Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1098-1101. doi: 10.19723/j.issn.1671-167X.2020.06.018

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Analysis of diagnosis and treatment of 100 patients with Hürthle cell adenoma

Qi KANG1,2,Ji-xin ZHANG3,Ying GAO1,(),Jun-qing ZHANG1,Xiao-hui GUO1   

  1. 1. Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
    2. Department of Geriatrics, First Affiliated Hospital of Tsinghua University, Beijing 100016, China
    3. Department of Pathology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-05-25 Online:2020-12-18 Published:2020-12-13
  • Contact: Ying GAO E-mail:bjgaoying@yahoo.com

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Abstract:

Objective: To summarize and analyze the clinical data and prognosis of the patients with Hürthle cell tumor (HCT) in order to raise the clinicians’ awareness of the disease. Methods: The clinical data on patients with histopathologically proven HCT, without other thyroid carcinomas, were collected retrospectively in Peking University First Hospital from January 2001 to February 2017. All the patients underwent surgery due to thyroid nodules. The follow-up information was also collected. Results: A total of 100 patients were enrolled in the current study. All of them were diagnosed with Hürthle cell adenoma (HCA). There were 77 females and 23 males, with the male-to-female ratio of 1:3.3. The average age of these patients was (52±14) years at the time of operation. Fifty-one patients were found their thyroid nodules accidentally by ultrasonography during their health check-ups. 69.4% of the 49 symptomatic patients presented with painless cervical nodules. 83.0% HCA patients were combined with multinodular goiters (MNGs). 88.4% (76/86) patients were euthyroid and 53.8% (21/39) had increasing thyroglobulin levels. The mean longest diameter of HCAs was (3.2±1.5) cm (range: 0.9-7.3 cm) on ultrasonography. There were a series of sonographic features of HCA, such as larger, solidity, hypoecho, a smooth outline, intranodular vascularization, perinodular vascularization, absence of calcification in nodules and absence of enlarged cervical lymph nodes. Compared with the histological diagnosis, the diagnostic accuracy by frozen section (FS) during operation was 97.4%. Twenty-nine patients were followed up with an average period of (49.2±22.1) months and none of them had local recurrence or cervical lymph node metastasis. Six patients accepted thyroid hormone replacement treatment and one had thyrotoxicosis due to over-dose. Conclusion: HCA is more common in women. It is often found accidentally by ultrasonography during their health check-ups or presented with painless cervical nodules. It is combined with MNG frequently. HCA exhibits numerous sonographic features but not unique. FS during operation is a reliable method to identify HCA with high diagnostic accuracy. Patients with thyroid hormone administration should be monitored for thyroid function after thyroid surgery.

Key words: Thyroid gland, Hürthle cell tumor, Adenoma, Diagnosis

CLC Number: 

  • R736.1

Table 1

Nonmalignant thyroid diseases of 53 HCA patients"

Nonmalignant thyroid diseases Cases Ratio
MNG 44 83.0%
HT 2 3.8%
Graves’ disease 2 3.8%
FTA 3 5.7%
HT with FTA 1 1.9%
MNG with HT 1 1.9%

Table 2

Analysis of the sonographic features of 100 HCA patients before the operation"

Sonographic features of HCA Cases Ratio
Composition
Total 88
Solid 64 72.7%
Solid-cystic 24 27.3%
Margin
Total 88
Well-defined 83 94.3%
Ill-defined 5 5.7%
Echogenicity
Total 44
Hypo-anechoic 1 2.3%
Hypoechoic 23 52.3%
Isoechoic 18 40.9%
Mixed 2 4.5%
Intranodular vascularization
Total 76
Yes 64 84.2%
No 12 15.8%
Perinodular vascularization
Total 20
Yes 19 95.0%
No 1 5.0%
Internal calcifications
Total 85
Yes 7 8.2%
Suspected 1 1.2%
No 77 90.6%
Enlarged cervical lymph nodes
Total 76
Yes 13 17.1%
No 63 82.9%
[1] DeLellis RA, Lloyd RA, Heitz PU, et al. 2004 World Health Organization classification of tumors. Pathology and genetics of tumors of endocrine glands [M]. France: IARC Press, Lyon: 2004.
[2] Carcangiu ML, Bianchi S, Savino D, et al. Follicular Hürthle cell tumors of the thyroid gland[J]. Cancer, 1991,68(9):1944-1953.
doi: 10.1002/1097-0142(19911101)68:9<1944::aid-cncr2820680917>3.0.co;2-i pmid: 1913544
[3] 崔志英, 张桦, 严梦寒. 甲状腺嗜酸细胞肿瘤超声表现[J]. 中国实用医刊, 2015,42(18):23-25.
[4] Lee SK, Rho BH, Woo SK. Hürthle cell neoplasm: correlation of gray-scale and power Doppler sonographic findings with gross pathology[J]. J Clin Ultrasound, 2010,38(4):169-176.
doi: 10.1002/jcu.20684 pmid: 20222048
[5] 杨觅. 甲状腺嗜酸细胞肿瘤的研究进展[J]. 医学研究生学报, 2004,17(1):75-77.
[6] 李俊生, 嵇振岭, 张亚男, 等. 甲状腺Hürthle细胞肿瘤15例诊治分析[J]. 中国实用外科杂志, 2008,28(4):283-284.
[7] Sippel RS, Elaraj DM, Khanafshar E, et al. Tumor size predicts malignant potential in Hürthle cell neoplasms of the thyroid[J]. World J Surg, 2008,32(5):702-707.
doi: 10.1007/s00268-007-9416-5 pmid: 18224463
[8] Chiappetta G, Toti P, Cetta F, et al. The RET/PTC oncogene is frequently activated in oncocytic thyroid tumors (Hürthle cell adenomas and carcinomas), but not in oncocytic hyperplastic lesions[J]. J Clin Endocrinol Metab, 2002,87(1):364-369.
doi: 10.1210/jcem.87.1.8180 pmid: 11788677
[9] Pisanu A, Di Chiara B, Reccia I, et al. Oncocytic cell tumors of the thyroid: Factors predicting malignancy and influencing prognosis, treatment decisions, and outcomes[J]. World J Surg, 2010,34(4):836-843.
doi: 10.1007/s00268-009-0357-z pmid: 20041243
[10] 李玉姝, 单忠艳, 关海霞, 等. 甲状腺过氧化物酶抗体和甲状腺球蛋白抗体阳性临界值的确定及其临床意义[J]. 中华检验医学杂志, 2006,29(9):780-783.
[11] 张韵华, 刘利民, 夏罕生, 等. 甲状腺嗜酸性腺瘤的超声表现[J]. 中国临床医学, 2009,16(5):775-777.
[12] Sangalli G, Serio G, Zampatti C, et al. Fine needle aspiration cytology of the thyroid a comparison of 5469 cytological and final histological diagnoses[J]. Cytopathology, 2006,17(5):245-250.
doi: 10.1111/j.1365-2303.2006.00335.x pmid: 16961652
[13] Gonzalez JL, Wang HH, Ducatman BS. Fine needle aspiration of Hürthle cell lesions. A cytomorphologic approach to diagnosis[J]. Am J Clin Patho, 1993,100(3):231-235.
[14] 马振海, 赵永福, 李世正, 等. 甲状腺嗜酸细胞腺瘤临床病理特点与外科治疗[J]. 中华内分泌外科杂志, 2011,5(4):283.
[15] Chen H, Nicol TL, Zeiger MA, et al. Hürthle cell neoplasms of the thyroid: Are there factors predictive of malignancy?[J]. Am Surg, 1998,227(4):542-546.
[16] Sugino K, Ito K, Mimura T, et al. Hürthle cell tumor of the thyroid: analysis of 188 cases[J]. World J Surg, 2001,25(9):1160-1163.
doi: 10.1007/BF03215865 pmid: 11571953
[17] Hillman N, Haniisson D, Hemmz L, et al. Hürthle cell tumors[J]. Ann Med Interne (Paris), 1997,148(6):434-439.
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