Hürthle cell carcinoma.
Patients with Hürthle cell carcinoma (HCC) of the thyroid often have aggressive tumors and generally have a worse prognosis than those with papillary or follicular thyroid carcinomas. A total thyroidectomy with ipsilateral central neck lymphadenectomy and a modified radical neck dissection, if central or lateral nodes are positive, are indicated for HCC. The completeness of this procedure should be assessed by radioiodine scan 3 to 4 months after surgery. Any thyroid remnant should be ablated with radiolabeled iodine 131 to eliminate all tissue at risk and to facilitate the use of serum thyroglobulin in surveillance for tumor recurrence. Fewer than 10% of these cancers take up radioiodine. Recurrent disease is treated surgically with good palliation and appreciable prolongation of life. Local excision and neck dissection for recurrent neck disease or pulmonary wedge resection for lung metastasis has been shown to be effective. All patients with HCC should be given thyroid hormone because most of these tumors have thyrotropin receptors. External beam radiation may be considered for patients with unresectable disease, but this is considered palliative.
Yutan
E
E
Mt. Zion/University of California, San Francisco Medical Center, Department of Surgery, 1600 Divisadero St., Room C-342, San Francisco, CA 94143-1674, USA. E-mail: eyutan@hotmail.com
Clark
O H
OH
D000236:Adenoma / Q000175:diagnosis; D018249:Adenoma, Oxyphilic / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009363:Neoplasm Proteins / Q000097:blood; D024862:Oxyphil Cells / Q000473:pathology; D010166:Palliative Care; D011867:Radioisotope Teletherapy; D018714:Radiotherapy, Adjuvant; D013954:Thyroglobulin / Q000097:blood; D013963:Thyroid Hormones / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy
D014408:Biomarkers, Tumor; D007457:Iodine Radioisotopes; D009363:Neoplasm Proteins; D013963:Thyroid Hormones; D013954:Thyroglobulin