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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:751-757 • 0278-4297

Hürthle Cell Neoplasms of the Thyroid

Sonographic Appearance and Histologic Characteristics

Zeev V. Maizlin, MD, Sam M. Wiseman, MD, Parag Vora, MBBS, John M. Kirby, MB, BCh, BAO, Andrew C. Mason, MD, Douglas Filipenko, MD and Jacqueline A. Brown, MD

Department of Radiology, McMaster University Medical Center, Hamilton, Ontario, Canada (Z.V.M., P.V., J.M.K.); Departments of Radiology (J.A.B.), Pathology (D.F.), and Surgery (S.M.W.), St Paul’s Hospital, Vancouver, British Columbia, Canada; and Department of Medical Imaging, Ridge Meadows Hospital, Maple Ridge, British Columbia, Canada (ACM).

Address correspondence to Zeev V. Maizlin, MD, Department of Radiology, McMaster University Medical Center, 1200 Main St W, Hamilton ON L8N 3Z5, Canada., E-mail: zeev25{at}yahoo.com

Objective. The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. Methods. We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. Results. The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. Conclusions. Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.

Key Words: Hürthle cell neoplasms • sonography • thyroid neoplasms

Abbreviations: FNA, fine-needle aspiration • HCA, Hürthle cell adenoma • HCC, Hürthle cell carcinoma • HCN, Hürthle cell neoplasm

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.