Abstract
The prediction of outcome in the rare Hürthle cell tumor of the thyroid continues to present a problem to surgeons and pathologists. To better clarify the distinctions between benign and malignant tumors, we have measured DNA content by flow cytometry on isolated cell nuclei derived from archival paraffin-embedded tissue blocks of 125 Hürthle cell tumors operated from 1943 to 1985 at the Mayo Clinic, Rochester, Minnesota, U.S.A. Nuclear DNA ploidy patterns were divided into 3 groups. A DNA normal (diploid) pattern was found in 55% of 75 Hürthle cell adenomas and in 26% of 50 Hürthle cell cancers; a DNA tetraploid/polyploid pattern was found in 11% of benign, and 14% of malignant tumors. An abnormal DNA stemline was detected in 34% of benign and 60% of malignant tumors. Hürthle cell cancer was the histologic diagnosis in 24% of the DNA normal, 47% of the DNA tetraploid/polyploid, and 54% of the DNA aneuploid tumors. None of the patients with adenomas developed tumor recurrence. However, 20% of the euploid and 40% of the aneuploid tumors developed local or distant recurrences. Survival to thyroid cancer death was significantly correlated with DNA ploidy status (p=0.02) but did not correlate with either tumor size or histologic grade. To date, deaths from thyroid cancer have been confined to patients whose tumors were DNA aneuploid. We would conclude that determination of DNA ploidy status may not aid the surgical pathologist in the diagnosis of Hürthle cell cancer. However, when a patient's Hürthle cell cancer is DNA aneuploid, there is significant risk of death from thyroid cancer.
Résumé
Prévoir l'évolution des tumeurs de Hürthle, rares, continue de poser un problème aux chirurgiens et aux anatomopathologistes. Afin de clarifier les différences entre les tumeurs bénignes et malignes, nous avons mesuré le contenu d'ADN des noyaux cellulaires isolés provenant de 125 pièces archivées et conservées en paraffine de tumeurs de Hürthle, opérés à la clinique Mayo, Rochester, Minnesota, entre 1943 et 1985. Selon la diploïdie nucléaire, ces tumeurs ont été divisées en 3 groupes. L'ADN a été classé normal dans 55% des 75 tumeurs de Hürthle bénignes et dans 26% des 50 tumeurs de Hürthle malignes; il était tétraploïde/polyploïde dans 11% des tumeurs bénignes, et dans 14% des tumeurs malignes. Une lignée anormale d'ADN a été détectée dans 34% des tumeurs bénignes et dans 60% des tumeurs malignes. Un cancer a été trouvé dans 24% des tumeurs à ADN normal, 47% des tumeurs à ADN tétraploïde/polyploïde et 54% des tumeurs à ADN aneuploïde. Aucun des patients ayant un adénome ne présentait de récidive. Cependant 20% des tumeurs euploïdes et 40% des tumeurs aneuploïdes ont développé une récidive locale à distance. La survie des patients cancéreux a été corrélé positivement avec l'état de ploïdie de l'ADN (p=0.02) mais ni avec la taille de la tumeur ni avec le degré de différentiation. Jusqu'à ce jour, les seuls décès dus an cancer se sont produits parmi les patients présentant une tumeur à ADN aneuploïde. Nous concluons que l'état de ploïdie de l'ADN n'aide pas dans le diagnostic des cancers des cellules de Hürthle. Cependant, lorsque le cancer des cellules de Hürthle est de type aneuploïde, le risque de mourir du cancer thyroïdien est élevé.
Resumen
La predicción del resultado final en la evolución de los raros tumores de células de Hürthle de la glándula tiroides continua siendo un problema para cirujanos y patólogos. Con el objeto de poder clarificar mejor la diferenciación entre los tumores benignos y los malignos, hemos realizado determinaciones del contenido de DNA mediante citometría de flujo sobre núcleos celulares aislados a partir de bloques de tejido incluído en parafina provenientes de 125 pacientes con tumores de células de Hürthle operados en la Clínica Mayo, Rochester, Minnesota, desde 1943 hasta 1985. Los patrones ploidales de DNA fueron divididos en 3 grupos. Un patrón de DNA normal (diploide) fue hallado en 55% de 75 adenomas de células de Hürthle y en 26% de 50 cánceres de células de Hürthle; un patrón tetraploide/ poliploide de DNA fue hallado en 11% de los tumores benignos, y en 14% de los malignos. Se detectó una linea primitiva anormal de DNA en 34% de los tumores benignos y en 60% de los malignos. Cáncer de células de Hürthle fue el diagnóstico histológico en 24% de los tumores con DNA normal, 47% de los tumores con DNA tetraploide/poliploide, y 54% de los tumores con DNA aneuploide. Ninguno de los pacientes con adenomas desarrolló recurrencia tumoral. Sin embargo, 20% de los euploides y 40% de los aneuploides desarrollaron recurrencias locales o distales. La supervivencia hasta la muerte por cancer tiroideo apareció significativamente correlacionada con el estado ploidal del DNA (p=0.02) pero nó con el tamaño o el grado histológico del tumor. Hasta la fecha las muertes por cancer de tiroides aparecen limitadas a los pacientes cuyos tumores presentaron DNA aneuploide. Podríamos proponer la conclusion de que la determinatión del estado ploidal del DNA puede no ser de ayuda para el patólogo en el diagnóstico de cáncer de células de Hürthle. Sinembargo, cuando el cancer de células de Hürthle presenta un patrón aneuploide de DNA existe considerable riesgo de muerte por cáncer de tiroides.
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Ryan, J.J., Hay, I.D., Grant, C.S. et al. Flow cytometric DNA measurements in benign and malignant Hürthle cell tumors of the thyroid. World J. Surg. 12, 482–487 (1988). https://doi.org/10.1007/BF01655427
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DOI: https://doi.org/10.1007/BF01655427