one had bone metastases at the time of thyroid surgery, and four subsequently developed cervical lymph node metastases. Two patients died of disease, and ten are alive either with or free of tumor. The OV-PDTC is a distinct entity which can be identified based on Turin criteria and the presence of a distinct “small cell” component. It is frequently associated with regional recurrence and distant metastases and can lead to tumor-related demise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Carcangiu ML, Zampi G, Rosai J. Poorly differentiated ("insular") thyroid carcinoma. A reinterpretation of Langhans' "wuchernde Struma". Am J Surg Pathol1984; 8:655–668

    Article  CAS  PubMed  Google Scholar 

  2. Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid. Cancer1983; 52:1849–1855

    Article  CAS  PubMed  Google Scholar 

  3. Hiltzik D, Carlson DL, Tuttle RM, Chuai S, Ishill N, Shaha A, Shah JP, Singh B, Ghossein RA. Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients. Cancer2006; 106:1286–1295

    Article  PubMed  Google Scholar 

  4. Volante M, Landolfi S, Chiusa L, Palestini N, Motta M, Codegone A, Torchio B, Papotti MG. Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer2004; 100:950–957

    Article  PubMed  Google Scholar 

  5. Akslen LA, LiVolsi VA. Poorly differentiated thyroid carcinoma—it is important. American Journal of Surgical Pathology2000; 24:310–313

    Article  CAS  PubMed  Google Scholar 

  6. Akslen LA, LiVolsi VA. Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma. [see comments]. Cancer2000; 88:1902–1908

    Article  CAS  PubMed  Google Scholar 

  7. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, Lloyd RV, LiVolsi VA, Papotti M, Sobrinho-Simoes M, Bussolati G, Rosai J. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol2007; 31:1256–1264

    Article  PubMed  Google Scholar 

  8. DeLellis RA, Lloyd RD, Heitz PU, Eng C, eds. WHO: Pathology and Genetics. Tumours of Endocrine Organs. Lyon, France: IARC Press; 2004. Kleihues P, Sobin LE, eds. WHO Classification of Tumours

  9. Dettmer M, Schmitt A, Steinert H, Moch H, Komminoth P, Perren A. Poorly differentiated oncocytic thyroid carcinoma—diagnostic implications and outcome. Histopathology2012; 60:1045–1051

    Article  PubMed  Google Scholar 

  10. Samulski TD, Bai S, LiVolsi VA, Montone K, Baloch Z. Malignant potential of small oncocytic follicular carcinoma/Hurthle cell carcinoma: an institutional experience. Histopathology2013; 63:568–573

    PubMed  Google Scholar 

  11. Friedman N. Celluar involution in thyroid gland; significance of Hürthle cells in myxedema, exhaustion atrophy, Hashimoto's disease and reaction to irradiation, thiouracil therapy and subtotal resection. J Clin Endocrinol Metab1949; 9:874–882

    Article  CAS  PubMed  Google Scholar 

  12. Sobrinho-Simoes MA, Nesland JM, Holm R, Sambade MC, Johannessen JV. Hurthle cell and mitochondrion-rich papillary carcinomas of the thyroid gland: an ultrastructural and immunocytochemical study. Ultrastruct Pathol1985; 8:131–142

    Article  CAS  PubMed  Google Scholar 

  13. Asa SL. My approach to oncocytic tumours of the thyroid. J Clin Pathol2004; 57:225–232

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Bronner M, LiVolsi V. Oxyphilic (Askanazy/Hurthle cell) tumors of the thyroid: Microscopic features predict biologic behavior. Surg Pathol1988; 1:137–150

    Google Scholar 

  15. Thompson N, Dun E, Batsakis J, Nishiyama R. Hürthle cell lesions of the thyroid gland. Surg Gynecol Obstet1974; 139:555–560

    CAS  PubMed  Google Scholar 

  16. Johnson TL, Lloyd RV, Burney RE, Thompson NW. Hurthle cell thyroid tumors. An immunohistochemical study. Cancer1987; 59:107–112

    Article  CAS  PubMed  Google Scholar 

  17. Arganini M, Behar R, Wu TC, Straus F, 2nd, McCormick M, DeGroot LJ, Kaplan EL. Hurthle cell tumors: a twenty-five-year experience. Surgery1986; 100:1108–1115

    CAS  PubMed  Google Scholar 

  18. Gosain AK, Clark OH. Hurthle cell neoplasms. Malignant potential. Archives of Surgery1984; 119:515–519

    Article  CAS  PubMed  Google Scholar 

  19. Har-El G, Hadar T, Segal K, Levy R, Sidi J. Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy. Cancer1986; 57:1613–1617

    Article  CAS  PubMed  Google Scholar 

  20. Flint A, Lloyd RV. Hurthle-cell neoplasms of the thyroid gland. Pathol Annu1990; 25 Pt 1:37–52

    PubMed  Google Scholar 

  21. Carcangiu ML, Bianchi S, Savino D, Voynick IM, Rosai J. Follicular Hurthle cell tumors of the thyroid gland. Cancer1991; 68:1944–1953.

    Article  CAS  PubMed  Google Scholar 

  22. Rosai J, Carcangui ML, DeLellis RA. Tumors of The Thyroid Gland. Vol 3rd Series, Fascicle 5. Washington, DC: Armed Forces Institute of Pathology.

  23. Gundry S, Burney R, Thompson N, Lloyd R. Total thyroidectomy for Hürthle cell neoplasm of the thyroid gland. Arch Surg1983; 118:529–553

    Article  CAS  PubMed  Google Scholar 

  24. Watson R, Brennan M, Goellner J, van Heerden J, McConahey W, Taylor W. Invasive Hürthle cell carcinoma of the thyroid: natural history and management. Mayo Clin Proc1984; 59:851–855

    Article  CAS  PubMed  Google Scholar 

  25. Granner DK, Buckwalter JA. Poorly differentiated carcinoma of the thyroid gland. Surg Gynecol Obstet1963; 116:650–656

    CAS  PubMed  Google Scholar 

  26. Papotti M, Botto Micca F, Favero A, et al. Poorly differentiated thyroid carcinomas with primordial cell component: A group of aggressive lesions sharing insular, trabecular and solid patterns. Am J Surg Pathol1993; 17:291

    Article  CAS  PubMed  Google Scholar 

  27. Pilotti S, Collini P, Manzari A, Marubini E, Rilke F. Poorly differentiated forms of papillary thyroid carcinoma: distinctive entities or morphological patterns? Semin Diagn Pathol1995; 12:249–255

    CAS  PubMed  Google Scholar 

  28. Pilotti S, Collini P, Mariani L, Placucci M, Bongarzone I, Vigneri P, Cipriani S, Falcetta F, Miceli R, Pierotti MA, Rilke F. Insular carcinoma: a distinct de novo entity among follicular carcinomas of the thyroid gland. Am J Surg Pathol1997; 21:1466–1473

    Article  CAS  PubMed  Google Scholar 

  29. Decaussin M, Bernard MH, Adeleine P, Treilleux I, Peix JL, Pugeat M, Tourniaire J, Berger N. Thyroid carcinomas with distant metastases: a review of 111 cases with emphasis on the prognostic significance of an insular component. Am J Surg Pathol2002; 26:1007–1015

    Article  PubMed  Google Scholar 

  30. Sobrinho-Simoes M, Sambade C, Fonseca E, Soares P. Poorly differentiated carcinomas of the thyroid gland: a review of the clinicopathologic features of a series of 28 cases of a heterogeneous, clinically aggressive group of thyroid tumors. Int J Surg Pathol2002; 10:123–131

    Article  PubMed  Google Scholar 

  31. Asioli S, Erickson LA, Righi A, Jin L, Volante M, Jenkins S, Papotti M, Bussolati G, Lloyd RV. Poorly differentiated carcinoma of the thyroid: validation of the Turin proposal and analysis of IMP3 expression. Mod Pathol2010; 23:1269–1278

    Article  PubMed  Google Scholar 

  32. Lazzi S, Spina D, Als C, Tosi P, Mazzucchelli L, Kraft R, Laissue JA, Cottier H. Oncocytic (Hurthle cell) tumors of the thyroid: distinct growth patterns comparedwith clinicopathological features. Thyroid1999; 9:97–103

    Article  CAS  PubMed  Google Scholar 

  33. Papotti M, Torchio B, Grassi L, et al. Poorly differentiated oxyphilic (Hurthle cell) carcinomas of the thyroid. Am J Surg Pathol1996; 20:686–694

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Pavilion, Philadelphia, PA, 19104, USA

    Shuting Bai, Zubair W. Baloch, Teresa D. Samulski, Kathleen T. Montone & Virginia A. LiVolsi

Authors
  1. Shuting Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zubair W. Baloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teresa D. Samulski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathleen T. Montone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Virginia A. LiVolsi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zubair W. Baloch.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bai, S., Baloch, Z.W., Samulski, T.D. et al. Poorly Differentiated Oncocytic (Hürthle Cell) Follicular Carcinoma: an Institutional Experience. Endocr Pathol 26, 164–169 (2015). https://doi.org/10.1007/s12022-015-9367-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12022-015-9367-6

Keywords

Search

Navigation