TY - BOOK AU - Seif Mohamed Ahmed El-Saban, AU - Tarek Khairy Mahmoud AU - Abdel-Wahab Raafat Abdel-Wahab AU - Eman Samy Abo-Senna TI - Clinico-pathological study of thyroid Hurthle cell neoplasm U1 - 616.994442 PY - 2024/// KW - Thyroid tumors KW - qrmak KW - Hurthle cell tumors KW - thyroid tumors KW - National Cancer Institute N1 - Thesis (M.Sc)-Cairo University, 2024; Bibliography: pages 101-119; Issues also as CD N2 - In this study, we report our experience with the Hürthle (oncocytic) cell neoplasms of thyroid gland, either Hürthle cell carcinoma or adenoma, and include a summary of the current literature to provide an insight on the current aspects of management for these diseases. We collected and analyzed retrospective data on the pathology, management, of patients with Hürthle cell neoplasms who underwent surgical management at department of surgical oncology, National Cancer Institute, Cairo University (NCI) from (January 2008 - January 2018). Hürthle thyroid neoplasm is a rare finding , in our study only 52 patients in 10 years from 2008 to 2018 were identified ; as of 27 cases were Hürthle cell adenoma and 25 cases were hürthle cell carcinoma. There were 18 female (66.7%) to 9 male (33.3%) HCA patients with median age of 47 years (range 21-69 years), and 20 (80%) female to 5 (20%) male HCC patients with median age of 43 years (range12-75 years). Only 2 cases had history of thyroid lobectomy for thyroid cancer before being diagnosed with Hürthle cell carcinoma. 3 HCA cases and only one HCC case had history of neck radiation. 22 HCA cases out of 27 and 16 HCC patients out of 25 had experienced clinical manifestations. The symptoms commonly ranged from neck swelling , dyspnea and dysphagia respectively. Most of Hurthle cell cancer patients diagnosed initially at presentation at stage 1 in 80% of them. The average tumor size in HCA patients (3.5cm) were smaller than that of HCC patients (4.0cm). The efficacy of imaging in detection of pathological staging and tumor size for all HCN patients in average was around 90% accurate, but for lymphadenopathy detection it was 25% accurate. Suspicious lymphadenopathy detected by imaging (U/S) in 8 (15.4%) out of 52 HCN cases with only 2 of them proved to be metastatic lymphadenopathy after lymphadenectomy for the 8 cases. 32 cases out of 52 HCN underwent pre-operative diagnostic biopsy either FNAC in 29 cases and Tru-cut in 3 cases. 34.4% of the biopsies were accurate for detection of Hürthle cell neoplasm but not reliable in differentiation between carcinoma and adenoma. All cases underwent surgical resection, only one of them was diagnostic for metastatic HCC and the others were curative. Pathological staging in HCA commonly seen at pT2 in 15 cases (55.6%) and in HCC cases commonly seen at PT3 in 12 cases (48%) Associated thyroiditis was seen in 5 cases (9.6%) of all 52 cases of HCN (2 in HCA and 3 in HCC). Extrathyroid extension was seen in 4 cases (16.0%) of HCC patients. No cases received adjuvant neck radiotherapy. 12 cases out of 25 HCC diagnosed cases only received RAI post operative with little impact on OS and DFS. 14 cases of all HCN population developed post operative complications , being hypo-calcemia the most common complication by 64.3%. A single HCA diagnosed case experienced recurrence and surgically removed; whether 4 HCC cases experienced recurrence Disease related mortality for HCC cases was mostly from pulmonary metastases and respiratory failure in 75% of them (3 cases). Median follow up after surgery was 83.5 months (ranged from 16 – 142 months of follow-up). On uni-variate and multi-variate analysis, older age (above 43 median age) was the only variable that was significant on overall survival. For every year increase in age there is about 6% increase in risk of death from disease, with 5-year and 10-year survival proportion for <= the median age 100% ,and 5-year survival for > the median age was 84% and 10-year survival was 70.3%. 5 year overall survival proportion for the whole HCN patients was 92.3% and 10-year survival was 85.1%. As for HCA cases, 5-year survival was 96.3% and 10-year survival was 88.3% . On the contrary, HCC cases 5-year survival was 88% and 10-year survival was 82.8%. Male patients (14) shows 5-year survival of 85.7% and 10-year survival of 57.1% ; in contrast to female patients, the 5-year survival shown to be 94.7% and 10-year survival to be 91.6%. On uni-variate analysis, older age (above 43 median age for HCC) and extrathyroid extension variables had significant impact on DFS. On multivariate analysis, only age above the median value had a significant impact on DFS. For every year increase in age there is about 5% increase in risk for recurrence of the disease, with 5-year and 10-year DFS proportion for <= the median age 100% ,and 5-year DFS for > the median age was 87.5% and 10-year DFS was 66%. 5 year disease free survival proportion for the whole cohort was 94.1% and 10-year survival was 82.9%. As for HCA cases, 5-year DFS was 96.3% and 10-year DFS was 84.7% . On the contrary, HCC cases 5-year DFS was 91.7% and 10-year DFS was 82.4%. Male patients (14) shows 5-year DFS of 85.7% and 10-year survival of 85.7% ; in contrast to female patients (37) , the 5-year DFS shown to be 97.3% and 10-year survival to be 88.6%. Also, previous history of neck exposure to radiotherapy has a 5-year and 10-year DFS of 75%. While extra-thyroid extension of the disease has a 5-year DFS of 75% and 10-year DFS of 50%; في هذه الدراسة، نورد تجربتنا مع أورام خلايا هرثل في الغدة الدرقية، إما خلايا هرثل السرطانية أو الحميده ، وندرج ملخصًا للأدبيات الحالية لتقديم نظرة ثاقبة على الجوانب الحالية للتعامل مع هذه الأمراض. قمنا بجمع وتحليل البيانات بأثر رجعي عن المرضى الذين يعانون من أورام خلايا هرثل الذين خضعوا للعلاج الجراحي في قسم الأورام الجراحية، المعهد القومي للأورام، جامعة القاهرة في الفترة من (يناير 2008 إلى يناير 2018). يعد ورم هرثل في الغدة الدرقية اكتشافًا نادرًا، ففي دراستنا تم تحديد 52 مريضًا فقط خلال 10 سنوات من 2008 إلى 2018؛ اعتبارًا من 27 حالة كانت ورمًا حميدا لخلايا هرثل و 25 حالة كانت سرطان خلايا هرثل. كان هنالك 18 أنثى (66.7%) و 9 ذكور (33.3%) مرضى بورم خلايا هرثل الحميد بالغدة الدرقية بمتوسط عمر 47 عامًا (المدى 21-69 عامًا)، و20 أنثى (80%) و 5 (20%) ذكور مرضى بسرطان خلايا هرثل بالغدة الدرقية بمتوسط عمر 43 سنة (المدى 12-75 سنة). حالتان فقط كان لهما تاريخ في استئصال فص من الغدة الدرقية بسبب سرطان الغدة الدرقية قبل تشخيص إصابتهما بـسرطان خلايا هرثل. 3 حالات من اورام هرثل الحميدة و حالة واحدة فقط من سرطان خلايا هرثل لديها تاريخ من إشعاع الرقبة. 22 حالة من اورام خلايا هرثل الحميدة من أصل 27 و16 مريض سرطان خلايا هرثل من أصل 25 لديهم اعراض باول عرض لهم بالعيادات. تراوحت الأعراض عادة بين تورم الرقبة وضيق التنفس وعسر البلع على التوالي. تم تشخيص معظم مرضى سرطان خلايا هرثل مبدئيًا عند العرض في المرحلة الأولىمن المرض في 80٪ منهم. كان متوسط حجم الورم لدى مرضى خلايا هرثل الحميدة (3.5 سم) أصغر من حجم الورم لدى مرضى سرطان هرثل (4.0 سم). كانت فعالية تصوير الاشعة في الكشف عن المراحل المرضية وحجم الورم لجميع المرضى في المتوسط دقيقة بنسبة 90٪ تقريبًا، ولكن بالنسبة للكشف عن اعتلال العقد الليمفاوية كانت بدقة اقل بكثير بنسبة 25٪. 8 حالات من اصل 52 حالة اورام هرثل تم اكتشاف اعتلال بالغدد الليمفاوية بواسطه اشعة سونار الرقبة و ثبت 2 فقط منهم بوجود ثانويات سرطانية بالغدد بواطه التحليل الباثولوجى. 32 حالة من اصل 52 حالة اورام هرثل تم تشخيصهم قبل العملية بواسطه استخدام الخزعة او خزعة بالابرة , و لكن 34.4% فقط من الخزعات كانت دقيقة فى تشخيص اورام هرثل و لكن لم تكن مفيدة فى التفرقة بين الاورام الحميدة او الخبيثة. جميع الحالات قامت باجراء استئصال جراحى , فقط حالة واحدة قامت بالاستئصال للتشخيص و الباقى استئصال علاجى. 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