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>Journals >Cirujano General >Year 2004, Issue 4


Barrera-Rodríguez F, Garza-Sánchez V, Gracida-Mancilla N, Hurtado-López LM
Hürthle cells tumor. What is to be done?
Cir Gen 2004; 26 (4)

Language: Español
References: 24
Page: 290-295
PDF: 4. Kb.


Full text




ABSTRACT

Antecedents: The Hürthle tumor, considered as the well-differentiated thyroid tumor of lowest incidence worldwide (5%) and in our country (0.2%), is classified in three histological variants: adenoma, carcinoma, and papillary cancer of Hürthle cells, which do not depict a well-established biological behavior and, hence, lack a standardized criterion for their management. Our criterion has been to manage these tumors similarly to a follicular tumor.
Objective: The present work is aimed at analyzing the clinical evolution after the surgical treatment of this type of neoplasm.
Setting: Third level health care hospital.
Patients and methods: We performed a retrospective, transversal, descriptive study at the thyroid clinic from the General Hospital of Mexico (1990-2003); 15 patients with histological diagnoses of Hürthle tumor, Hürthle adenoma, oncocytic tumor and/or Hürthle cells carcinoma were included. Analyzed variables were: age, gender, clinical characteristics, time of evolution until diagnosis, diagnosis through fine needle aspiration biopsy (FNAB), gammagraphic studies with metastable technetium 99 (Tc-99-m) and methoxylisobutyl isonitrile (Tc-99-MIBI), hormonal functional state, frozen transoperative study (FTS), surgical extension, final histopathological study, and postoperative evolution. Patients were followed-up until August 2003, and central tendency statistical tests were used.
Results: Fifteen patients were studied; 14 women and 1 man, mean age of 39.8 years, range 22 to 73 years, SD ± 14.3 years. Time of evolution until diagnosis was of 2.7 years (0.5 to 11 years), SD ± 2.9. The clinical presentation form was as diffused goiter in three patients, as thyroid nodule in eleven, and as multinodular goiter in one patient. FNAB was performed in 12 patients, only in four (33%) was a diagnosis of Hürthle cells tumor reached, in 25% of possible papillary cancer, in 20% of follicular tumor, in 17% of colloid goiter, and in 8% of probable medullar cancer. Tc-99-m gammagraphy revealed a hot nodule in 10 patients. Thyroid profiles confirmed 13 patients to be euthyroid and 2 as hypothyroid. Hemithyroidectomy was performed in 12 patients (80%). FTS was diagnostic in 26% of the patients. The final histological study revealed benign disease in 14 (96%) and malignant in 1 (4%). The mean follow-up was of 4.4 years (0.6 to 13 years).
Conclusion: We recommend to treat the Hürthle cells tumor similarly to the suggested management of follicular tumor, performing additionally a transoperative lymphatic mapping.


Key words: Thyroid, Hürthle cells tumor, lymphatic mapping transoperative.


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