Un caso de carcinoma de tiroides de células de Hürthle. Abordando la incertidumbre del papel del Yodo I-131 / A case of Hürthle Cell Thyroid Carcinoma. Dealing with the Uncertainty of the Role of Iodinel-131 / Um caso de carcinoma de tireoides de células de Hürthle. Abordando a incerteza do papel do Iodo I-131

Objetivo: el fin de este artículo es dar a conocer la experiencia del manejo multidisciplinario de un caso documentado de carcinoma de células de Hürthle en el que se encontró captación con I-131 y por lo tanto opción terapéutica con el mismo. Presentación de caso: se trata de una paciente en la sexta década de la vida, diagnosticada inicialmente con bocio difuso quien fue manejada con terapia de sustitución hormonal con análogos de tiroxina sin respuesta satisfactoria, por lo que se realizó biopsia tiroidea, cuyo resultado reportó neoplasia de células de Hürthle de comportamiento inespecífico. Se realizó tiroidectomía oncológica y linfadenectomía. Se realizó revisión de placas de patología y se llegó a un diagnóstico definitivo de carcinoma de Hürthle. Se llevó el caso a junta multidisciplinaria y se decide terapia con I-131 pero este proceso llevó a que la terapia se realizara de forma tardía; aun así se evidencia en el rastreo postratamiento, captación en adenopatía cervical. Finalmente, presentó recaída pulmonar 12 meses después. Este tipo de tumor es un desafío para los médicos tratantes por la incertidumbre en su historia natural, en su tratamiento y en la utilidad del I-131, esta última es muy debatida debido a su alta tendencia a la desdiferenciación y al bajo porcentaje de los mismos que presentan captación del radiofármaco. Es incierto si la paciente de este caso se hubiese podido beneficiar de una terapia ablativa con I-131 más temprana disminuyendo el riesgo de recaída luego de haberse documentado avidez tumoral por el mismo

Objetive: The objective is to present a case with successful I-131 uptake in a patient with Hürthle cell carcinoma. Case presentation: A 60 years old female patient with diagnosed goiter, that was treated with thyroid hormone analogues that didn't decreased the growth of the mass; due to that, it was biopsied. The report of the pathology reported a Hürthle cell neoplasm with indeterminate behavior, lately oncologic thyroidectomy and lymphadenectomy were performed, from which the pathology plates were revised showing a definitive diagnosis of Hurthle cell carcinoma. The case was reviewed in a medical board where I-131 therapy was suggested. In the postheraphy scan performed, there was evidence of I-131 uptake in the neck and in an adenopathy. Twelve months later, there was evidence of pulmonary relapse. Is an uncertainty to know if the patient in this case would have been able to benefit from an early ablative therapy with I-131 decreasing the risk of relapse after having documented tumor avidity for it. The Hürthle thyroid carcinoma is rare, and its natural history is still controversial because it's challenging diagnosis, treatment and monitoring. Because there is no definitive agree about his integral approach despite it has been considered differentiated thyroid cancer even therapy with I-131 is still debated

Objetivo: O fim deste artigo é dar a conhecer a experiência do manejo multidisciplinar de um caso documentado de carcinoma de células de Hürthle no qual encontrou-se captação com I-131 e pelo tanto opção terapêutica com o mesmo. Presentación de caso: Trata-se de uma paciente na sexta década da vida, diagnosticada inicialmente com bócio difuso que foi tratada com terapia de substituição hormonal com análogos de tiroxina sem resposta satisfatória, pelo que se realizou biopsia tireóidea, cujo resultado reportou neoplasia de células de Hürthle de comportamento inespecífico. Realizou-se tireoidectomia oncológica e linfadenectomia. Realizou-se revisão de placas de patologia e chegou-se a um diagnóstico definitivo de carcinoma de Hürthle. Levouse o caso à junta multidisciplinar e decide-se terapia com I-131 mas este processo levou a que a terapia se realizara de forma tardia; ainda assim evidencia-se no rastreamento pós-tratamento captação em adenopatia cervical. Finalmente, apresentou recaída pulmonar 12 meses depois. Este tipo de tumor pe um desafio para os médicos tratantes pela incerteza na sua história natural, no seu tratamento e na utilidade do I-131, esta útlima é muito debatida devido à sua alta tendência à desdiferenciação e à baixa percentagem dos mesmos que apesentam captação do radiofármaco. É incerto se a paciente deste caso se tivesse conseguido beneficiar de uma terapia ablativa com I-131 mais temporã diminuindo o risco de recaída após ter-se documentado avidez tumoral pelo mesmo

Bilateral Renal Metastasis of Hürthle Cell Thyroid Cancer with Discordant Uptake Between I-131 Sodium Iodide and F-18 FDG / 대한핵의학회잡지

Renal metastasis of thyroid cancer is extremely rare. We report the case of a 62-year-old woman with Hürthle cell thyroid cancer (HCTC) with lungs, bones, and bilateral kidneys metastases. The renal metastatic lesions were clearly demonstrated by ¹³¹I whole body scan (WBS) with SPECT/CT. However, they exhibited false-negative results in ¹⁸F-FDG PET/CT, kidney ultrasonography, and contrast-enhanced CT scan. The findings imply that tumors have low glucose metabolism and are able to accumulate radioiodine, which is not commonly found in the relatively aggressive nature of HCTC. The patient received two sessions of 200 mCi ¹³¹I therapy within 6 months duration. There was complete treatment response as evaluated by the second post-therapeutic ¹³¹I SPECT/CT and serum thyroglobulin. To our knowledge, renal metastasis from HCTC with positive ¹³¹I but negative ¹⁸F-FDGuptake has not been reported in the literature. This case suggests that ¹³¹I SPECT/CTis useful for lesion localization and prediction of ¹³¹I therapy response.

Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data

BACKGROUND/AIMS: Follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC) of the thyroid are relatively uncommon thyroid malignancies in iodine-sufficient areas. In this study we evaluated the clinical behavior, prognostic factors and treatment outcomes of FTC and HCC in Korea. METHODS: This multicenter study included 483 patients with FTC and 80 patients with HCC who underwent an initial surgery between 1995 and 2006 in one of the four tertiary referral hospitals in Korea. We evaluated clinicopathological factors associated with distant metastases and recurrence during a median of 6 years of follow-up. RESULTS: HCC patients were significantly older (49 years vs. 43 years; p < 0.001) and had more lymphovascular invasions (22% vs. 14%; p = 0.03) compared with FTC patients. Distant metastases were confirmed in 40 patients (8%) in the FTC group and in two patients (3%) in the HCC group (p = 0.07). Distant metastases were significantly associated with older age, widely invasive cancer and extrathyroidal invasion. Only 14 patients (3%) had recurrent disease and there was no significant difference between FTC and HCC groups (p = 0.38). Recurrence was associated with larger tumor size and cervical lymph node metastasis. CONCLUSIONS: HCC patients were older and had more lymphovascular invasions than FTC patients. However, FTC and HCC patients had similar initial clinicopathological features. Older age, wide invasiveness and extrathyroidal invasion were independent risk factors for predicting distant metastases in FTC and HCC patients.