A Dissertation submitted to the Faculty of Health Sciences of University of the
Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of
Master of Medicine in Surgery.
Johannesburg, 2017 / Background: Hurthle cell neoplasms (HCN) are considered a variant of follicular thyroid neoplasms, and accounts for 3-10% of neoplasms of the thyroid gland. They include Hurthle cell adenomas (HCA) and carcinomas (HCC). Differentiating HCA from HCC preoperatively is currently not possible. We retrospectively searched for demographic and histopathological factors which can be used to predict the risk of malignancy in HCN.
Aim: To determine the prevalence of HCC and its demographic factors and histopathological features that can be used to predict the risk of malignancy in HCN.
Methods: Records of all patients who underwent thyroidectomy at Academic Hospitals associated with University of the Witwatersrand from January 2001 to October 2015 were reviewed. Patients’ demographic data and the final histology of HCN were further analyzed including pre-operative fine needle aspiration cytology (FNAC) results. Data collected included patients’ demographic, final histology, tumor size and preoperative FNAC result. Data was entered into Excel Spreadsheet and analyzed using STATICA 13.1 program.
Results: At total of 2641 records of thyroidectomies were found of which 25.6% (676/2641) were for thyroid neoplasms. Only 15.8% (107/676) of the neoplasms were HCNs and 25.2% (27/107) of HCNs were HCCs. Hurthle cell carcinoma made up 5.6% (27/481) of thyroid carcinomas. 70.4% (19/27) of HCCs were incidentally found following thyroidectomy for multinodular goiter (MNG). The mean tumor size was significantly greater for carcinomas than for adenomas (4.9 cm vs. 3.5 cm; p = 0.016). The risk of malignancy increased from 11.1% when the size was less or equal to 1cm, through 33.3% for size of 1-4cm to 51.8% when the size was greater than 4cm in diameter.
A total of 58 FNACs results of 107 HCNs were available for further analysis. Thirty one (53.4%: 31/58) of FNAC results were suspicious for HCN (Bethesda IV), seven (12.1%: 7/58) suspicious of papillary carcinoma (Bethesda V) and eight (13.8%: 8/58) were reported as benign (Bethesda II). Around 10.3% (6/58) were non-diagnostic (Bethesda I) whereas 8.6% (5/58) were reported as atypia of unknown significance (Bethesda III). Both HCA and HCC were more prevalent in females, 88.7% (71/80) and 77.8% (21/27); respectively. The mean age of the patients who had HCA and HCC in years was 52.3+/- 15.6 SD and 55.0 +/- 15.0 SD, respectively.
Conclusion: Majority of HCCs are diagnosed following thyroidectomy for benign disease. Close to a quarter of HCNs are malignant and the risk of malignancy increases with size. Age and gender are not useful to predict malignancy in HCNs. We recommend total thyroidectomy for thyroid nodule greater than 4cm in diameter if FNAC result is suggestive of HCN as the risk of malignancy is above 50%. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23399 |
| Date | January 2017 |
| Creators | Malith, V J W |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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