A Patient with a Large Hürthle Cell Carcinoma of the Thyroid and Nodal Metastases

Abstract

A patient presented with a large thyroid nodule that was eventually diagnosed as a Hürthle cell variant of follicular thyroid carcinoma. The case is unusual in its presentation with locoregional lymph node metastases, generally thought to be characteristic of papillary thyroid carcinoma but not follicular thyroid carcinoma. The patient illustrates the typical presentation of Hürthle cell carcinoma, in that he was of advanced age and the nodule lacked calcification on ultrasonography and was relatively large. The case illustrates the difficulty in differential diagnosis based upon cytology alone and the need for aggressive initial management with surgery and radioiodine when there is pathologic evidence of a highly invasive nature of the tumor. Unfortunately, many of these tumors are either radioiodine uptake negative or radioresistant, and other modalities of therapy are often required.