Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and Risk of Malignancy

This study assesses the role of [18F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1–2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy—12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.

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Expression of Autophagy-Related Proteins in Hürthle Cell Neoplasm Is Different from That in Follicular Neoplasm

Disease Markers ◽

10.1155/2017/1372387 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Yoon Jin Cha ◽

Hye Min Kim ◽

Ja Seung Koo

Keyword(s):

Western Blot ◽

Immunohistochemical Staining ◽

Beclin 1 ◽

Follicular Neoplasm ◽

Clinical Implications ◽

Positive Staining ◽

Hürthle Cell ◽

Cell Neoplasm ◽

Expression Rate ◽

Related Proteins

Purpose. We aimed to evaluate expression of autophagy-related proteins in Hürthle cell neoplasm (HCN) and follicular neoplasm (FN) and assess the clinical implications. Methods. 265 FNs (112 follicular carcinomas and 153 follicular adenomas) and 108 HCNs (27 Hürthle cell carcinomas and 81 Hürthle cell adenomas) were made into a tissue microarray. Immunohistochemical staining and Western blot for autophagy-related proteins (beclin-1, light chain (LC) 3A, LC3B, p62, and BNIP3) were performed, and the results were statistically analyzed. Results. A higher expression rate of beclin-1, LC3B, p62, and BNIP3 was found in HCN than in FN (P<0.001). The expression rate of beclin-1, LC3B, p62, and BNIP3 was the highest in HCCs followed by HCAs, FCs, and FAs in that order (P<0.001). HCCs were positive for the largest number of autophagy-related proteins followed by HCAs, FCs, and FAs (P<0.001), and most of the positive markers identified in HCCs were the high autophagy type (P<0.001), defined by positive staining for three or more of the five autophagy-related proteins. Conclusion. The autophagy-related proteins, beclin-1, LC3A, LC3B, p62, and BNIP3, were more frequently expressed in HCNs than in FNs, and HCCs showed the highest expression rate.

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Does the fine-needle aspiration diagnosis of ?H�rthle-cell neoplasm/follicular neoplasm with oncocytic features? denote increased risk of malignancy?

Diagnostic Cytopathology ◽

10.1002/dc.20132 ◽

2004 ◽

Vol 31 (5) ◽

pp. 307-312 ◽

Cited By ~ 100

Author(s):

Tamar Giorgadze ◽

Esther D. Rossi ◽

Guido Fadda ◽

Prabodh K. Gupta ◽

Virginia A. LiVolsi ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Fine Needle ◽

Increased Risk ◽

Cell Neoplasm ◽

Risk Of Malignancy

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Should “Indeterminate” Diagnoses Be Used for Thyroid Fine-Needle Aspirates of Nodules Smaller Than 1 cm?

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0575-oa ◽

2013 ◽

Vol 137 (11) ◽

pp. 1627-1629 ◽

Cited By ~ 8

Author(s):

Andrew A. Renshaw ◽

Edwin W. Gould

Keyword(s):

Papillary Carcinoma ◽

Follicular Cells ◽

Fine Needle ◽

Fine Needle Aspirates ◽

Hürthle Cell ◽

Cell Neoplasm ◽

Risk Of Malignancy ◽

Bethesda System ◽

The Bethesda System ◽

Undetermined Significance

Context.—The Bethesda System for thyroid fine-needle aspirates does not account for the size of the lesion that is aspirated. Objective.—To determine whether the size of the lesion would be helpful in order to reduce indeterminate thyroid aspirations. Design.—We correlated the results of all thyroid aspirations and surgical resection for the last 16 years at our institutions. Results.—A total of 9080 cases were aspirated and 1393 resections were performed. Of those resected, a total of 236 (17%) were classified as atypical follicular cells of undetermined significance, and 256 (18%) were classified as suspicious for a follicular/Hürthle cell neoplasm. A total of 52 incidental papillary carcinomas were identified in these indeterminate cases at resection (52 of 492; 11%). Thirty-seven (16%) atypical follicular cells of undetermined significance cases and 21 (8%) suspicious for a follicular/Hürthle cell neoplasm cases were for nodules smaller than 1 cm in diameter. When cases subtyped as atypical, a papillary carcinoma cannot be ruled out, were removed (13 cases), the remaining 24 and 21 aspirates identified 3 tumors each (13% and 14%), all papillary carcinomas. Together, the incidence of identified carcinomas was not significantly different than that of incidental carcinomas (13% versus 11%, P = .48). The rate of identified carcinomas was significantly less than for similar indeterminate cases smaller than 1 cm (excluding cases of atypical, papillary carcinoma cannot be ruled out) (88 of 330 cases; 27%; P = .05). Conclusions.—For nodules smaller than 1 cm in our series, indeterminate aspirates without features of papillary carcinomas have the same risk of malignancy as benign aspirates.

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Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms

Radiology and Oncology ◽

10.1515/raon-2016-0025 ◽

2016 ◽

Vol 50 (3) ◽

pp. 269-273 ◽

Cited By ~ 3

Author(s):

Andrej Vogrin ◽

Hana Besic ◽

Nikola Besic ◽

Maja Marolt Music

Keyword(s):

Lymph Nodes ◽

Preoperative Diagnosis ◽

Ultrasound Examination ◽

Follicular Neoplasm ◽

Lateral Neck ◽

Regional Lymph Nodes ◽

Neck Ultrasound ◽

Hürthle Cell ◽

Cell Neoplasm

Abstract Background Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm. Patients and methods Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma. Results Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm. Conclusions Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.

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