1. What is the presumptive diagnosis and at least two other potential diagnoses in the differential? Why is the presumptive diagnosis most likely?
Hurthle Cell Carcinoma. This is the presumptive diagnosis at this point. The evidence that supports this is the cells were large and brightly eosinophilic which is likely the staining of the mitochondria within the cell. The combination of the eosinophilic staining and poorly formed follicles, likely makes this tumor follicular cell tumor more specifically a Hurthle Cell. It is likely Hurthle Cell because this is the type of tumor which would stain this way. The reason that this is more likely a carcinoma is the identification of angiolymphatic invasion which is what is used to distinguish between …show more content…
What other tests or diagnostic studies should be performed on this patient and why?
A total thyroid work up is required for this patient. This includes a thyroid panel of TSH, T4, T3 and thyroglobulin. These tests provide a baseline function of the thyroid gland and can then be used for further management. Antiperoxidase and Antithyroglobulin antibodies also need to be tested because a there is a significant percentage of patient’s with Hurthle Cell Carcinoma will have these antibodies. If present these antibodies can cause artificial changes in the serum thyroglobulin. These antibodies are more often associated with autoimmune thyroid disease. Ultrasound of thyroid can be used to assess the presence of other nodules on the left lobe of the thyroid, additionally, an ultrasound can help detect enlarged lymph nodes. This test is also helpful for staging the disease.
Radioactive Iodine uptake should also be performed. The purpose of this test is to determine if the tumor has metastasized. Unfortunately, not all Hurthle Cell carcinomas uptake radioactive iodine, it is estimated only 10% do. Since radioactive uptake is not common in these tumors another suggested diagnostic test that can be performed to stage and locate and possible metastases is a 18F-FDG PET scan. This is a specialized PET scan that is often used post operatively in patient with Hurthle Cell Carcinoma. This is especially indicated if the serum thyroglubin is
Hurthle Cell Carcinoma. This is the presumptive diagnosis at this point. The evidence that supports this is the cells were large and brightly eosinophilic which is likely the staining of the mitochondria within the cell. The combination of the eosinophilic staining and poorly formed follicles, likely makes this tumor follicular cell tumor more specifically a Hurthle Cell. It is likely Hurthle Cell because this is the type of tumor which would stain this way. The reason that this is more likely a carcinoma is the identification of angiolymphatic invasion which is what is used to distinguish between …show more content…
What other tests or diagnostic studies should be performed on this patient and why?
A total thyroid work up is required for this patient. This includes a thyroid panel of TSH, T4, T3 and thyroglobulin. These tests provide a baseline function of the thyroid gland and can then be used for further management. Antiperoxidase and Antithyroglobulin antibodies also need to be tested because a there is a significant percentage of patient’s with Hurthle Cell Carcinoma will have these antibodies. If present these antibodies can cause artificial changes in the serum thyroglobulin. These antibodies are more often associated with autoimmune thyroid disease. Ultrasound of thyroid can be used to assess the presence of other nodules on the left lobe of the thyroid, additionally, an ultrasound can help detect enlarged lymph nodes. This test is also helpful for staging the disease.
Radioactive Iodine uptake should also be performed. The purpose of this test is to determine if the tumor has metastasized. Unfortunately, not all Hurthle Cell carcinomas uptake radioactive iodine, it is estimated only 10% do. Since radioactive uptake is not common in these tumors another suggested diagnostic test that can be performed to stage and locate and possible metastases is a 18F-FDG PET scan. This is a specialized PET scan that is often used post operatively in patient with Hurthle Cell Carcinoma. This is especially indicated if the serum thyroglubin is