Thyroid Hurthle cell neoplasm; NCI experience

Background: Hürthle cell neoplasms (HCNs) are rare thyroid tumors that account for about 5% of differentiated thyroid cancers. They may present as either Hürthle cell adenoma (HCA) or carcinoma (HCC), and surgical management remains the mainstay of treatment. This study aimed to present the National Cancer Institute (NCI), Cairo University experience with Hürthle cell neoplasms and evaluate clinical outcomes and prognostic factors. Methods: A retrospective study was conducted on patients diagnosed with Hürthle cell neoplasms at the NCI between January 2008 and January 2018. Data were collected from patient records, including demographics, clinical presentation, imaging, pathology, surgical management, adjuvant therapy, and follow-up outcomes. Statistical analyses were performed using SPSS version 24. Survival outcomes were assessed using Kaplan–Meier and Cox regression models. Results: Fifty-two patients were identified: 27 with Hürthle cell adenoma and 25 with Hürthle cell carcinoma. Females predominated (66.7% in HCA, 80% in HCC). Neck swelling was the most common presentation. All patients underwent surgical resection; 12 HCC cases (48%) received adjuvant radioactive iodine (RAI). Five- and ten-year survival rates were 96.3% and 88.3% for HCA, and 88% and 82.8% for HCC, respectively. Older age and extra-thyroidal extension were associated with worse disease-free survival and overall survival. Conclusions: Hürthle cell neoplasms are uncommon thyroid tumors with generally favorable outcomes after surgery. Total thyroidectomy with neck dissection is recommended for HCC, even in the absence of radiologically evident lymphadenopathy. Adjuvant RAI showed limited benefit on survival. Age and extra-thyroidal extension are significant predictors of prognosis.