Visible enlargement of the thyroid gland, as well as the presence of one or more nodules, should raise suspicion of thyroid pathology.
Oncocytic cancer or Hürthle cell cancer is a tumor of the thyroid gland. It can be benign in its behavior or, to a lesser extent, malignant when it invades nearby tissues or spreads to other organs.
Oncocytic cancer is usually asymptomatic but can cause visible growth of the thyroid gland. Its treatment is surgical removal, so a diagnosis is necessary.
The origin of oncocytic cancer
Oncocytic cancer is also called Hürthle cell cancer after the physiologist Karl Hürthle, who in 1984 described the disease with the theory that it comes from cells in the thyroid gland.
Later, in 1898, Askanazy described the oxyphilic cells and in 1919 it was Ewing who determined that the tumor arose from follicular cells in the thyroid gland. Thus, Hürthle cell cancer is also called “oxyphilic tumor” or “Askanazy cell tumor”.
Hürthle cells are large and polygonal, characterized by acid-prone cytoplasm, fine granules with abundant mitochondria, and a large, darkly colored nucleus.
A type of thyroid cancer
Oncocytic cancer is a cytological variant of follicular thyroid carcinoma, but more aggressive. It is considered the most aggressive because there is greater lymphatic involvement leading to lymph node spread or metastasis, in addition to the hematic spread. On the other hand, they usually respond poorly to radioiodine therapy.
The Eskenazi cell tumor represents 3 to 4% of all cases of thyroid cancer and 25% of all follicular carcinomas. In the literature, it is considered an intermediate-grade tumor, since 20-33% of all Hürthle cell carcinomas have malignant behavior as evidenced by invasive growth and the ability to metastasize distantly.
The incidence of Oncocytic cancer is low
Research shows that this type of cell cancer is rare and that it most often occurs in individuals between the ages of 50 and 70. It is even more common around age 75, and the ratio of women to men is 3:1.
The only treatment is surgical where a subtotal or total thyroidectomy is performed. The prognosis depends on the degree of invasion.
Hürthle cell carcinoma is usually asymptomatic. It usually causes no symptoms until it becomes large and oppressive.
It is usually an incidental finding during a routine physical examination when a solid nodule or dominant mass in the thyroid is evident. When the lump in the thyroid gland is large enough, it can cause compression in the neck, leading to other clinical manifestations, such as the following:
- Dysphonia or other voice changes
- Hard to breathe
- Difficult to swallow
- Sore throat or neck pain
Difficulty swallowing and breathing occur as the mass compresses the digestive tract (esophagus) and trachea. Other possible complications of oncocytic cancer may include the spread of cancer cells to other tissues or organs, which worsens the prognosis.
Associated risk factors
Risk factors associated with oncocytic cancer are:
- High age
- Being a woman
- A family history of thyroid cancer
- Previous radiotherapy to the head or neck
Diagnosis of oncocytic cancer
Thyroid oncocytoma is usually an incidental finding in the presence of an enlarged thyroid gland or a lump during a physical examination performed for any reason. In addition to identifying the presence of this anomaly, the physician should analyze its size and shape, as well as examine the surrounding lymph nodes for inflammation and/or lymphatic spread.
On the other hand, when oncocytic cancer causes voice changes or symptoms suggestive of vocal cord involvement, the vocal cords should be examined with laryngoscopy.
However, the definitive diagnosis is made through a histological study by biopsy, where a sample of thyroid tissue is extracted for analysis. This is done with a fine needle that passes through the skin on the neck guided by ultrasound images.
Initially, the treatment of oncocytic cancer is surgical. Surgery is performed to remove the thyroid gland, with total or near-total removal (total or subtotal thyroidectomy).
If spread to the surrounding lymph nodes is suspected, it is necessary to remove them. After the thyroidectomy, the physiological production of thyroid hormones is suppressed, which is why they must be supplemented daily for life. Levothyroxine is one of the key hormones for proper metabolic function.
There are also some risks associated with thyroidectomy :
- Accidental damage to the nerve that controls the larynx (laryngeal nerve) which can result in temporary or permanent dysphonia and even loss of voice.
- Excessive bleeding at the incision site.
- Involvement of the parathyroid gland, which is located behind the thyroid gland and regulates calcium levels in the blood. If suspected, as with levothyroxine, it should be administered daily for life.
After surgery, radioactive iodine treatment is usually recommended to destroy any remaining thyroid tissue that may contain traces of cancer cells. It is not enough to just destroy the remaining tissue, you also have to get rid of cells that spread to other parts of the body.
The treatment consists of a radioactive iodine pill and has temporary side effects, such as dry mouth, slight loss of taste, neck pain, nausea, and fatigue.
If the above treatment does not work, radiation therapy with powerful energy beams such as X-rays or protons can be used to destroy the cancer cells. This is usually the ideal option in case of metastases.
Thyroid enlargement requires medical evaluation
Oncocytic cancer, like other types of thyroid cancer, can be asymptomatic and asymptomatic. Therefore, when doctors find an enlarged thyroid gland or the presence of a single nodule, this should prompt a histological study of the tissue to determine if cancer cells are present.
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