Minimal invasive Hürthle cell adenoma of thyroid gland : A rare case report

Introduction: Hürthle cell adenoma (HCA) is a rare thyroid neoplasm including less than 5% of all thyroid tumors with predominance in adult females. Prognosis depends on patient’s age, size of the initial lesion, histologic appearance and extent of invasion. Size more than 4 cm is rare finding and only few cases had been reported from this type of HCA. Methods: In this article we report a 50-year-old woman who presented with swelling in the left side of her neck. The patient had lost 10 kg over the past 2 years but loss of appetite was denied by her. She complained of shortness of breath, excessive sweating, anxiety, irregular menstrual cycles and hot flashes which may contribute to premenopausal symptoms according to her age. In physical examination no tracheal deviation was observed. She had history of hypothyroidism and chronic hypertension. She had been under treatment by Atenolol and levothyroxine. Results: Ultrasonography of thyroid gland showed mildly enlarged left lobe and a cyst with uniform consistency measuring 3× 4×2 cm. Fine needle aspiration biopsy (FNAB) of thyroid gland was performed. Smears showed moderate amount of colloid, few inflammatory cells and moderate number of follicular cells that arranged as large follicle as well as papillary structures. There were some atypical as nuclear grooves, rarely nuclear inclusions and also a few psammoma body like calcifications. These microscopic views were suggestive for presence of papillary thyroid carcinoma. With this diagnosis the patient underwent total thyroidectomy. Post operational pathological study of the specimen revealed cells with eosinophilic cytoplasm and small regular nuclei with low grade of capsular Invasion the diagnosis was minimal invasive Hürthle cell adenoma. Conclusion: Ultrasound fails to identify thyroid tumors potential of malignancy while FNAB couldn’t differentiate it from thyroid carcinoma. As we see in our case, if the diagnosis of HCA was made before surgery, the surgeon might consider other less radical treatment options like thyroid lobectomy and preserve some parts of patient’s thyroid gland. On the other hand, because of unpredictable behavior of these tumors, a dilemma in management arises even after accurate diagnosis.

Keywords:

Hürthle cell adenoma , Thyroid neoplasm , Total thyroidectomy