# Biopsy report came in clean, but question?



## Alaina (Sep 1, 2011)

Hello everyone.

My doctor said my biopsy was clean. hugs4

He mentioned that there were Huerthal cells (not sure how to spell), but it was nothing to be concerened about. He said to come back in a year if I felt it was needed.

What are these "cells" and do I need to go back in a year or will it go away?

Thank you,

Alaina


----------



## Andros (Aug 26, 2009)

Alaina said:


> Hello everyone.
> 
> My doctor said my biopsy was clean. hugs4
> 
> ...


Alaina; it would be good to get a copy of the pathologist report.

There are Hurthle cells indigneous to Hashimoto's and Hurthle cells indigenous to cancer.

http://en.wikipedia.org/wiki/Hurthle_cell

Why did you have FNA in the first place? Are you symptomatic? Are you on thyroxine replacement? Have you had other labs such as these?

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/


----------



## Alaina (Sep 1, 2011)

Dear Andros,

The Hurthle (thanks for the spelling) cells are worrisome. I am assuming the cells must be of the Hashi type since the Doctor didn't seem concerned. Can the pathologist make a distiction between benign and malignant Hurthle cells? I will try to get a copy of the report. I don't have any real symptoms of Hashi's, and I have not been given any sort of diagnosis. There is nothing in my blood work that is alarming my Doctor. I am within range on everything, with the exception of TGAB and TPO. A year ago my Doctor indicated somewhere down the road he felt I may become Hypo because of the antibodies, but everything looks great.

So sorry for making another post, I should have posted in the same place. Below is my labwork and reports. I will still work on getting the Biopsy pathology.

Lab work (August 2011)
Prolactin-Diluted 3.5 (3.3 - 26.7 ng/ml)
T3 Free 3.2 (2.0 - 4.8)
T4 Free 1.4 (0.8 - 1.7)
Thyroglobulin 276 H (<56)
Thyroglobulin Antibodies 1274 H (<41l)
TPO-AB 338 H (<35)
Protein 8.2 H (6.0-8.0) 
TSH 0.35 L (.45-4.50)

Ultrasound Report (September 2011)

Right lobe: Was found to be lobular/Heterogeneous. The nodule within the midpole is heterogeneous in echotexture and is not seen as a discrete lesion, the size of this area measures 3.4cm x 1.6cm x 2cm. No hyperemia.
Size=5.3cm x 2.1cm x 2.1cm

Left lobe: Was found to be lobular/Heterogeneous. In the upper pole there is a 1.2cm x 1.1cm x 0.8 cm hypoechoic structure. There is another echogenic lesion with no significant acoustic shadowing medially within the lower pole that measures 0.8cm x 0.6 x0.6cm. The lobular region in the lower pole measures 2.8cm x 1.4cm x 1.9cm
Size of lobe 5.2cm x 1.7cm x 2.1cm

I did have an FNA last year (August 2010) and THAT report was "non-diagnostic". A repeat FNA was recommended but was never ordered. The report showed macrophages, lymphocytes, and follicular cells rare.

I will get the new report, I promise 

Thank you,

Alaina


----------



## Andros (Aug 26, 2009)

Alaina said:


> Dear Andros,
> 
> The Hurthle (thanks for the spelling) cells are worrisome. I am assuming the cells must be of the Hashi type since the Doctor didn't seem concerned. Can the pathologist make a distiction between benign and malignant Hurthle cells? I will try to get a copy of the report. I don't have any real symptoms of Hashi's, and I have not been given any sort of diagnosis. There is nothing in my blood work that is alarming my Doctor. I am within range on everything, with the exception of TGAB and TPO. A year ago my Doctor indicated somewhere down the road he felt I may become Hypo because of the antibodies, but everything looks great.
> 
> ...


Thank you for doing that; now it "all" comes back to me. You know I suspect cancer; we have discussed this.

Now as to the Hurthle cells: Either they are the type found in Hashi's or the type found in Cancer. There is no inbetween. Also, many w/Hashi's and Graves' are highly susceptable to cancer in the future.

For all you know, you may have had undiagnosed Hashi's for years and it has evolved into something else namely cancer.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

Hurthle Cell Tumors
Hurthle cell tumors are histologically distinct from other follicular tumors, but they pursue a similar course. They tend to invade and metastasize locally and have a strong propensity to recur after surgery. The course tends to be prolonged. These carcinomas often do not accumulate 131I. However, in a large survey, Caplan et al (274) found that 4.4% of Hurthle cell neoplasms were hot on scan and 8.9% were warm. Serum TG levels may be normal or elevated. Cheung et al recently studied the presence of ret/PTC gene rearrangements in Hurthle cell tumors and found that many expressed ret/PTC, and also had other evidence of a papillary cancer origin, including focal nuclear hypochromasia, grooves, and nuclear inclusions. Tumors with the ret/PTC gene rearrangement tended to have lymph node metastases, rather than hematogenous spread. Thus Hurthle cell tumors can be classified into Hurthle cell adenomas, Hurthle cell carcinomas, and Hurthle cell papillary thyroid carcinoma (275).

http://www.thyroidmanager.org/Chapter18/18-cancerframe.htm

FNA typically reveals lymphocytes, macrophages, scant colloid, and a few epithelial cells which may show Hurthle cell change. In this context Hurthle cells do not represent a discrete adenoma. However if only abundant Hurthle cells dominate the specimen, and there are few or no lymphocytes or macrophages, the biopsy must be interpreted as a possible Hurthle cell tumor.

FNA is indicated if there is uncertainty. However, it must be remembered that lymphoma or a small-cell carcinoma of the thyroid can be and has been mistaken for Hashimoto's thyroiditis. Clusters of nodes at the upper poles strongly suggesting papillary cancer may disappear when thyroid hormone replacement therapy is given. However, we have seen a sufficient number of patients with both thyroiditis and tumor to know that one diagnosis in no way excludes the other. Thyroid lymphoma must always be considered if there is continued (especially asymmetric) enlargement of a Hashimoto's gland, or if pain, tenderness, hoarseness, or nodes develop. Thyroiditis is a risk factor for thyroid lymphoma, although the incidence is very low. Thyroid lymphoma develops in most cases in glands which harbor thyroiditis. Distinguishing thyroid lymphoma from Hashimoto's thyroiditis is sometimes quite difficult Reverse transcription-polymerase chain reaction (RT-PCR) detecting the monoclonality of immunoglobulin heavy chain mRNA is useful for differentiation between the two(99). This condition and its management are discussed in Chapter 18.

http://www.thyroidmanager.org/Chapter8/8-frame.htm

My humble opinion is you really need to talk to an "expert" about all of this. The best case scenario is that you need to know you don't have cancer.

From what I gather, no one seems worried or seems to know anything beyond the fact that they are not worried. Well, it's your thyroid, your body!

For the record: "I am worried!"


----------



## Alaina (Sep 1, 2011)

Dear Andros,

That is a lot of great information. I cannot thank you enough. This puts a different spin on things now doesn't it!?

I will seek a second oppinion. Just to make sure. I wonder if I could somehow get a detailed report frot the pathologist? My greatest fear is that I remove my thyroid, and it be perfectly healthy (with the exception of a couple nodules..lol). On the other hand NOT removing a cancerous thyroid would be a disaster. I don't know what to do.
There isn't ANY other way to find out if there is cancer? MRI?

What would you do? Get a second oppinion? Have another biopsy? How soon can another FNA be done?

Thanks Andros.

Sincerely,

Alaina


----------



## Andros (Aug 26, 2009)

Alaina said:


> Dear Andros,
> 
> That is a lot of great information. I cannot thank you enough. This puts a different spin on things now doesn't it!?
> 
> ...


I would get ahold of that path report for sure. And I would get a second opinion, maybe from an ENT surgeon.

Now listen to me; the very very high Thyroglobulin Ab does in fact suggest cancer okay?

I don't want you to have cancer; no way. But at this point it would surely be stupid to not make sure you don't. People just don't walk around w/those high antibodies for no good reason.


----------



## Alaina (Sep 1, 2011)

I will call around for an appointment. Thank you Andros for being so straight forward.


----------



## Alaina (Sep 1, 2011)

Good Morning,

I cannot seem to get a copy of the report from my Doctor. They said they would mail it and it could take two weeks. I called the Radiologist, and they don't have a copy of the cytology.

I am also having difficulty getting in to see any other Endo's. I am continuing my search.

My latest issues....it's been more than a week since my FNA. The "smaller nodule on the left is still hurting, and every time I swallow I can feel it and it hurts to touch too. Could it be inflamed? and how long does it take for the pain to go away after the FNA. I didn't experience this with my first one. Can I call the radiologist to check it or do I have to go through my Dr?

Thanks. I must say, I am really getting discouraged. I don't want to come off sounding paranoid, but I need to get to the bottom of this.

I was also reading that a nodule greater than 3cm should probably be removed. Is this correct. I need to get answers from my doctor, but I feel as if I am being swept under the rug.

Sorry for the rant.

Sincerely,

Alaina 

TGIF!!!!!!!!


----------



## Andros (Aug 26, 2009)

Alaina said:


> Good Morning,
> 
> I cannot seem to get a copy of the report from my Doctor. They said they would mail it and it could take two weeks. I called the Radiologist, and they don't have a copy of the cytology.
> 
> ...


Oh, my goodness! This is terrible. I don't know what to tell you about all of this. Can't you pick up the report? Have they mailed it and why would it take 2 weeks? Sounds like a run around to me!

Believe me, I am upset along with you.

Wonder if you saw an ENT if that doctor could request your reports STAT? Not sure an endo is going to be much help but you could give it a try.

Make a post to ask others about their FNA experience to see if they have had pain like yours.

Keeping you in my prayers.


----------



## Alaina (Sep 1, 2011)

Well i talked to the nurse and she said the cytology report will not provide me with any additional information. It just says there are follicular cells, hurthle cells, lymphocytes and other cells present and that the nodule IS benign. She will mail it on Monday. I dont think they will ever want me back in that office again. They said if i am running a fever or cant swallow go to urgent care or the ER. Ouch!

In three months i will have it checked again. Hopefully i can find a doctor soon. I will look into finding a ent dr. this time.

THANK YOU AGAIN!

Sincerely,

Alaina


----------



## Octavia (Aug 1, 2011)

Alaina said:


> Thanks. I must say, I am really getting discouraged. I don't want to come off sounding paranoid, but I need to get to the bottom of this.


Alaina, BE PARANOID!!!!! I would call that a healthy paranoia. Nobody else will be paranoid on your behalf like you will. Have you made all these symptoms and discomforts crystal clear to your doctor? If not, you need to.

Looking forward to hearing how this all goes. I will keep my fingers crossed!

(I was so paranoid I went to the ER when a lump "suddenly" appeared in my neck. It was large, and I sure didn't see it the day before! Turned out to be cancer.]

Octavia


----------



## webster2 (May 19, 2011)

I would not say you are paranoid. I would say you are being a very good advocate for yourself, and you need to be. It is a really good idea to get a copy of every test or anything you have done and keep it in a file. You are wise to not give up.


----------



## lainey (Aug 26, 2010)

> The Hurthle (thanks for the spelling) cells are worrisome. I am assuming the cells must be of the Hashi type since the Doctor didn't seem concerned. Can the pathologist make a distiction between benign and malignant Hurthle cells? I will try to get a copy of the report. I don't have any real symptoms of Hashi's, and I have not been given any sort of diagnosis. There is nothing in my blood work that is alarming my Doctor.


Yes, I think the pathologist can tell the difference. That is their job, to know the identifying characteristics of different kinds of cells, that is what they have experience doing.

Why would they say it was benign if they even suspected that the cells were of the cancerous type? They don't want you to have cancer, and usually edge on the side of caution--it really isn't something that you would want to mis-diagnose.

I am not saying that you shouldn't seek a second opinion, or repeat the FNA very soon if you have any doubts.

However, the doctor said the report was benign. You need to take that for what it is.


----------



## Alaina (Sep 1, 2011)

Thank you for your replies.

I too believe it to be benign. I am still seeking another opinion. I will also wait for the report to come in the mail. Maybe that will put my mind at ease.

I know the pathologists dont want me to have cancer. I dont want to have cancer. But, I didnt know that it was possible to tell the difference between Hurthle cells. Is it? And is it normal to have them? Cancer or not should there be hurthle cells? I really appreciate all of your responses!!!!

Thanks again. I will stop obsessing over all of this.

Sincerely,

Alaina:rolleyes:


----------



## webster2 (May 19, 2011)

My path report had Hurthle cells too. I thought they were only present in Hashimoto's but apparently in cancer too. In a way, I was relieved....didn't want Hashi's too! :O


----------



## Andros (Aug 26, 2009)

Alaina said:


> Thank you for your replies.
> 
> I too believe it to be benign. I am still seeking another opinion. I will also wait for the report to come in the mail. Maybe that will put my mind at ease.
> 
> ...


Absolutely. A good pathologist can tell the diffence. You can too if you look them up.


----------



## lainey (Aug 26, 2010)

> But, I didnt know that it was possible to tell the difference between Hurthle cells. Is it? And is it normal to have them? Cancer or not should there be hurthle cells? I really appreciate all of your responses!!!!


You have the antibodies for Hashimotos', and there are specific Hurthle cells that are common to the disease. No, I do not think it's unusual for you to have them, because you have other indicators of thyroid disease. Likely the pathologist did not have access to your labs, so if they were unsure they would have referred to "coordinate with other clinical data" or some other sentence that would indicate their doubt that it might go either way.

Who knows, normal people could have them too. Why don't we know? Because we are not in the habit of taking cell samples from people without disease or another reason and looking at them. They could be a whole lot more common than you think.

I am not entirely familiar with your history--in a prior post you mention a larger nodule. Which cytology goes with which nodule?

Personally, I would skip the endo and see instead an endocrine surgeon or doctor that specializes in needle biopsies such as those done for breast cancer, etc. They have the best approach on the radiology and cytology reports from the cancer perspective, IMHO.


----------



## Alaina (Sep 1, 2011)

Thank you for your help.

Best of luck to you all. I really appreciate the information. 
I wish you all the best of health and happiness.

Thanks for your support. I have decided to go on and put this behind me. No more doctors, no more tests, done, done, done. If something comes up, I will go from there.
They say benign. I wont doubt the doctors. I dont care even to see the report.

Thanks. It was nice to have "met" you.

God bless

Alaina


----------



## Andros (Aug 26, 2009)

Alaina said:


> Thank you for your help.
> 
> Best of luck to you all. I really appreciate the information.
> I wish you all the best of health and happiness.
> ...


We don't like to lose our friends so do stop by once in a while and let us know how you are doing.

Everyone needs a respite!


----------



## Christinals (Sep 9, 2010)

Alaina,

Just checking on you. I read your posts and your story is MY story! Please let us know how you are doing. Best of luck to you 

-Christi


----------

