Older age and larger tumor size predict malignancy in hürthle cell neoplasms of the thyroid

Abstract
Background  Hürthle cell neoplasms (HCNs) are rare tumors of the thyroid gland. The definitive treatment for Hürthle cell carcinoma (HCC)
is total thyroidectomy, while thyroid lobectomy is adequate for Hürthle cell adenoma (HCA). However, differentiating HCC from
HCA either before or during surgery is a challenge. The purpose of this study was to identify factors that predict malignancy
in patients with HCN.

Methods  Between May 1994 and January 2007, 1,199 patients underwent thyroid surgery at an academic medical center. Medical records
of 55 consecutive patients who underwent thyroid resections for the preoperative diagnosis of HCN were reviewed.

Results  Of the 55 patients with HCN, 46 (84%) had adenomas and 9 (16%) had carcinomas. Patients with HCC were significantly older
than those with HCA (66 ± 6 years versus 53 ± 2 years, P = 0.01). Patients with carcinoma also had significantly larger thyroid nodules (4.5 ± 0.7 cm versus 2.5 ± 0.2 cm, P < 0.001). All HCNs less than 2 cm in diameter were benign. The malignancy rate increased with nodule size: 18% of nodules
measuring 2–4 cm, and 44% of those larger than 4 cm were HCC. One patient with HCC had recurrence of the disease, but there
were no disease-related deaths.

Conclusion  Advanced patient age and larger nodule size are two important factors that predict malignancy in patients with HCN. In patients
with these and other known risk factors for HCC, total thyroidectomy should be considered.

Content Type Journal ArticleCategory Endocrine TumorsDOI 10.1245/s10434-008-0079-8Authors
Yi Wei Zhang, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USADavid Yu Greenblatt, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USADaniel Repplinger, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USAAnna Bargren, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USAJoel T. Adler, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USARebecca S. Sippel, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USAHerbert Chen, University of Wisconsin Section of Endocrine Surgery, Department of Surgery H4/750 Clinical Science Center, 600 Highland Avenue Madison WI 53792 USA

Journal Annals of Surgical OncologyOnline ISSN 1534-4681Print ISSN 1068-9265 (Source: Annals of Surgical Oncology)