Oncocytic follicular nodules of the thyroid with or without chronic lymphocytic thyroiditis: An institutional experience

Abstract

Background:Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT). Because OF cells can be present in non-neoplastic and neoplastic thyroid lesions it can be challenging to differentiate between these two in FNA specimens. The aims of this study were to determine the risk of malignancy in cases diagnosed as either oncocytic follicular neoplasm (OFN) or hyperplastic/adenomatoid nodule with OF on FNA and to identify clinicopathologic features that may help in predicting malignancy in such cases, especially the presence or absence of CLT.Design:We retrospectively searched the computerized laboratory information system at our institution between 1998 and 2009 for thyroid US guided FNA specimens in which the term “oncocytic/oncocytes” was mentioned in the final cytopathologic diagnosis. A total of 340 cases were selected for this study. The following data points were collected: Patient demographics, site of thyroid biopsy, size of lesion, FNA diagnosis, histopathologic follow-up and presence of CLT. Surgical pathology follow-up (SPFU) was available in 269 (79%) cases.Results:Two hundred and sixty patients were females and 80 males (average age 53 years). The lesion size was <3.0 cm in 241 (71%) and ≥ 3.0 cm in 99 (29%) cases. Cytologic diagnoses included: Follicular neoplasm with oncocytic features (FNOF) 321 and suggestive of FNOF 19 cases; a secondary cytologic diagnosis of CLT was made in 20 cases. SPFU was available in 269 (79%) cases; it was benign in 213 (213/267 = 79%) and malignant in 56 (56/269 = 21%) cases. The background thyroid showed CLT in 67 (25%) cases; 24% (48/196) neoplasms occurred with versus 76% (147/196) without CLT. The rate of malignancy was lower in nodules measuring less than 3.0 cm as compared to those equal or greater than 3.0 cm in size (17% vs. 28% respectively). The presence of CLT did not significantly alter the rate of malignancy in both FNA and surgical pathology specimens.Conclusions:Based on this study, nodule size and not CLT appears to be an important clinicopathologic features in the management of thyroid FNA specimens diagnosed as OFN.

The cytologic category of oncocytic (Hurthle) cell neoplasm mostly includes low-risk lesions at histology: an institutional experience

“…A further problem has been underlined in few recent papers by Roh and by Canberk, where the authors compared the different risk of malignancy in cases of oncocytic proliferation with presence or absence of HT, which is often responsible for the pitfalls due to the reactive nuclear atypia and pleomorphisms (22,28). Additionally, our previous paper on HTs stated that the evidence of the lymphocytic component is a key feature of thyroiditis with a 94% histologically benign diagnosis, in the same way that Giorgadze et al expressed their concern in the over-diagnosis of pleomorphisms and grooves in the presence of the lymphocytic component (14,29).…”

“…Hence, in series described by Nguyen and Gonzales-Campora, the presence of extensive cellularity, large/pleomorphic nuclei, and monomorphic small cells favor a diagnosis of carcinoma, while several other authors have also suggested the evaluation of some further clinical parameters such as gender, size of the lesion, and age (14,15,16,24,25,26,27). In this regard, very few papers have specifically underlined the cytological parameters which might be helpful in discriminating between benign and malignant oncocytic neoplasms, whereas clinical parameters to guide the preoperative decision making have been sought by numerous investigators (9,13,14,22,24,25,26,27,28).…”

“…The main difficulty is found in grading the oncocytic/ Hurthle atypia, which might discriminate oncocytic adenomas from OCC and which might select the best treatment (6, 7). Owing to the wide range of pathologies with oncocytic components, it is justified that a definitive classification can be challenging (11,18,19,20,21,22). Although the morphological definition of the oncocytic/Hurthle cell (round or ovoid pleomorphic nuclei, prominent central nucleoli, and large granular oxyphilic cytoplasms; Fig.…”

Preoperative Diagnosis of Neoplastic or Malignant Hürthle Cell Lesions: A Chimera?

“…HC carcinoma has been considered a subtype of follicular carcinoma; they show similar clinical behavior [5, 7, 9]. Other studies, however, describe differences in their behavior and oncogene expression [10-12].…”

Association between p53-binding protein 1 expression and genomic instability in oncocytic follicular adenoma of the thyroid

“…15062617). As this was a retcytic follicular adenomas (FAs), and those that exhibit vascular and/or capsular invasion in the absence of diagnostic nuclear features of papillary carcinomas are diagnosed as oncocytic follicular carcinoma [4][5][6][7]. However, the clinical significance of oncocytic change in thyroid tumors remains unclear and controversial.…”