[Hürthle-cell thyroid neoplasms: a clinical enigma]

Hürthle cell neoplasms represent a pathological entity whose diagnosis and therapy are still not defined. These neoplasms constitute from 1.5% to 10% of all thyroid tumors. Hürthle cell nodule is clinically indistinguishable from other nodular thyroid diseases and histologic features of the tumors do not always allow us to distinguish benign nodules from malignant ones. The authors, analyzing a segment of their own experience (335 surgical thyroid diseases), observed nine cases of Hürthle cell adenomas (0.03%). Because of concomitant presence of heterolobar thyroid disease, seven cases were treated with a total thyroidectomy, and two cases were treated with a lobo-isthmectomy. In a long-term follow-up study, there were not signs of Hürthle cells neoplastic disease. The authors suggest that the treatment of choice for patients with "surely benign" Hürthle cell nodule is lobo-isthmectomy. For malignant Hürthle cell tumors, total thyroidectomy is the most rational treatment associated with cervical lymphadenectomy in presence of metastatic nodes. In all cases, a long-term periodical check-up proves to be the best solution, also for patients treated for benign pathological Hürthle cell.