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[Analysis of diagnosis and treatment of 100 patients with Hürthle cell adenoma]
1Department of Endocrinology, Peking University First Hospital, Beijing 100034, China.
Insights
Hürthle cell adenoma (HCA) is more common in women and often found incidentally. Frozen section during surgery is reliable for diagnosis, with no observed recurrence in follow-up.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Hürthle cell tumor (HCT) is a rare thyroid neoplasm.
- Clinical data and prognosis of HCT patients require further analysis to improve clinical awareness.
Purpose of the Study:
- To analyze the clinical data and prognosis of patients with Hürthle cell tumor (HCT).
- To enhance clinicians' awareness and understanding of HCT.
Main Methods:
- Retrospective collection of clinical data from 100 patients with histopathologically proven HCT (Hürthle cell adenoma - HCA) between 2001 and 2017.
- Analysis of patient demographics, clinical presentation, sonographic features, intraoperative frozen section (FS) accuracy, and follow-up data.
- Inclusion criteria: patients with HCT without other thyroid carcinomas who underwent surgery for thyroid nodules.
Main Results:
- 100 patients (77 female, 23 male) with HCA were analyzed; average age was 52 years.
- HCA often presents as painless cervical nodules or is found incidentally via ultrasonography, frequently associated with multinodular goiters (MNGs).
- High diagnostic accuracy (97.4%) for HCA using intraoperative frozen section; no local recurrence or metastasis observed in 29 patients during a mean follow-up of 49.2 months.
Conclusions:
- HCA is more prevalent in women, often asymptomatic or presenting as painless nodules, and commonly co-exists with MNGs.
- While HCA has characteristic sonographic features, they are not unique; intraoperative frozen section is a reliable diagnostic tool.
- Post-operative monitoring of thyroid function is crucial for patients receiving thyroid hormone replacement therapy.
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.
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