Significance of Hurthle Cells In Thyroid Cytology.

Eswari, V (2006) Significance of Hurthle Cells In Thyroid Cytology. Masters thesis, Madras Medical College, Chennai.

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Abstract

Thyroid gland is unique among endocrine organs. It is the largest of all the endocrine glands. Because of its superficial location, it is the only gland that is amenable to direct physical evaluation, cytological evaluation and histopathological study. The modern procedure of Fine needle aspiration cytology has found world wide acceptance in clinical use as a quick and reliable diagnostic modality. The method is applicable to lesions that are easily palpable. For ex. Superficial growths of the skin, subcutis, soft tissues and organs such as the thyroid, breast, salivary glands and lymph nodes. The technique is relatively painless produces a speedy result and is cost effective. It is less complicated than surgical biopsy and so is very suitable for practice in countries with limited resources. The low risk of complications is an additional advantage which allows Fine needle aspiration cytology to be performed as an out patient procedure. Fine needle aspiration cytology has become an area for research both fundamental and clinical. One can visualize the increasing use of Electron microscopy and immuno cytochemistry of Fine needle aspiration samples and smears. It has been established that morphometric technique applied to Fine needle aspiration preparations can aid not only in diagnosis of malignancy but also in assessing prognosis and selection of appropriate therapy. Fine needle aspiration cytology of the thyroid gland is firmly established as a first line diagnostic test for the evaluation of goiter and the single most effective test for the preoperative diagnosis of a solitary thyroid nodule. From our study it was observed that the cytological features of Hurthle cells varied in different lesions of the thyroid, thus enabling us to differentiate between non-neoplastic and neoplastic lesions by way of which we could guide the clinicians regarding further therapeutic management. As Hurthle cell Tumours are being a source of controversy for several decades, distinction between benign and malignant Hurthle cell tumours is not made out easily by cytology as in the case of Follicular neoplasms. Our findings indicate that a high percentage of Hurthle cells (>90%) as compared with all follicular cells, with >10% being single exhibiting cellular dyshesion, macronucleoli, nuclear enlargement with pleomorphism and few - no lymphocytes is predictive of Hurthle cell Tumours. In contrast in non neoplastic lesions Hurthle cells appeared as cohesive clusters or sheets without macronucleoli. In Hashimoto's Thyroiditis there was often a background of chronic inflammatory cells including plasma cells. In Goitre the Hurthle cells were associated with ordinary follicular cells arranged in large sheets and macrofollicles with abundant collorid. The amount of colloid in the background is not a significant parameter as we have seen in our study that there were cases of Hashimoto's thryoiditis which showed abundant colloid which is not a feature of Hashimoto's thyroiditis. Likewise there were cases of goitre which showed scant colloid with few lymphocytes, thus explaining why lack of colloid is not a significant parameter in differentiating neoplasms of Hurthle cells from non neoplastic Hurthle cells. In conclusion, the cytodiagnosis of Hurthle cell lesions of the thyroid by fine needle aspiration cytology is challenging since Hurthle cell neoplasm and non-neoplastic Hurthle cell nodules have some overlapping cytologic features. When Hurthle cell tumour is suspected, surgical excision of the lesion should be done for histological evaluation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Significance of Hurthle Cells; Thyroid Cytology.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 22 Jun 2017 09:58
Last Modified: 22 Jun 2017 10:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/251

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