Thyroid FNAC containing hürthle cells and hürthle-like cells: A study of 128 cases
Aylin Yazgan1, Serdar Balci2, Nazmiye Dincer1, Pamir Eren Ersoy3, Dilek Tuzun4, Reyhan Ersoy5, Cigdem Irkkan6, Bekir Cakir5, Gulnur Guler7
1 Department of Pathology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
2 Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
3 Department of General Surgery, Guven Hospital, Ankara, Turkey
4 Department of Endocrinology and Metabolism, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
5 Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
6 Department of Pathology, Ankara Oncology Hospital, Ankara, Turkey
7 Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Dr. Aylin Yazgan
Ankara Ataturk Research and Training Hospital, Bilkent Yolu No: 3, Bilkent Ankara
Source of Support: None, Conflict of Interest: None
Aim: It is a diagnostic challenge to differentiate benign and malignant cytology in the presence of Hürthle cells. In our previous study, it was determined that in fine needle aspirations (FNA), the malignancy outcome of the Hürthle cells containing group tend to be papillary thyroid carcinoma (PTC) in a higher percentage. The most common misinterpretation is caused by PTC cells with large cytoplasm-like Hürthle cells. The aim of this study is to predict histologic outcome of the nodules, which have Hürthle cells in FNA according to cytological, clinical features, and BRAF V600Emutation status.
Materials and Methods: Detailed cytological features of 128 cases were compared with histopathological diagnosis. The analysis of BRAF V600Emutation of the PTC cases were performed by real-time polymerase chain reaction.
Results: The neoplastic outcome was increased statistically significantly with younger age (P = 0.020), increase in cellular dyshesion (P = 0.016), presence of nuclear budding (P = 0.046), and granular chromatin (P = 0.003). Nuclear budding (P = 0.014), granular chromatin (P = 0.012), and hypoechoic nodules in ultrasonography (P = 0.011) were significant independent factors for the increase in the malignancy risk. Increased lymphocytes (P= 0.015) and colloid were related to non-neoplastic outcome. According to the surgical outcome, more than half of the malign cases were PTC (74%). BRAF V600Emutation was detected in 27.8% of the PTC cases.
Conclusion: PTC cases containing Hürthle cell-like cells may lead to diagnostic errors. Nuclear budding and granular chromatin of Hürthle cells are significant, remarkable findings to predict the outcome of neoplasm and malignancy.