Alaedeen Diya I, Khiyami Amer, McHenry Christopher R
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA.
Surgery. 2005 Oct;138(4):650-6; discussion 656-7. doi: 10.1016/j.surg.2005.06.047.
A fine-needle aspiration biopsy (FNAB) specimen of a thyroid nodule with a predominance of Hürthle cells usually is indicative of a Hürthle cell neoplasm, but it also may occur with nonneoplastic disease.
A prospective nodular thyroid disease database was used to identify patients with a FNAB specimen consisting of a predominance of Hürthle cells. Clinical factors were investigated and FNAB specimens were examined in a blinded fashion by a single cytopathologist to determine if there were specific factors that could be used to distinguish nonneoplastic from neoplastic disease.
Of the 738 patients with nodular thyroid disease, 622 had a FNAB specimen. The FNAB specimen was interpreted as consistent with a Hürthle cell neoplasm in 45 (7%) patients, 7 (16%) with carcinoma, 21 (47%) with adenoma, 12 (27%) with adenomatous hyperplasia, and 5 (11%) with thyroiditis. Extensive cellularity and absent colloid were associated with neoplastic disease (P < .05). No cytologic feature reliably excluded neoplastic disease (P > .05). No significant differences in age (x +/- SD) (51 +/- 17 vs 54 +/- 17 y), sex (female/male ratio, 6/1 vs 15/2), nodule size (3.9 +/- 1.9 vs 3.4 +/- 2.0 cm), weight of excised thyroid tissue (42 +/- 27 vs 33 +/- 30 g), or functional status of the thyroid gland was observed between patients with neoplastic (n = 28, 62%) versus nonneoplastic (n = 17, 38%) disease.
Neoplastic disease accounts for two thirds of the pathology in patients with a predominance of Hürthle cells on FNAB specimen and neither clinical nor cytologic features reliably exclude Hürthle cell adenoma or carcinoma. As a result, thyroidectomy is recommended for all patients with a thyroid nodule and a predominance of Hürthle cells on FNAB specimen.
甲状腺结节的细针穿刺活检（FNAB）标本中若以许特莱细胞为主，通常提示为许特莱细胞瘤，但也可能出现在非肿瘤性疾病中。
利用一个前瞻性甲状腺结节疾病数据库，识别出FNAB标本以许特莱细胞为主的患者。对临床因素进行调查，并由一名细胞病理学家以盲法检查FNAB标本，以确定是否存在可用于区分非肿瘤性疾病与肿瘤性疾病的特定因素。
在738例甲状腺结节疾病患者中，622例有FNAB标本。FNAB标本被解读为与许特莱细胞瘤一致的有45例（7%），其中7例（16%）为癌，21例（47%）为腺瘤，12例（27%）为腺瘤样增生，5例（11%）为甲状腺炎。细胞丰富和无胶质与肿瘤性疾病相关（P < 0.05）。没有细胞学特征能可靠地排除肿瘤性疾病（P > 0.05）。肿瘤性疾病患者（n = 28，62%）与非肿瘤性疾病患者（n = 17，38%）在年龄（x±SD）（51±17岁 vs 54±17岁）、性别（女性/男性比例，6/1 vs 15/2）、结节大小（3.9±1.9 cm vs 3.4±2.0 cm）、切除甲状腺组织重量（42±27 g vs 33±30 g）或甲状腺功能状态方面均未观察到显著差异。
FNAB标本以许特莱细胞为主的患者中，肿瘤性疾病占病理学情况的三分之二，临床和细胞学特征均不能可靠地排除许特莱细胞腺瘤或癌。因此，建议对所有FNAB标本以许特莱细胞为主的甲状腺结节患者进行甲状腺切除术。
