Hürthle cell
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A '''Hürthle cell''' is a transformed ([[metaplasia]]) [[thyroid follicular cell]] with "enlarged [[Mitochondrion|mitochondria]] and enlarged round [[Cell nucleus|nuclei]] with prominent [[Nucleolus|nucleoli]]", resulting in [[eosinophilia]] in the [[cytoplasm]].{{Cite book |last=Robertson |first=R. Paul |title=DeGroot's Endocrinology, E-Book: Basic Science and Clinical Practice |date=2022 |publisher=Elsevier |isbn=978-0-323-69412-4 |edition=8th |location=Philadelphia |pages=1166}} |
A '''Hürthle cell''' is a transformed ([[metaplasia]]) [[thyroid follicular cell]] with "enlarged [[Mitochondrion|mitochondria]] and enlarged round [[Cell nucleus|nuclei]] with prominent [[Nucleolus|nucleoli]]", resulting in [[eosinophilia]] in the [[cytoplasm]].{{Cite book |last=Robertson |first=R. Paul |title=DeGroot's Endocrinology, E-Book: Basic Science and Clinical Practice |date=2022 |publisher=Elsevier |isbn=978-0-323-69412-4 |edition=8th |location=Philadelphia |pages=1166}} |
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[[Oncocyte]]s in the thyroid are often called Hürthle cells. Although the terms oncocyte, [[Oxyphil cell (parathyroid)|oxyphil cell]], and Hürthle cell are used interchangeably, "Hürthle cell" is used only to indicate cells of thyroid follicular origin.Cannon |
[[Oncocyte]]s in the thyroid are often called Hürthle cells. Although the terms oncocyte, [[Oxyphil cell (parathyroid)|oxyphil cell]], and Hürthle cell are used interchangeably, "Hürthle cell" is used only to indicate cells of thyroid follicular origin.{{cite journal |vauthors=Cannon J |title=The significance of hurthle cells in thyroid disease |journal=Oncologist |volume=16 |issue=10 |pages=1380–7 |date=2011 |doi=10.1634/theoncologist.2010-0253 |pmid=21964000 |pmc=3228061}} |
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==Diseases== |
==Diseases== |
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[[File:Cytopathology suspicious for Hürthle cell neoplasm, annotated.png|thumb|350px|Cytopathology suspicious for [[Hürthle cell neoplasm]] ([[Bethesda category]] IV, rather than Hürthle cell hyperplasia), Pap stain.Image by Mikael Häggström, MD. References for findings: - {{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthlecellneoplasm.html|title=Hürthle cell neoplasm|website=Pathology Outlines| - {{cite journal| author=Shawky M, Sakr M| title=Hurthle Cell Lesion: Controversies, Challenges, and Debates. | journal=Indian J Surg | year= 2016 | volume= 78 | issue= 1 | pages= 41–8 | pmid=27186039 | doi=10.1007/s12262-015-1381-x | pmc=4848220 }}]] |
[[File:Cytopathology suspicious for Hürthle cell neoplasm, annotated.png|thumb|350px|Cytopathology suspicious for [[Hürthle cell neoplasm]] ([[Bethesda category]] IV, rather than Hürthle cell hyperplasia), Pap stain.Image by Mikael Häggström, MD. References for findings: - {{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthlecellneoplasm.html|title=Hürthle cell neoplasm|website=Pathology Outlines|first=Ayana |last=Suzuki |first2=Andrey |last2=Bychkov}} Last author update: 7 May 2020. Last staff update: 12 May 2022 - {{cite journal| author=Shawky M, Sakr M| title=Hurthle Cell Lesion: Controversies, Challenges, and Debates. | journal=Indian J Surg | year= 2016 | volume= 78 | issue= 1 | pages= 41–8 | pmid=27186039 | doi=10.1007/s12262-015-1381-x | pmc=4848220 }}]] |
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While Hurthle cells can occur in healthy thyroid glands, they are often associated with [[Hashimoto's thyroiditis]]{{cite web |title=Endocrine Pathology |url=http://library.med.utah.edu/WebPath/ENDOHTML/ENDO018.html |access-date=2009-05-07}} and [[Graves' disease]]. |
While Hurthle cells can occur in healthy thyroid glands, they are often associated with [[Hashimoto's thyroiditis]]{{cite web |title=Endocrine Pathology |url=http://library.med.utah.edu/WebPath/ENDOHTML/ENDO018.html |access-date=2009-05-07}} and [[Graves' disease]]. |
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Typically a painless thyroid mass is found in patients with this type of cancer. As expected, patients with carcinoma usually present larger tumors than patients with adenoma. Rarely, the cancer can spread to the lymph nodes. On few occasions, patients with Hürthle cell carcinoma have distant metastases in the lungs or surrounding bones. |
Typically a painless thyroid mass is found in patients with this type of cancer. As expected, patients with carcinoma usually present larger tumors than patients with adenoma. Rarely, the cancer can spread to the lymph nodes. On few occasions, patients with Hürthle cell carcinoma have distant metastases in the lungs or surrounding bones. |
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Hürthle cell neoplasms are somewhat difficult to differentiate between being benign or malignant. Since the size and growth pattern of the tumor cannot be used to determine malignancy, although larger tumors have higher incidence of malignancy, Hürthle cell adenomas and carcinomas have to be separated by the presence of both capsular invasion and vascular invasion in the case of carcinomas, or their absence in the case of adenomas. Tumors displaying only capsular invasion tend to behave less aggressively than those with vascular invasion. |
Hürthle cell neoplasms are somewhat difficult to differentiate between being benign or malignant. Since the size and growth pattern of the tumor cannot be used to determine malignancy, although larger tumors have higher incidence of malignancy, Hürthle cell adenomas and carcinomas have to be separated by the presence of both capsular invasion and vascular invasion in the case of carcinomas, or their absence in the case of adenomas. Tumors displaying only capsular invasion tend to behave less aggressively than those with vascular invasion.{{cite book |first=Lori A. |last=Erickson |chapter=Hurthle Cell Thyroid Neoplasms |chapter-url=https://link.springer.com/chapter/10.1007/978-1-4939-0443-3_8 |doi=10.1007/978-1-4939-0443-3_8 |title=Atlas of Endocrine Pathology |publisher=Springer |date=2014 |isbn=978-1-4939-0443-3 |pages=63–66 }} |
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Hürthle cell carcinomas are characterized as either minimally invasive or widely invasive tumors. While the minimally invasive or encapsulated carcinoma is fully surrounded by a fibrous capsule, the widely invasive carcinoma shows extensive area of both capsular and vascular invasion with the leftover capsule typically difficult to identify. Classification is important since widely invasive tumors can have outcomes with a 55% mortality rate. |
Hürthle cell carcinomas are characterized as either minimally invasive or widely invasive tumors. While the minimally invasive or encapsulated carcinoma is fully surrounded by a fibrous capsule, the widely invasive carcinoma shows extensive area of both capsular and vascular invasion with the leftover capsule typically difficult to identify. Classification is important since widely invasive tumors can have outcomes with a 55% mortality rate. |
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==Histology== |
==Histology== |
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Hürthle cells arise from the follicular epithelium. A Hürthle cell is larger than a follicular cell, and polygonal with distinct cell borders. Key features of these [[Oncocytic cell|oncocytic]] cells include a granular [[cytoplasm]] that stains eosinophilic (pink on [[H&E stain]]), which is commonly due to the oncocytes' high content of [[Mitochondrion|mitochondria]], and a vesicular nucleus with a large nucleolus. |
Hürthle cells arise from the follicular epithelium. A Hürthle cell is larger than a follicular cell, and polygonal with distinct cell borders. Key features of these [[Oncocytic cell|oncocytic]] cells include a granular [[cytoplasm]] that stains eosinophilic (pink on [[H&E stain]]), which is commonly due to the oncocytes' high content of [[Mitochondrion|mitochondria]], and a vesicular nucleus with a large nucleolus.{{cite book |first=James E. |last=Gervasoni Jr. |first2=Blake |last2=Cady |chapter=Endocrine Tumors §I. Thyroid Cancers: Hurthle cell cancer |doi=10.1016/B0-12-227555-1/00071-X |editor-last=Bertino |editor-first=Joseph R. |title=Encyclopedia of Cancer |publisher=Academic Press |edition=2nd |date=2002 |isbn=0-12-227555-1 |volume=2 |pages=136–7 }}
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