Hrthle Cell Adenoma and Carcinoma

Herbert Chen, MD, FACS ■ Robert Udelsman, MD, MBA, FACS

Few topics in endocrine surgery have been as controversial as Hürthle cell neoplasms of the thyroid. Hürthle cell neoplasms (adenomas and carcinomas) are "solitary masses in the thyroid comprised of Hürthle cells exclusively, or at least over 50% so comprised, and confined by a capsule found in a gland not otherwise overcome by chronic thyroiditis.'" They comprise 3% to 10% of all epithelial thyroid tumors and have been reported to account for 15% to 20% and 2% to 8% of all follicular and papillary cancers, respectively.2 Hürthle cell tumors are well differentiated and tend to be more aggressive than routine follicular thyroid cancers but less so than sporadic medullary thyroid cancers. Since their initial description, there has been debate about their origin, clinical behavior, classification, diagnosis, surgical management, and prognosis. Part of the difficulty in characterizing the behavior of these tumors is due to the relative low incidence of malignant Hürthle cell lesions; therefore, experience obtained in any single institution is limited. In this chapter, we discuss the controversy surrounding Hürthle cell neoplasms and outline our current management.

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