Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy

  • Vera WenterEmail author
  • Annamirl Jellinek
  • Marcus Unterrainer
  • Freba Ahmaddy
  • Sebastian Lehner
  • Nathalie Lisa Albert
  • Peter Bartenstein
  • Thomas Knösel
  • Christine Spitzweg
  • Harun Ilhan
  • Andrei TodicaEmail author
Original Article
Part of the following topical collections:
  1. Oncology – Head and Neck



Oncocytic (Hürthle cell) papillary thyroid carcinoma (OPTC) is a rare variant of the papillary thyroid carcinoma (PTC) which comprises approximately 1 to 11 % of PTC cases. Its clinical course and prognosis have not been comprehensively documented and the clinical outcome remains a controversial issue. Therefore, we investigated the long-term prognosis after thyroidectomy and (adjuvant) initial radioactive iodine therapy (RIT) of OPTC compared to PTC.


A total of 563 patients (47 with OPTC and 516 with PTC) with a median follow-up of 9.9 (0.3; 23.5) years were studied. All patients underwent thyroidectomy followed by (adjuvant) initial RIT. Data on the patients’ demographics, pathology, laboratory findings, imaging studies, treatment, and follow-up including recurrence, and disease-specific survival were collected. Cox’s multivariate regression model was used to identify independent prognostic factors for survival.


OPTC patients were significantly older (55.2 ± 12.3 years) than PTC patients (50.3 ± 13.5) at the time of initial diagnosis (p value 0.016). Initial tumor size was larger in the OPTC group (2.8 ± 1.8 cm for OPTC patients, 1.5 ± 1.2 cm for PTC patients, p value < 0.001). Before matching, OPTC patients presented more often with evidence of disease at the last visit of follow-up (p value 0.046). However, this difference was not observed anymore after matching for risk factors (p value 0.637). Disease-specific survival did not differ significantly. Age (HR, 1.183; 95% CI, 1.097–1.276) was identified as an independent prognostic factor for disease-specific survival. OPTC patients predominantly showed a recurrence of distant metastasis within a shorter time despite being not statistically significant.


At initial diagnosis, OPTC shows significant differences in terms of age and initial tumor size compared to PTC. Patients suffering from OPTC present with the same clinical long-term outcome indifferent to PTC after (adjuvant) initial RIT after matching.


Papillary thyroid cancer Oncocytic Oxyphilic papillary thyroid cancer Hürthle cell carcinoma Thyroid gland 



Parts of this paper originate from Annamirl Jellinek’s doctoral thesis.


This work was financially supported by the Kuhbier-Langewiesche foundation. Vera Wenter was financially supported by the Bavarian Equal Opportunities Sponsorship (BGF) to promote equal opportunities for women in research and teaching. The sponsorship did not influence study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was authorized by the local ethics committee (Ethics committee of the Medical Faculty, University Hospital, LMU Munich, Munich, Germany, IRB 18-768) in accordance with the ICH Guideline for Good Clinical Practice (GCP) and the Declaration of Helsinki.

Informed consent

The requirement to obtain informed consent was waived by the local ethics committee due to the retrospective design of this study.


  1. 1.
    Montone KT, Baloch ZW, LiVolsi VA. The thyroid Hurthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review. Arch Pathol Lab Med. 2008;132:1241–50.[1241:TTHOCA]2.0.CO;2.Google Scholar
  2. 2.
    Mai KT, Thomas J, Yazdi HM, Commons AS, Lamba M, Stinson AW. Pathologic study and clinical significance of Hurthle cell papillary thyroid carcinoma. Appl Immunohistochem Mol Morphol. 2004;12:329–37.CrossRefGoogle Scholar
  3. 3.
    Herrera MF, Hay ID, Wu PS, Goellner JR, Ryan JJ, Ebersold JR, et al. Hurthle cell (oxyphilic) papillary thyroid carcinoma: a variant with more aggressive biologic behavior. World J Surg. 1992;16:669–74 discussion 774–5.CrossRefGoogle Scholar
  4. 4.
    Gross M, Eliashar R, Ben-Yaakov A, Weinberger JM, Maly B. Clinicopathologic features and outcome of the oncocytic variant of papillary thyroid carcinoma. Ann Otol Rhinol Laryngol. 2009;118:374–81. Scholar
  5. 5.
    Hong JH, Yi HS, Yi S, Kim HW, Lee J, Kim KS. Implications of oncocytic change in papillary thyroid cancer. Clin Endocrinol. 2016;85:797–804. Scholar
  6. 6.
    Janovitz T, Barletta JA. Clinically relevant prognostic parameters in differentiated thyroid carcinoma. Endocr Pathol. 2018.
  7. 7.
    Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordonez NG, et al. Prognostic factors in patients with Hurthle cell neoplasms of the thyroid. Cancer. 2003;97:1186–94. Scholar
  8. 8.
    Liu C, Zhao Q, Zeng W, Chen C, Ming J, Wang S, et al. Do patients with oxyphilic cell papillary thyroid carcinoma have a poor prognosis? Analysis of the surveillance, epidemiology, and end results database 2004-2013 with propensity score matching. Oncotarget. 2017;8:77075–85. Scholar
  9. 9.
    Carr Azadeh A, Yen Tina WF, Ortiz Diana I, Hunt Bryan C, Fareau Gilbert, Massey Becky L, et al. Oncocytic papillary thyroid cancer has similar prognosis to matched classical papillary thyroid cancer controls. Thyroid. 2018.Google Scholar
  10. 10.
    Bhattacharyya N. Survival and prognosis in Hurthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg. 2003;129:207–10.CrossRefGoogle Scholar
  11. 11.
    Xiong Y, Zhao Q, Li Z, Wang S, Guo H, Liu Z, et al. Correction: propensity score matching analysis of the prognosis for the rare oxyphilic subtype of thyroid cancer (Hurthle cell carcinoma). Oncotarget. 2018;9:16273. Scholar
  12. 12.
    Mills SC, Haq M, Smellie WJ, Harmer C. Hurthle cell carcinoma of the thyroid: retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol. 2009;35:230–4. Scholar
  13. 13.
    Xiong Y, Zhao Q, Li Z, Wang S, Guo H, Liu Z, et al. Propensity score matching analysis of the prognosis for the rare oxyphilic subtype of thyroid cancer (Hurthle cell carcinoma). Oncotarget. 2017;8:101362–71. Scholar
  14. 14.
    Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, et al. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer. 2017;17:371. Scholar
  15. 15.
    Edge S, Byrd D, Compton C, Fritz A, Greene F, TRitt A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
  16. 16.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133. Scholar
  17. 17.
    Fagin JA, Wells SA Jr. Biologic and clinical perspectives on thyroid cancer. N Engl J Med. 2016;375:2307. Scholar
  18. 18.
    Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see comments]. Cancer. 1998;83:2638–48.CrossRefGoogle Scholar
  19. 19.
    Beckner ME, Heffess CS, Oertel JE. Oxyphilic papillary thyroid carcinomas. Am J Clin Pathol. 1995;103:280–7.CrossRefGoogle Scholar
  20. 20.
    Goffredo P, Roman SA, Sosa JA. Hurthle cell carcinoma: a population-level analysis of 3311 patients. Cancer. 2013;119:504–11. Scholar
  21. 21.
    Petric R, Gazic B, Besic N. Prognostic factors for disease-specific survival in 108 patients with Hurthle cell thyroid carcinoma: a single-institution experience. BMC Cancer. 2014;14:777. Scholar
  22. 22.
    Barnabei A, Ferretti E, Baldelli R, Procaccini A, Spriano G, Appetecchia M. Hurthle cell tumours of the thyroid. Personal experience and review of the literature. Acta Otorhinolaryngol Ital. 2009;29:305–11.Google Scholar
  23. 23.
    Ernaga Lorea A, Migueliz Bermejo I, Anda Apinaniz E, Pineda Arribas J, Toni Garcia M, Martinez de Esteban JP, et al. Comparison of clinical characteristics of patients with follicular thyroid carcinoma and Hurthle cell carcinoma. Endocrinol Diabetes Nutr. 2018;65:136–42. Scholar
  24. 24.
    Kim WG, Kim TY, Kim TH, Jang HW, Jo YS, Park YJ, et al. Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data. Korean J Intern Med. 2014;29:325–33. Scholar
  25. 25.
    Piccardo A, Arecco F, Puntoni M, Foppiani L, Cabria M, Corvisieri S, et al. Focus on high-risk DTC patients: high postoperative serum thyroglobulin level is a strong predictor of disease persistence and is associated to progression-free survival and overall survival. Clin Nucl Med. 2013;38:18–24. Scholar
  26. 26.
    Heemstra KA, Liu YY, Stokkel M, Kievit J, Corssmit E, Pereira AM, et al. Serum thyroglobulin concentrations predict disease-free remission and death in differentiated thyroid carcinoma. Clin Endocrinol. 2007;66:58–64. Scholar
  27. 27.
    Lin JD, Huang MJ, Hsu BR, Chao TC, Hsueh C, Liu FH, et al. Significance of postoperative serum thyroglobulin levels in patients with papillary and follicular thyroid carcinomas. J Surg Oncol. 2002;80:45–51. Scholar
  28. 28.
    Grogan RH, Kaplan SP, Cao H, Weiss RE, Degroot LJ, Simon CA, et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up. Surgery. 2013;154:1436–46; discussion 46-7. Scholar
  29. 29.
    Jillard CL, Youngwirth L, Scheri RP, Roman S, Sosa JA. Radioactive iodine treatment is associated with improved survival for patients with Hurthle cell carcinoma. Thyroid. 2016;26:959–64. Scholar
  30. 30.
    Stojadinovic A, Hoos A, Ghossein RA, Urist MJ, Leung DH, Spiro RH, et al. Hurthle cell carcinoma: a 60-year experience. Ann Surg Oncol. 2002;9:197–203.Google Scholar
  31. 31.
    Kushchayeva Y, Duh QY, Kebebew E, Clark OH. Prognostic indications for Hurthle cell cancer. World J Surg. 2004;28:1266–70. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, University HospitalLMU MunichMunichGermany
  2. 2.Ambulatory Healthcare Center Dr. Neumaier & Colleagues, Radiology, Nuclear Medicine, Radiation TherapyRegensburgGermany
  3. 3.Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University HospitalLMU MunichMunichGermany
  4. 4.Institute of Pathology, Faculty of Medicine, University HospitalLMU MunichMunichGermany
  5. 5.Department of Internal Medicine IV, University HospitalLMU MunichMunichGermany

Personalised recommendations