Origin and Classification

Controversy exists regarding the presumed origin of Hürthle cells. Most believe that they originate from thyroid follicular cells. This conclusion is supported by the following: (1) histology from a single thyroid gland can show the transition from follicular cells to Hiirthle cells; (2) Hurthle cells can secrete thyroglobulin similar to thyroid follicular cells; (3) a high concentration of Hurthle cells is seen in inflammatory diseases of the thyroid; and (4) a functional thyroid-stimulating hormone (TSH) receptor-adenylate cyclase system is present in Hurthle cell neoplasms.6 There are some investigators, however, who suggest that Hurthle cells are of parafollicular origin. This is based on the fact that HUrthle cell cancers more often metastasize to lymph nodes, are less likely to trap radioactive iodine, and have a distinct oncogene expression profile as compared to follicular cancers.7

The confusion surrounding the description of Hurthle cell tumors continues today. The nomenclature is not standardized; HUrthle cell tumors (adenomas and carcinomas) are also referred to as oncocytomas, oxyphilic tumors, Askanazy cell tumors, Langhans tumors, and follicular Hurthle cell tumors. In 1988, the World Health Organization formally classified Hurthle cell carcinoma as an oxyphilic variant of follicular carcinoma. However, since then, several investigators have presented convincing evidence that these tumors should be classified separately as Hurthle cell carcinomas.

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