Azadian A, Rosen I B, Walfish P G, Asa S L
Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Surgery. 1995 Oct;118(4):711-4; discussion 714-5. doi: 10.1016/s0039-6060(05)80039-x.
Hürthle cell tumors still pose issues concerning diagnosis and management.
From 1984 to 1993 forty-seven patients underwent thyroidectomy, and they were diagnosed after operation to have presumptive Hürthle cell tumors. The surgical pathologic findings were reviewed. In the neoplastic group the chart was reviewed for clinical features and outcome.
Thirty-one patients had nonneoplastic Hürthle cell nodules. Eleven (69%) of the 16 tumors were malignant affecting 11 women and five men ranging in age from 22 to 86 years. Two patients died of cancer for a 18% rate; one patient is alive with disease. Operations were uncomplicated. Factors for adverse outcome include tumor size greater than 4 cm, woman older than 60 years of age, and complete capsular invasion on surgical pathologic findings.
Fine-needle aspiration biopsy demonstration of Hürthle cell lesion is an indication for operation, providing Hashimoto's thyroiditis is excluded. Our surgical practice (I.B.R.) is to perform total thyroidectomy for all Hürthle cell neoplasms, as well as jugular node sampling and adjuvant radioiodine for cancer. Stringent histologic interpretation is possible and necessary for true appreciation of Hürthle cell tumor incidence and behavior. Cancer mortality of 18% is greater than the rate (2%) of our well-differentiated thyroid cancer group.
许特尔细胞肿瘤在诊断和治疗方面仍然存在问题。
1984年至1993年期间，47例患者接受了甲状腺切除术，术后被诊断为疑似许特尔细胞肿瘤。回顾了手术病理结果。在肿瘤组中，对病历进行了临床特征和预后的回顾。
31例患者有非肿瘤性许特尔细胞结节。16例肿瘤中有11例（69%）为恶性，累及11名女性和5名男性，年龄在22岁至86岁之间。2例患者死于癌症，死亡率为18%；1例患者带瘤生存。手术无并发症。不良预后因素包括肿瘤大小大于4厘米、年龄大于60岁的女性以及手术病理结果显示有完整包膜侵犯。
细针穿刺活检显示许特尔细胞病变是手术指征，前提是排除桥本甲状腺炎。我们的手术做法（I.B.R.）是对所有许特尔细胞肿瘤行全甲状腺切除术，以及对癌症行颈淋巴结采样和辅助放射性碘治疗。为了真正了解许特尔细胞肿瘤的发病率和行为，严格的组织学解释是可能且必要的。18%的癌症死亡率高于我们分化良好的甲状腺癌组的死亡率（2%）。
