Review Note

Last Update: 02/18/2024 05:30 AM

Current Deck: Part 2::1. Subsites::Endocrine::Thyroid cancer

Published

Fields:

Front
Endocrine | Thyroid | 1.5.3.4 | Hurthle cell carcinoma
Back
Previously called oncocytic
Previously a sub-category of follicular, re-classified as a separate entity by WHO and AJCC in 2017

Epidemiology:
  • I: 3-10% primary thyroid ca NCCN: 1.8%
  • A: Older patients than follicular, mean age 57 years
  • S: M>F
Aetiology / RFs
  • No known exogenous risk factors 
Biological:
  • More aggressive than follicular
  • Primary often bilateral and multifocal
  • LN mets 30%
  • Haematological spread more common (35%)
    • About twice as common as in FTC
  • 10 year OS 75%
  • Prognostic factors: old age, tumour >4cm, LVSI
 
Macro:
  • Most >2cm
  • Prone to infarction
  • Hemorrhage
  • Solitary and solid
  • Bright brown to mahogany
  • Encapsulated, lobulated, central scar
 
Micro:
  • Cell of origin is unclear – may be related to follicular or papillary
  • Follicular tumour cells with >75% Hurthle cells (large cell, large nuclei, abundant cytoplasm (granular or eosinophilic), cherry pink nucleoli)
  • Can have oncocytes: large size, distinct cell borders, deeply eosinophilic and granular cytoplasm dysfunctional, mitochondria, hypercellular
  • Need capsule to assess invasion → malignant if capsular invasion
  • Nonspecific growth pattern
  • Carcinoma tends to have thicker capsule than adenoma, solid/trabecular rather than follicular growth pattern, smaller cells with high N/C ratio, increased mitotic figures
IHC:
  • TTF1, CK7, TG positive
  • CK20 negative
RAI
  • less uptake than in follicular 


Further information, not for memorising (no card)
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