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Fine needle aspiration of Hurtle cell neoplasms of the thyriod: a cytomorphologic and clinical review

All patients with subsequent histopathologic diagnosis of Hurtle cell neoplasm of the thyroid and preoperative cytologic evaluation by fine needle aspiration (FNA) biopsy during the last 6 years were studied for a number of cytomorphologic features and clinical (age, gender and nodule size) parameters to determine factors predictive of carcinoma. There were 17 cases in total: four cases were Hurtle cell carcinomas (HCC) and other thirteen were Hurtle cell adenomas (HCA). Carcinoma was diagnosed in 3 of 13 (23%) women and in 1 of 4 (25%) men. Age range in adenoma patients is 32-75 (median 57) and in carcinoma patients 46-70 (median 58). The mean size of tumor in HCC patients was 4, 5 cm and in HCA patients 3, 1 cm. Among 13 patients with histopathologic diagnosis of HCA there were 3 (23, 1%) aspirates classified as follicular neoplasm, 3 (23, 1%) as Hurtle cell neoplasm, 6 (46, 2%) as suspicious for Hurtle cell neoplasms and 1 (7, 6%) aspirate was not diagnostic. The reported FNA diagnoses of the 4 patients with HCC were: two follicular neoplasms, one suspicious for Hurtle cell neoplasms and one cellular follicular lesion. Cytomorphologic features indicating an HCC versus HCA including the following: papillary structures, syncytial clusters and a number of single cells with prominent nucleoli. Hurtle cells showing significant nuclear and cellular pleomorphism in monolayered sheets with inconspicuous nucleoli appear to be a characteristic of HCA. Although the number of cases is limited and the differentiation between benign and malignant lesions is not reliable, it seems that the presence of relatively uniform tumor cells with prominent nucleoli in syncytial clusters and papillary structures and abundant single cells in the FNA of the thyroid nodule should alert observer about possibility of an HCC.

neoplasm; thyroid; cytomorphology; fine needle aspiration

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