Hyalinizing Trabecular Neoplasm of the Thyroid: Controversies in Management

Objectives/Hypothesis: To review the clinical and pathological picture of hyalinizing trabecular neoplasm of the thyroid [HTN] and compare HTN with papillary thyroid carcinoma [PTC] in order to discuss the appropriate management of this uncommon but potentially confusing neoplasm. Study Design: A case review of a patient with HTN treated at our institution. Methods: Case review and MEDLINE literature search. Results: Although recognized as a tumor of uncertain malignant potential in the pathology literature, HTN has been rarely reported in otolaryngology journals, and its management remains controversial. HTN and PTC share similar histopathological characteristics and have been described as coexistent lesions in the same thyroid. HTN's have also exhibited proto-oncogenes associated with PTC. Moreover, recent reports have described cases of HTN exhibiting vascular or capsular invasion and metastases. Conclusions: HTN should still be considered a neoplasm of uncertain malignant potential. Criteria for the treatment of HTN have yet to be determined, and many investigators are concerned about the prudence of making broad recommendations on the basis of a few studied cases. Nonetheless, when discussing surgical treatment options and recommendations for postoperative monitoring and radionuclide ablation in patients diagnosed with HTN, physicians may be guided by the criteria for the treatment of PTC at their respective institutions.