title: A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent.
abstract: BACKGROUND
  Hürthle cell (HC) neoplasms are rare among pediatric thyroid cancers. HC adenomas (HCA) are typically benign and localized unilaterally without recurrence, and they are thus treated by hemithyroidectomy. HC carcinomas (HCC) can be bilateral and are more aggressive, necessitating total thyroidectomy. Diagnosis relies upon surgical histopathology demonstrating invasion for classification as HCC or lack of invasion in HCA, since fine needle aspiration fails to differentiate between the two.
  
  
  METHODS
  We report a case of a 14-year-old adolescent female with bilateral HCA. She had an initial left hemithyroidectomy for a large nodule measuring 2 × 1.5 × 1.2 cm3 in the left lobe, while smaller subcentimeter nodules remained under surveillance in the right. One year later, a nodule in the right lobe doubled in size, necessitating a right hemithyroidectomy which also revealed HCA.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of bilateral HCA in pediatrics. It highlights the importance of close surveillance of persistent small nodules, even in patients with previously documented benign lesions such as HCA, which are typically thought to be unilateral and localized. Both HCA and HCC remain unpredictable in behavior, and treatment of HCA should be individualized.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, N.Y., USA.
authors.forename: Elna
authors.initials: E
authors.lastname: Kochummen
authors.forename: Schuyler
authors.initials: S
authors.lastname: Tong
authors.forename: Vatcharapan
authors.initials: V
authors.lastname: Umpaichitra
authors.forename: Vivian L
authors.initials: VL
authors.lastname: Chin
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D005260:Female; D006801:Humans; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D013965:Thyroidectomy