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thyroid
Hurthle cell neoplasm
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Clinical
30% has nodal metastasis (vs regular follicular neoplasm)
carcinoma vs adenoma depends on capsule invasion
lobectomy, followed by completion thyroidectomy if carcinoma
Cytology
follicular, trabecular or solid, crowded or dyscohesive
abundant granular cytoplasm, can have prominent clear cell change
prominent nucleoli
can have psammoma-like colloid bodies
Stains
TTF1
Ddx
Hashimoto thyroiditis
lack prominent nucleoli
Benign follicular nodule
lack prominent nucleoli
macrophages
coarse vacuoles / foamy
papillary carcinoma
nuclear grooves
RCC
lack TTF1
medullary carcinoma
lack prominent nucloli
calcitonin
parathyroid neoplasm
lack TTF1
granular cell tumor
S100
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suspicious for follicular neoplasm, Hurthle cell type