Hürthle cell

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Hürthle cell
Other namesAskanazy cell
Hurthle cell neoplasm.jpg
Micrograph showing Hürthle cells in a Hürthle cell neoplasm. Pap stain.
Pronunciation
Specialty Pathology

A Hürthle cell is a cell in the thyroid that is often associated with Hashimoto's thyroiditis [1] as well as benign and malignant tumors (Hürthle cell adenoma and Hürthle cell carcinoma [2] , formerly considered a subtype of follicular thyroid cancer). This version is a relatively rare form of differentiated thyroid cancer, accounting for only 3-10% of all differentiated thyroid cancers. [3] Oncocytes in the thyroid are often called Hürthle cells. Although the terms oncocyte, oxyphilic cell, and Hürthle cell are used interchangeably, Hürthle cell is used only to indicate cells of thyroid follicular origin. [4]

Thyroid endocrine gland in the neck; secretes hormones that influence metabolism

The thyroid gland, or simply the thyroid, is an endocrine gland in the neck, consisting of two lobes connected by an isthmus. It is found at the front of the neck, below the Adam's apple. The thyroid gland secretes three hormones, namely the two thyroid hormones (thyroxine/T4 and triiodothyronine/T3), and calcitonin. The thyroid hormones primarily influence the metabolic rate and protein synthesis, but they also have many other effects, including effects on development. Calcitonin plays a role in calcium homeostasis.

Hashimotos thyroiditis autoimmune disease

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis and Hashimoto's disease, is an autoimmune disease in which the thyroid gland is gradually destroyed. Early on there may be no symptoms. Over time the thyroid may enlarge, forming a painless goiter. Some people eventually develop hypothyroidism with accompanying weight gain, feeling tired, constipation, depression, and general pains. After many years the thyroid typically shrinks in size. Potential complications include thyroid lymphoma.

Hürthle cell adenoma is a rare benign tumor, typically seen in women between the ages of 70 and 80 years old. This adenoma is characterized by a mass of benign Hürthle cells. Typically such a mass is removed because it is not easy to predict whether it will transform into the malignant counterpart, a subtype of follicular thyroid cancer called a Hürthle cell carcinoma.

Contents

Diseases

Hürthle cell cancer can be separated into Hürthle cell adenoma and carcinomas, which are respectively benign and malignant tumors arising from the follicular epithelium of the thyroid gland. [5] The mitochondrial DNA of Hürthle cell carcinoma contain somatic mutations. [5] Hürthle cell carcinomas consists of at least 75% Hürthle cells. [6] Chronic lymphocytic thyroiditis or Hashimoto's thyroiditis, along with cases of long-standing Graves' disease, show Hürthle cells present. [4]

Carcinoma A category of types of cancer that develops from epithelial cells

Carcinoma is a category of types of cancer that develop from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis.

Mitochondrial DNA DNA located in cellular organelles called mitochondria

Mitochondrial DNA is the DNA located in mitochondria, cellular organelles within eukaryotic cells that convert chemical energy from food into a form that cells can use, adenosine triphosphate (ATP). Mitochondrial DNA is only a small portion of the DNA in a eukaryotic cell; most of the DNA can be found in the cell nucleus and, in plants and algae, also in plastids such as chloroplasts.

Graves disease Autoimmune endocrine disease

Graves' disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea and unintentional weight loss. Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves' ophthalmopathy. About 25 to 80% of people with the condition develop eye problems.

Diagnosis

Hürthle cell adenomas are most likely diagnosed much more frequently than Hürthle cell carcinomas. The female to male ratio for Hurthle cell adenomas is 8:1, while the ratio is 2:1 for the malignant version. [5] Hürthle cell cancer tends to occur in older patients. The median age at diagnosis for Hürthle cell carcinomas is approximately 61 years old. [5] Typically a painless thyroid mass is found in patients with this type of cancer. [5] As expected, patients with carcinoma usually present larger tumors than patients with adenoma. Rarely, the cancer can spread to the lymph nodes. [6] On few occasions, patients with Hürthle cell carcinoma have distant metastases in the lungs or surrounding bones. [5] 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, in the case of carcinomas, or absence, in the case of adenomas, of both capsular invasion and vascular invasion. [5] Tumors displaying only capsular invasion tend to behave less aggressively than those with vascular invasion. [7] 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. [5] Classification is important since widely invasive tumors can have outcomes with a 55% mortality rate. [5]

Adenoma Type of benign tumor

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

Histology

Hürthle cells arise from the follicular epithelium. Key features of these oncocytic cells include an eosinophilic granular cytoplasm and a vesicular nucleus with a large nucleolus. [5] A Hürthle cell is larger than a follicular cell, and its cellular material stains pink. Hürthle cells also tend to be large, polygonal cells with distinct cell borders. [4] The cytoplasm of the oncocytes in Hürthle cell adenomas and carcinomas is characterized by an eosinophilic granular nature, which is commonly due to the oncocytes' high content of mitochondria. [5] Some of these cells can contain up to 5,000 mitochondria, which fills the cytoplasm to the point of nearly excluding other organelles. [4] This high amount of mitochondria is reported to be a result of mutations in the mitochondrial DNA. [4] Some scientists have identified these mutations as deletions in the mitochondrial DNA of Hürthle cells found in neoplasms and Hashimoto's thyroiditis. [6]

Cytoplasm all of the contents of a cell excluding the plasma membrane and nucleus, but including other subcellular structures

In cell biology, the cytoplasm is all of the material within a cell, enclosed by the cell membrane, except for the cell nucleus. The material inside the nucleus and contained within the nuclear membrane is termed the nucleoplasm. The main components of the cytoplasm are cytosol – a gel-like substance, the organelles – the cell's internal sub-structures, and various cytoplasmic inclusions. The cytoplasm is about 80% water and usually colorless.

Mitochondrion Semi-autonomous, self-replicating organelle that occurs in varying numbers, shapes, and sizes in the cytoplasm of virtually all eukaryotic cells; the site of tissue respiration

The mitochondrion is a double-membrane-bound organelle found in most eukaryotic organisms. Some cells in some multicellular organisms may, however, lack them. A number of unicellular organisms, such as microsporidia, parabasalids, and diplomonads, have also reduced or transformed their mitochondria into other structures. To date, only one eukaryote, Monocercomonoides, is known to have completely lost its mitochondria. The word mitochondrion comes from the Greek μίτος, mitos, "thread", and χονδρίον, chondrion, "granule" or "grain-like". Mitochondria generate most of the cell's supply of adenosine triphosphate (ATP), used as a source of chemical energy. A mitochondrion is thus termed the powerhouse of the cell.

Treatment

A non-minimally invasive Hürthle cell carcinoma is typically treated by a total thyroidectomy followed by radioactive iodine therapy. [5] A Hürthle cell adenoma or a minimally invasive tumor can be treated by a thyroid lobectomy, although some surgeons will perform a total thyroidectomy to prevent the tumor from reappearing and metastasizing. [5] A modified radical neck dissection may be performed for clinically positive lymph nodes.

Thyroidectomy Total or partial removal of the thyroid gland

A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. General, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland or goiter. Other indications for surgery include cosmetic, or symptomatic obstruction. Thyroidectomy is a common surgical procedure that has several potential complications or sequelae including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon.

Lobectomy surgical excision of a lobe

Lobectomy means surgical excision of a lobe. This may refer to a lobe of the lung, a lobe of the thyroid (hemithyroidectomy), or a lobe of the brain.

History

The Hürthle cell is named after German histologist Karl Hürthle, who investigated thyroid secretory function, particularly in dogs. [8] However, this is a misnomer since Hürthle actually described parafollicular C cells. [4] The cell known as the Hürthle cell was first described in 1898 by Max Askanazy, who noted it in patients with Graves' disease. [4] [9]

Karl Hürthle German physioloigst

Karl Hürthle was a German physiologist and histologist who was a native of Ludwigsburg.

Parafollicular cell

Parafollicular cells, also called C cells, are neuroendocrine cells in the thyroid. The primary function of these cells is to secrete calcitonin. They are located adjacent to the thyroid follicles and reside in the connective tissue. These cells are large and have a pale stain compared with the follicular cells. In teleost and avian species these cells occupy a structure outside the thyroid gland named the ultimobranchial body.

Max Askanazy Swiss pathologist (1865-1940)

Max Askanazy was a German-Swiss pathologist.

See also

Related Research Articles

Thyroid neoplasm

Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm, such as papillary, follicular, medullary or anaplastic thyroid cancer. Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men. The estimated number of new cases of thyroid cancer in the United States in 2010 is 44,670 compared to only 1,690 deaths. Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

Benign tumor disease of cellular proliferation that results in abnormal growths in the body which lack the ability to metastasize

A benign tumor is a mass of cells (tumor) that lacks the ability to invade neighboring tissue or metastasize. However, they can sometimes be quite large. When removed, benign tumors usually do not grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life threatening. Benign tumors generally have a slower growth rate than malignant tumors and the tumor cells are usually more differentiated. They are typically surrounded by an outer surface or remain with the epithelium. Common examples of benign tumors include moles and uterine fibroids.

Oncocytoma Human disease

An oncocytoma is a tumor made up of oncocytes, epithelial cells characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm. The cells and the tumor that they compose are often benign but sometimes may be premalignant or malignant.

The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.

Papillary thyroid cancer thyroid carcinoma that is characterized by the small mushroom shape of the tumor which has a stem attached to the epithelial layer

Papillary thyroid cancer or papillary thyroid carcinoma is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.

An adrenal tumor or adrenal mass is any benign or malignant neoplasms of the adrenal gland, several of which are notable for their tendency to overproduce endocrine hormones. Adrenal cancer is the presence of malignant adrenal tumors, and includes neuroblastoma, adrenocortical carcinoma and some adrenal pheochromocytomas. Most adrenal pheochromocytomas and all adrenocortical adenomas are benign tumors, which do not metastasize or invade nearby tissues, but may cause significant health problems by unbalancing hormones.

Thyroid adenoma Human disease

A thyroid adenoma is a benign tumor of the thyroid gland, that may be inactive or active as a toxic adenoma.

Follicular thyroid cancer thyroid carcinoma that has material basis in follicular cells

Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumor marker for well-differentiated follicular thyroid cancer. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.

Salivary gland tumour human disease

Salivary gland tumours or neoplasms are tumours that form in the tissues of salivary glands. The salivary glands are classified as major or minor. The major salivary glands consist of the parotid, submandibular, and sublingual glands. The minor salivary glands consist of 800-1000 small mucus-secreting glands located throughout the lining of the oral cavity.

ICD-10 is an international statistical classification used in health care and related industries.

Oncocyte

An oncocyte is an epithelial cell characterized by an excessive number of mitochondria, resulting in an abundant acidophilic, granular cytoplasm. Oncocytes can be benign or malignant.

Renal oncocytoma tumour of the kidney made up of oncocytes, a special kind of cell

A renal oncocytoma is a tumour of the kidney made up of oncocytes, a special kind of cell.

Thyroid cancer endocrine gland cancer located in the thryoid gland located in the neck below the thyroid cartilage

Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Cancer can also occur in the thyroid after spread from other locations, in which case it is not classified as thyroid cancer.

Squamous-cell thyroid carcinoma A rapidly growing primary carcinoma of the thyroid gland composed of malignant squamous cells. The clinical course is usually aggressive.

Squamous-cell thyroid carcinoma is rare malignant neoplasm of thyroid gland which shows tumor cells with distinct squamous differentiation. The incidence of SCTC is less than 1% out of thyroid malignancies.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor that was previously classified as an encapsulated follicular variant of papillary thyroid carcinoma, necessitating a new classification as it was recognized that encapsulated tumors without invasion have an indolent behavior, and may be over-treated if classified as a type of cancer.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects the nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

References

  1. "Endocrine Pathology" . Retrieved 2009-05-07.
  2. Grani, Giorgio; Lamartina, Livia; Durante, Cosimo; Filetti, Sebastiano; Cooper, David S (2018). "Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management". The Lancet Diabetes & Endocrinology. 6 (6): 500–514. doi:10.1016/s2213-8587(17)30325-x. PMID   29102432.
  3. Aytug, Serhat (June 13, 2006). "Hurthle Cell Carcinoma". eMedicine.Cite journal requires |journal= (help)
  4. 1 2 3 4 5 6 7 Cannon, J. (2011). The Significance of Hurthle Cells in Thyroid Disease. The Oncologist. doi:10.1634/theoncologist.2010-0253
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 Schwab, M. (2011). Encyclopedia of Cancer. Encyclopedia of Cancer. doi:10.1016/B0-12-227555-1/00151-9
  6. 1 2 3 Montone, Kathleen T., Zubair W. Baloch, and Virginia A. LiVolsi. "The thyroid Hurthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review." Archives of Pathology and Laboratory Medicine 132.8 (2008): 1241-1250.
  7. Erickson, Lori A. "Hurthle Cell Thyroid Neoplasms." Atlas of Endocrine Pathology. Springer New York, 2014. 63-66.
  8. Hürthle, Karl (1894). "Beitrage zur Kenntnis des Sekretionsvorgangs in der Schilddruse". Archiv für die gesamte Physiologie des Menschen und der Tiere. 56: 10–44. doi:10.1007/bf01662011.
  9. M. Askanazy. Pathologisch-anatomische Beiträge zur Kenntniss des morbus basedowii, insbesondere uber die dabei auftretende Muskelerkrankkung. Deutsches Archiv für klinische Medicin, Leipzig, 1898, 61:118-186.
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