title: Clinical and molecular features of Hürthle cell carcinoma of the thyroid.
abstract: BACKGROUND
  Hürthle cell cancer (HCC) of the thyroid remains the subject of controversy with respect to natural course, treatment, and follow-up.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the clinical and molecular features associated with outcome in HCC.
  
  
  METHODS
  The study was a review of 173 HCC cases treated at Mayo Clinic over 11 years with a median 5.8-year follow-up.
  
  
  RESULTS
  None of the patients with minimally invasive histology had persistent disease, clinical recurrence, or disease-related death. Male gender and TNM stage were independently associated with increased risk of clinical recurrence or death in widely invasive patients. The 5-year cumulative probability of clinical recurrence or death was higher in patients with TNM stage III-IV (females, 74%; males, 91%) compared with patients with TNM stage I-II (females, 0%; males, 17%). Pulmonary metastases were best identified by computed tomography, whereas radioactive iodine scans were positive in only two of 27 cases. Thyroglobulin was detectable in patients with clinical disease, with the notable exception of five patients with distant metastases. The common TERT C228T promoter mutation was detected in both widely invasive and minimally invasive tumors. TERT mRNA was below the limit of detection in all samples.
  
  
  CONCLUSIONS
  Widely invasive HCC with TNM stage III-IV is aggressive, with low probability of recurrence-free survival. Males have worse outcomes than females. Minimally invasive HCC appears to be considerably less aggressive. Radioactive iodine scan performs poorly in detecting distant disease. Although the TERT gene is mutated in HCC, the role of this mutation remains to be demonstrated.
authors.affiliation: Department of Otorhinolaryngology (A.-M.C., J.D.C.) and Division of Endocrinology and Metabolism (V.J.B., R.C.S.), Mayo Clinic, Jacksonville, Florida 32224; Department of Anatomic Pathology (M.R.), Mayo Clinic, Rochester, Minnesota 55905; Departments of Health Sciences Research (C.T.) and Cancer Biology (J.M.K., B.M.N., E.A.T.), Mayo Clinic, Jacksonville, Florida 32224; Division of Endocrinology and Metabolism (I.D.H.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology and Metabolism (S.A.W.), Mayo Clinic, Scottsdale, Arizona 85259; Department of Surgery (C.S.G., G.B.T.), Mayo Clinic, Rochester, Minnesota 55905; and Department of Surgery (R.T.S.), Mayo Clinic, Scottsdale, Arizona 85259.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Chindris
authors.forename: John D
authors.initials: JD
authors.lastname: Casler
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Bernet
authors.forename: Michael
authors.initials: M
authors.lastname: Rivera
authors.forename: Colleen
authors.initials: C
authors.lastname: Thomas
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Kachergus
authors.forename: Brian M
authors.initials: BM
authors.lastname: Necela
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hay
authors.forename: Sydney A
authors.initials: SA
authors.lastname: Westphal
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Richard T
authors.initials: RT
authors.lastname: Schlinkert
authors.forename: E Aubrey
authors.initials: EA
authors.lastname: Thompson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smallridge
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011401:Promoter Regions, Genetic; D012189:Retrospective Studies; D012737:Sex Factors; D019098:Telomerase / Q000235:genetics / Q000378:metabolism; D013964:Thyroid Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D055815:Young Adult
chemical_list: C509186:TERT protein, human; D019098:Telomerase