Hurthle cell thyroid cancer

Case contributed by Ammar Ashraf

Presentation

Left lower neck swelling with mild respiratory compression symptoms.

Patient Data

Age: 50 years
Gender: Male
ultrasound

Relatively enlarged left thyroid lobe 3.9 x 3.1 x 6.1 cm. A large heterogeneous nodule measuring 2.8 x 3.6 x 5.5 cm, with increased vascularity on color Doppler ultrasound examination is noted in the left lobe.

Right thyroid lobe measures 1.6 x 1.6 x 5.2 cm and shows homogeneous parenchymal echogenicity. A tiny hypoechoic nodule measuring 3 mm is seen in the right lobe.

ct

Left thyroid lobe is almost replaced by a heterogeneous enhancing lesion measuring 38 x 44 mm. Few small hypodensities (cystic spaces/necrotic changes) are seen within this lesion.  No obvious invasion/infiltration is seen in to the surrounding soft tissues. No significant cervical lymphadenopathy is seen. No retrosternal extension is seen.

Photo

Histopathology reports of the fine needle aspiration cytology (FNAC) of the left thyroid lobe nodule and thyroidectomy specimen.

Case Discussion

Fine needle aspiration cytology of the left thyroid lobe nodule was suspicious for malignancy (category V by the Bethesda system). The main differential diagnosis was medullary carcinoma and Hurthle cell neoplasm. Serum calcitonin level and surgical excision was recommended for further evaluation.

A histopathological diagnosis of the Hurthle cell carcinoma of the left thyroid lobe was made post-thyroidectomy. Serum calcitonin level was normal.

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