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
- 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
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Further information, not for memorising (no card)
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