Hurthle cell neoplasm of the thyroid: Still a dilemma?

Abstract

Hurthle cells are large epithelial cells producing thyroglobulin and are observed in both nonneoplastic and neoplastic thyroid lesions. Hurthle cell neoplasms are classified as benign Hurthle cell adenoma or malignant hurthle cell carcinomas. These two entities are distinguished according to the presence of thyroid capsular or vascular invasion or metastatic disease. Their biologic behavior is unpredictable. Cytomorphologic features that are associated with neoplastic disease are absence of colloid, absence of chronic inflammation, nonmacrofollicular architecture, presence of transgressing blood vessels, extensive overall cellularity, extensive Hurthle cellularity, small cell dysplasia, large cell dysplasia, crowding, and dyshesion. These cytomorphologic features that support malignancy in nodules including Hurthle cells could guide the clinicians about the approach to the patients.