Hurthle cell adenoma of the mediastinum: Intraoperative cytology and differential diagnosis with correlative gross, histology, and ancillary studies

Abstract Context.—Hürthle cells are eosinophilic, follicular-derived cells that are associated with a variety of nonneoplastic and neoplastic thyroid lesions. The differential diagnosis of Hürthle cell lesions is quite broad. Objective.—To review the pathologic conditions associated with Hürthle cells in the thyroid and to discuss pathology of thyroid lesions associated with oncocytic cytology. Data Sources.—A variety of thyroid nonneoplastic (autoimmune thyroiditis, multinodular goiter) and neoplastic conditions (Hürthle cell adenoma, Hürthle cell carcinoma) are associated with Hürthle cell cytology. In addition, there are several thyroid neoplasms that should be considered when one observes a Hürthle cell neoplasm in the thyroid (oncocytic variant of medullary carcinoma, several variants of papillary thyroid carcinoma). Conclusions.—Oncocytic cytology is seen in a variety of thyroid conditions that are associated with a broad differential diagnosis and care must be used for accurate diagnosis. Newer molecular-based techniques may be useful for further classification of thyroid neoplasms with oncocytic pathology.

Download Full-text

The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland

BMC Medical Imaging ◽

10.1186/s12880-020-00506-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lihui Zhao ◽

Yiran Mao ◽

Jie Mu ◽

Jing Zhao ◽

Fangxuan Li ◽

...

Keyword(s):

Differential Diagnosis ◽

Parotid Gland ◽

Color Doppler ◽

Benign Tumors ◽

Color Doppler Flow Imaging ◽

Cell Adenoma ◽

Mixed Distribution ◽

Superb Microvascular Imaging ◽

Grade 3 ◽

Microvascular Imaging

Abstract Background We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin’s tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. Methods The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. Results The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI. Conclusion SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

Download Full-text

Phyllodes Tumor Metastatic to Thyroid HürthleCell Adenoma

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-1233-ptmtth ◽

2002 ◽

Vol 126 (10) ◽

pp. 1233-1236

Author(s):

Tamar Giorgadze ◽

Richard M. Ward ◽

Zubair W. Baloch ◽

Virginia A. LiVolsi

Keyword(s):

Tumor Metastasis ◽

Unusual Case ◽

Cellular Proliferation ◽

Phyllodes Tumor ◽

Thyroid Tumor ◽

Cell Adenoma ◽

Malignant Phyllodes Tumor ◽

Hürthle Cell ◽

Thyroid Mass ◽

Tumor To Tumor Metastasis

Abstract We present a case of a malignant phyllodes tumor metastasizing to a Hürthle cell adenoma of the thyroid. A 55-year-old woman underwent mastectomy for a malignant phyllodes tumor. Two years later, she presented with a left thyroid mass, which was a single, circumscribed, soft, deep red-brown nodular lesion with an eccentric area of firmer consistency. Histologically, the thyroid tumor was composed of 2 distinct types of cellular proliferation. Atypical spindle cells were infiltrating between the Hürthle cell cords and follicles in a fibrosarcomatous pattern. A battery of immunohistochemical stains was applied to both the thyroid and breast tumors for comparison. Based on the histologic and immunophenotypic features of the fibrosarcomatous components of both the breast and thyroid tumors, we rendered a diagnosis of cystosarcoma phyllodes metastatic to Hürthle cell adenoma. To the best of our knowledge, this unusual case is a first report of tumor-to-tumor metastasis of a sarcoma to a primary thyroid neoplasm.

Download Full-text

Genetics, Diagnosis, and Management of Hürthle Cell Thyroid Neoplasms

Frontiers in Endocrinology ◽

10.3389/fendo.2021.696386 ◽

2021 ◽

Vol 12 ◽

Author(s):

David G. McFadden ◽

Peter M. Sadow

Keyword(s):

Molecular Genetic ◽

Thyroid Neoplasms ◽

Invasive Disease ◽

Thyroid Tumor ◽

Molecular Testing ◽

Cell Adenoma ◽

Tumor Subtypes ◽

Hürthle Cell ◽

Hürthle Cell Tumors ◽

Widely Invasive

Hürthle cell lesions have been a diagnostic conundrum in pathology since they were first recognized over a century ago. Controversy as to the name of the cell, the origin of the cell, and even which cells in particular may be designated as such still challenge pathologists and confound those treating patients with a diagnosis of “Hürthle cell” anything within the diagnosis, especially if that anything is a sizable mass lesion. The diagnosis of Hürthle cell adenoma (HCA) or Hürthle cell carcinoma (HCC) has typically relied on a judgement call by pathologists as to the presence or absence of capsular and/or vascular invasion of the adjacent thyroid parenchyma, easy to note in widely invasive disease and a somewhat subjective diagnosis for minimally invasive or borderline invasive disease. Diagnostic specificity, which has incorporated a sharp increase in molecular genetic studies of thyroid tumor subtypes and the integration of molecular testing into preoperative management protocols, continues to be challenged by Hürthle cell neoplasia. Here, we provide the improving yet still murky state of what is known about Hürthle cell tumor genetics, clinical management, and based upon what we are learning about the genetics of other thyroid tumors, how to manage expectations, by pathologists, clinicians, and patients, for more actionable, precise classifications of Hürthle cell tumors of the thyroid.

Download Full-text