Abstract
Hurthle cell lesion is one of the most questionable clinico-pathological entities in most of its aspects. Literature has used the terms oncocytic, oxyphilic, Hurthle, and Ashkanazy interchangeably; what does each term denote? Who first described these cells? What is the cell of origin? How much Hurthle cells should be present to define the lesion as Hurthle cell one? Is it possible to differentiate hyperplastic from neoplastic and benign from malignant Hurthle cell lesion on a non-histopathologic ground? Does it belong to follicular or to papillary neoplasms or should it be classified separately? Can we anticipate its clinical behavior or predict its outcome? How can we manage? We will try to answer these questions in light of the ongoing relevant arguments with the aim of resolving some uncertainties and suggesting how to solve others.
Similar content being viewed by others
References
Wakely PE Jr (2008) Oncocytic and oncocyte-like lesions of the head and neck. Ann Diagn Pathol 12(3):222–230
Kontaxis A, Zanarotti U, Kainz J, Beham A (2004) Die diffuse Onkozytose der Glandula Parotidea. Laryngo-Rhino-Otologie 83(03):185–188
Prabakaran SS, Chen F, Aguirre A (2010) Oncocytoma of the parotid gland and its mimickers: a comprehensive review. N Am J Med Sci 3:171–180
Mete O, Asa SL (2010) Oncocytes, oxyphils, Hurthle, and Askanazy cells: morphological and molecular features of oncocytic thyroid nodules. Endocr Pathol 21(1):16–24
Hurthle K (1894) BeitrÃgezurKenntniss des Secretionsvorgangs in der. SchilddrÃse. Pflugers Arch Physiol 56:10–44
Ashkanazy M (1898) Pathologisch-anatomischeBeitrÃgezurKenntniss des. MorbusBasedowii, insbesondere über die dabeiauftretendeMuskelerkrankung. Dtsch Arch Klin Med 61:118–186
Johnson TL, Lloyd RV, Burney RE, Thompson NW (1987) Hurthle cell thyroid tumors. An immunohistochemical study. Cancer 59(1):107–112
Clark OH, Gerend PL (1985) Thyrotropin receptor-adenylate cyclase system in Hurthle cell neoplasms. J Clin Endocrinol Metab 61(4):773–778
Chen H, Udelsman R (2005) Chapter 14 - Hürthle cell adenoma and carcinoma. In: Kebebew OHC-YD (ed) Textbook of endocrine surgery, 2nd edn. W.B. Saunders, Philadelphia, pp 123–128
Evans HL, Vassilopoulou-Sellin R (1998) Follicular and Hurthle cell carcinomas of the thyroid: a comparative study. Am J Surg Pathol 22(12):1512–1520
Sanders LE, Silverman M (1998) Follicular and Hürthle cell carcinoma: predicting outcome and directing therapy. Surgery 124(6):967–974
Masood S, Auguste L-J, Westerband A et al (1993) Differential oncogenic expression in thyroid follicular and Hürthle cell carcinomas. Am J Surg 166(4):366–368
Stankov K, Romeo G (2003) Oxyphilic carcinoma of the thyroid gland. Arch Oncol 11(2):81–89
Rosai J, Kuhn E, Carcangiu ML (2006) Pitfalls in thyroid tumour pathology. Histopathology 49(2):107–120
Asa S (2004) My approach to oncocytic tumours of the thyroid. J Clin Pathol 57(3):225–232
Kroeker T, Prisman E, Shah M et al (2014) Hurthle cell lesions-a retrospective review of final surgical pathology. Thyroid Disord Ther 3(155):2
Elliott DD, Pitman MB, Bloom L, Faquin WC (2006) Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland: a cytomorphologic study of 139 cases with statistical analysis. Cancer 108(2):102–109
Barnabei A, Ferretti E, Baldelli R et al (2009) Hurthle cell tumours of the thyroid. Personal experience and review of the literature. Acta Otorhinolaryngol Ital 29(6):305–311
McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A (1999) Follicular or Hu ̈rthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery 126(4):798–804
Pisanu A, Di Chiara B, Reccia I, Uccheddu A (2010) Oncocytic cell tumors of the thyroid: factors predicting malignancy and influencing prognosis, treatment decisions, and outcomes. World J Surg 34(4):836–843
Yang YJ, Khurana KK (2001) Diagnostic utility of intracytoplasmic lumen and transgressing vessels in evaluation of Hurthle cell lesions by fine-needle aspiration. Arch Pathol Lab Med 125(8):1031–1035
Lee KH, Shin JH, Ko ES et al (2013) Predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm of thyroid nodules. Int J Surg 11(9):898–902
Mills SC, Haq M, Smellie WJ, Harmer C (2009) Hurthle cell carcinoma of the thyroid: retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol 35(3):230–234
Hoos A, Stojadinovic A, Singh B et al (2002) Clinical significance of molecular expression profiles of Hurthle cell tumors of the thyroid gland analyzed via tissue microarrays. Am J Pathol 160(1):175–183
Maizlin ZV, Wiseman SM, Vora P et al (2008) Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics. J Ultrasound Med 27(5):751–757, quiz 9
Cannon J (2011) The significance of Hürthle cells in thyroid disease. Oncologist 16(10):1380–1387
Melck A, Bugis S, Baliski C et al (2006) Hemithyroidectomy: the preferred initial surgical approach for management of Hurthle cell neoplasm. Am J Surg 191(5):593–597
Chao T-C, Lin J-D, Chen M-F (2005) Surgical treatment of Hurthle cell tumors of the thyroid. World J Surg 29(2):164–168
Chen H, Nicol TL, Zeiger MA et al (1998) Hurthle cell neoplasms of the thyroid: are there factors predictive of malignancy? Ann Surg 227(4):542–546
Hudak K, Mazeh H, Sippel RS, Chen H (2012) Hürthle cell metaplasia on fine-needle aspiration biopsy is not by itself an indication for thyroid surgery. Am J Surg 203(3):287–291
Montone KT, Baloch ZW, LiVolsi VA (2008) The thyroid Hurthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review. Arch Pathol Lab Med 132(8):1241–1250
Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214
Pu RT, Yang J, Wasserman PG et al (2006) Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? Diagn Cytopathol 34(5):330–334
Alaedeen DI, Khiyami A, McHenry CR (2005) Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells: a dilemma in the management of nodular thyroid disease. Surgery 138(4):650–657
Galera-Davidson H, González-Cámpora R (2008) Chapter 23 - thyroid. In: Wilbur MB (ed) Comprehensive cytopathology, 3rd edn. W.B. Saunders, Edinburgh, pp 633–670
Clark D, Faquin W (2010) Hurthle cell lesions. Thyroid cytopathology. Springer, US, pp 93–107
Kasper K, Stewart J III, Das K (2012) Fine needle aspiration cytology of thyroid nodules with Hürthle cells: cytomorphologic predictors for neoplasms, improving diagnostic accuracy and overcoming pitfalls. J Am Soc Cytopathol 1(1):S62–S63
Baloch ZW, LiVolsi VA, Asa SL et al (2008) Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 36(6):425–437
Chiappetta G, Toti P, Cetta F et al (2002) The RET/PTC oncogene is frequently activated in oncocytic thyroid tumors (Hurthle cell adenomas and carcinomas), but not in oncocytic hyperplastic lesions. J Clin Endocrinol Metab 87(1):364–369
Zhang YW, Greenblatt DY, Repplinger D et al (2008) QS264. Factors that predict malignancy in Hürthle cell neoplasms of the thyroid. J Surg Res 144(2):371–372
Stojadinovic A, Ghossein RA, Hoos A et al (2001) Hurthle cell carcinoma: a critical histopathologic appraisal. J Clin Oncol 19(10):2616–2625
Pisanu A, Sias L, Uccheddu A (2004) Factors predicting malignancy of Hürthle cell tumors of the thyroid: influence on surgical treatment. World J Surg 28(8):761–765
Lopez-Penabad L, Chiu AC, Hoff AO et al (2003) Prognostic factors in patients with Hurthle cell neoplasms of the thyroid. Cancer 97(5):1186–1194
Zhang Y, Greenblatt D, Repplinger D et al (2008) Older age and larger tumor size predict malignancy in Hürthle cell neoplasms of the thyroid. Ann Surg Oncol 15(10):2842–2846
Suh I, Vriens MR, Guerrero MA et al (2010) Serum thyroglobulin is a poor diagnostic biomarker of malignancy in follicular and Ḧurthle-cell neoplasms of the thyroid. Am J Surg 200(1):41–46
Parikh PP, Allan BJ, Lew JI (2013) Surgeon-performed ultrasound predictors of malignancy in patients with Hürthle cell neoplasms of the thyroid. J Surg Res 184(1):247–252
Sugino K, Ito K, Mimura T et al (2001) Hürthle cell tumor of the thyroid: analysis of 188 cases. World J Surg 25(9):1160–1163
Sippel RS, Elaraj DM, Khanafshar E et al (2008) Tumor size predicts malignant potential in Hurthle cell neoplasms of the thyroid. World J Surg 32(5):702–707
Paunovic I, Krgovic K, Tatic S et al (2006) Surgery for thyroid Hürthle cell tumours—a single institution experience. Eur J Surg Oncol 32(4):458–461
Petric R, Besic H, Besic N (2014) Preoperative serum thyroglobulin concentration as a predictive factor of malignancy in small follicular and Hürthle cell neoplasms of the thyroid gland. World J Surg Oncol 12(1):1–7
Arduc A, Dogan BA, Tuna MM, et al (2015) Higher body mass index and larger waist circumference may be predictors of thyroid carcinoma in patients with Hurthle-cell lesion/neoplasm fine-needle aspiration diagnosis. Clin Endocrinol (Oxf) 83(3):405–411
Erickson LA, Jin L, Goellner JR et al (2000) Pathologic features, proliferative activity, and cyclin D1 expression in Hurthle cell neoplasms of the thyroid. Mod Pathol 13(2):186–192
Cheung CC, Ezzat S, Ramyar L et al (2000) Molecular basis of Hurthle cell papillary thyroid carcinoma. J Clin Endocrinol Metab 85(2):878–882
Histopathology A (2004) Histopathology of thyroid tumors. An overview. Hormones 3(2):100–110
Berho M, Suster S (1997) The oncocytic variant of papillary carcinoma of the thyroid: a clinicopathologic study of 15 cases. Hum Pathol 28(1):47–53
Sabino de Matos P (2008) Thyroid epithelial tumours. Diagn Histopathol 14(5):236–246
Lloyd RV, Buehler D, Khanafshar E (2011) Papillary thyroid carcinoma variants. Head Neck Pathol 5(1):51–56
Belchetz G, Cheung CC, Freeman J et al (2002) Hürthle cell tumors: using molecular techniques to define a novel classification system. Arch Otolaryngol Head Neck Surg 128(3):237–240
Musholt PB, Imkamp F, von Wasielewski R et al (2003) RET rearrangements in archival oxyphilic thyroid tumors: new insights in tumorigenesis and classification of Hürthle cell carcinomas? Surgery 134(6):881–889
Nikiforov YE, Biddinger PW, Thompson LDR (2012) Diagnostic pathology and molecular genetics of the thyroid: a comprehensive guide for practicing thyroid pathology. USA, Wolters Kluwer Health
Haigh PI, Urbach DR (2005) The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart. Surgery 138(6):1152–1158
Khafif A, Khafif RA, Attie JN (1999) Hürthle cell carcinoma: a malignancy of low-grade potential. Head Neck 21(6):506–511
Kushchayeva Y, Duh Q-Y, Kebebew E et al (2008) Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer. Am J Surg 195(4):457–462
Dettori T, Frau DV, Lai ML et al (2003) Aneuploidy in oncocytic lesions of the thyroid gland: diffuse accumulation of mitochondria within the cell is associated with trisomy 7 and progressive numerical chromosomal alterations. Genes Chromosom Cancer 38(1):22–31
Wada N, Duh QY, Miura D et al (2002) Chromosomal aberrations by comparative genomic hybridization in hurthle cell thyroid carcinomas are associated with tumor recurrence. J Clin Endocrinol Metab 87(10):4595–4601
Máximo V, Soares P, Lima J et al (2002) Mitochondrial DNA somatic mutations (point mutations and large deletions) and mitochondrial DNA variants in human thyroid pathology: a study with emphasis on Hürthle cell tumors. Am J Pathol 160(5):1857–1865
Carcangiu ML, Bianchi S, Savino D et al (1991) Follicular Hurthle cell tumors of the thyroid gland. Cancer 68(9):1944–1953
Finley DJ, Zhu B, Fahey Iii TJ (2004) Molecular analysis of Hurthle cell neoplasms by gene profiling. Surgery 136(6):1160–1168
Chindris A-M, Casler JD, Bernet VJ, et al (2014) Clinical and molecular features of Hürthle cell carcinoma of the thyroid. J Clin Endocrinol Metab 0(0):jc.2014-1634
Papotti M, Torchio B, Grassi L et al (1996) Poorly differentiated oxyphilic (Hurthle cell) carcinomas of the thyroid. Am J Surg Pathol 20(6):686–694
Dedivitis RA, Di Giovanni JH, Silva GF et al (2004) Oncocytic variant of medullary thyroid carcinoma: case report. Arq Bras Endocrinol Metabol 48(2):315–317
Sobrinho-Simões M, Magalhães J, Fonseca E, Amendoeira I (2005) Diagnostic pitfalls of thyroid pathology. Curr Diagn Pathol 11(1):52–59
Ain K (2000) Unusual types of thyroid cancer. Rev Endocr Metab Disord 1(3):225–231
Bhattacharyya N (2003) Survival and prognosis in Hürthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg 129(2):207–210
Ozlem Kucuk N, Kulak H, Tokmak E et al (2006) Hurthle cell carcinoma: a clinicopathological study of thirteen cases. Nucl Med Commun 27(4):377–379
Yutan E, Clark O (2001) Hürthle cell carcinoma. Curr Treat Options in Oncol 2(4):331–335
Shaha AR, Shah JP, Loree TR (1996) Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg 172(6):692–694
Ruegemer JJ, Hay ID, Bergstralh EJ et al (1988) Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables. J Clin Endocrinol Metab 67(3):501–508
Schneider DF, Chen H (2013) New developments in the diagnosis and treatment of thyroid cancer. CA Cancer J Clin 63(6):373–394
Shaha AR, Loree TR, Shah JP (1995) Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery 118(6):1131–1138
Herrera M, Hay I, Wu PC et al (1992) Hürthle cell (oxyphilic) papillary thyroid carcinoma: a variant with more aggressive biologic behavior. World J Surg 16(4):669–674
McDonald MP, Sanders LE, Silverman ML et al (1996) Hürthle cell carcinoma of the thyroid gland: prognostic factors and results of surgical treatment. Surgery 120(6):1000–1005
Stojadinovic A, Hoos A, Ghossein R et al (2002) Hürthle cell carcinoma: a 60-year experience. Ann Surg Oncol 9(2):197–203
Goldstein NS, Czako P, Neill JS (2000) Metastatic minimally invasive (encapsulated) follicular and Hurthle cell thyroid carcinoma: a study of 34 patients. Mod Pathol 13(2):123–130
Azadian A, Rosen IB, Walfish PG, Asa SL (1995) Management considerations in Hürthle cell carcinoma. Surgery 118(4):711–715
Kauffmann PR, Dejax C, de Latour M, Dauplat J (2004) The meaning and predictivity of Hürthle cells in fine needle aspiration cytology for thyroid nodular disease. Eur J Surg Oncol 30(7):786–789
Gallagher L, Hughes M, McMillian L (2013) National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Thyroid Carcinoma Version 2. 2013. Available from: http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
Alexander EK, Kennedy GC, Baloch ZW et al (2012) Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med 367(8):705–715
Tuzun D, Ersoy R, Kilicyazgan A, et al (2014) Elastosonography scoring and strain index of thyroid nodules with Hurthle cells. Minerva Endocrinol [Epub ahead of print]
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Shawky, M., Sakr, M. Hurthle Cell Lesion: Controversies, Challenges, and Debates. Indian J Surg 78, 41–48 (2016). https://doi.org/10.1007/s12262-015-1381-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-015-1381-x