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Hürthle Cell Tumors
Using Molecular Techniques to Define a Novel Classification System
Greg Belchetz, MD;
Carol C. Cheung, MD;
Jeremy Freeman, MD;
Irving B. Rosen, MD;
Ian J. Witterick, MD;
Sylvia L. Asa, MD
Arch Otolaryngol Head Neck Surg. 2002;128:237-240.
Background Since ret/PTC gene rearrangements are specific
to papillary thyroid carcinoma (PTC), the diagnosis of Hürthle cell PTC
(HCPTC) has recently been expanded to include a subset of Hürthle cell
tumors (HCTs) that may lack both papillary architecture and/or classic nuclear
features but that harbor a ret/PTC gene rearrangement.
We hypothesize that such HCPTCs behave in a fashion analogous to other papillary
carcinomas, while Hürthle cell carcinomas (HCCs) behave similarly to
follicular carcinomas.
Educational Objectives At the conclusion of this article, participants should be able to discuss
HCTs and to identify HCPTCS using molecular techniques.
Methods A retrospective chart review was carried out on 56 patients with HCTs.
All pathological specimens were analyzed for ret/PTC
gene rearrangements. Hürthle cell adenoma (HCA) was defined as an HCT
that did not exhibit capsular and/or vascular invasion and that lacked a ret/PTC gene rearrangement when evaluated by immunohistochemical
and reverse transcription polymerase chain reaction analysis. An HCC was defined
as an HCT with capsular and/or vascular invasion that lacked a ret/PTC gene rearrangement, and an HCPTC was defined as any HCT that
harbored a ret/PTC gene rearrangement.
Results The subclassification of the 56 HCTs was as follows: 21 HCAs, 15 HCCs,
and 20 HCPTCs. No patients with HCA or HCC were ret/PTC positive. Five of the 6 patients with definite lymph node metastasis
were in the HCPTC group, demonstrating that molecular analysis helps to explain
biological behavior.
Conclusions Hürthle cell neoplasms can now be classified using histopathological
as well as molecular criteria. It appears that the new subclassification of
malignant HCTs into follicular (HCC) and papillary (HCPTC) variants identifies
2 distinct biological groups.
From the Departments of Otolaryngology (Drs Belchetz, Freeman, and
Witterick), Pathology (Drs Cheung and Asa), and Surgery (Dr Rosen) and the
Freeman Centre in Endocrine Oncology (Drs Freeman and Asa), Mount Sinai Hospital,
Toronto, Ontario.
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