Operative and postoperative management of the patient with follicular and Hürthle cell carcinoma. Do they differ?
Most characteristics of follicular carcinoma and Hüthle cell carcinoma are similar, but important differences must be recognized (Table 1). The diagnosis usually follows palpation of a thyroid nodule, which, by FNA, can only be interpreted as either a follicular or Hürthle cell neoplasm. Approximately 20% of nodules with this FNA report prove to be malignant, the remaining 80% representing benign follicular or Hürthle cell adenomas, or occasionally adenomatous nodules or Hashimoto's thyroiditis with prominent Hürthle cell nodularity. This distinction poses one of the most difficult challenges to the surgical pathologist. We rely heavily on frozen section differentiation of benign and malignant tumors. Benign adenomas are usually managed with a unilateral total lobectomy, whereas carcinomas and tumors quite suspicious for carcinoma (e.g., tumors with suspicion of either capsular or vascular invasion) are removed with a total or near-total thyroidectomy. This affords not only complete clearance of the tumor, but facilitates postoperative follow-up both diagnostically and therapeutically with 131I.
Grant
C S
CS
Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery*; D001707:Biopsy, Needle; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D011182:Postoperative Care; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D013967:Thyroiditis, Autoimmune / Q000473:pathology