Do Small Oncocytic Follicular Carcinoma/Hurthle Cell Carcinoma Exist? An Institutional Experience
Teresa Samulski, Bai Shuting, Virginia LiVolsi, Kathleen Montone, Zubair Baloch. Hospital of the University of Pennsylvania, Philadelphia, PA; New York University Medical Center, New York, NY
Background: Oncocytic follicular carcinoma / Hurthle cell carcinoma (OFCA/HCC) is a rare tumor of the thyroid gland; when compared to non-oncocytic follicular carcinoma; it is more frequently associated with an aggressive clinical course. Usually OFCA/HCA are large, however, tumors measuring 2.0 cm can occur. In this study, we report our institutional experience with 119 cases of OFCA/HCA diagnosed between 2000-2012.
Design: One hundred nineteen cases of HCC diagnosed between 2000-2012 were retrieved from electronic pathology files at University of Pennsylvania Medical Center employing the search terms of “Hurthle cell”, “carcinoma” and “thyroid”. The data points recorded for this study included patient's age, sex, size of tumor, method of diagnosis (fine needle aspiration vs. biopsy vs. resection), lymph node status at time of resection, and clinical follow-up.
Results: The case cohort included 37 males and 82 females (average age 55 yrs, median 56 yrs). Pre-operative fine-needle aspiration (FNA) was performed in 73/119 cases (61%) and was diagnosed as consistent with “Follicular neoplasm with oncocytic features / Hurthle cell neoplasm” in 58 cases. Twenty five (21%) tumors measured ≤ 2.0 cm (including 4 measuring ≤ 1.0 cm) in 20 females and 5 males (average age 54 yrs); and 94 (79%) measured > 2.0 cm in 62 females and 32 males (average age 56 yrs). Definite angioinvasion was present in 48/119 (40%, 8 with >5 foci of angioinvasion) and lymph node metastases in 7/119 (6%) cases. Of these, 8/48 (17%) tumors with angioinvasion (2 with >5 foci of angioinvasion) and 1 with lymph node metastasis measured ≤2.0 cm. Clinical follow-up was available in 40 (40/119 34%) cases (range 1-137 months); 10/40 (25%) developed lymph node metastases, 4 developed tissue recurrence and distant metastases were seen in 12/40 (30%) cases. One case with distant metastasis to lung and 1 case with lymph node recurrence measured 1.1 cm and 2.0 cm respectively.
Conclusions: In our experience, OFCA/HCC can present as small (≤2.0) tumors with sex and age distribution similar to large (≥ 2.0) tumors. Importantly, small tumors can be associated with angioinvasion (8/25 32%), lymph node and, rarely, distant metastases. Both large and small OFCA/HCC can be easily detected as oncocytic tumors by FNA.
Category: Head & Neck
Monday, March 4, 2013 2:30 PM
Proffered Papers: Section F, Monday Afternoon