Diagnostic and therapeutic strategies for oncocytic carcinoma of the thyroid

WANG Yuan-yuan; FU Xing-hao; WU Guo-yang

doi:10.19538/j.cjps.issn1005-2208.2025.09.19

Abstract：Oncocytic carcinoma of the thyroid(OCA)is a rare malignant tumor arising from thyroid follicular cells,characterized by cytoplasm enriched with abundant eosinophilic granules.It exhibits highly aggressive behavior and a high risk of recurrence,posing major challenges in clinical management.Research has demonstrated that mitochondrial DNA mutations and alterations in the MAPK pathway(RAS/RAF/MEK/ERK)are critically involved in tumorigenesis,while activation of the PI3K/AKT/mTOR pathway contributes to invasiveness and therapeutic resistance.Diagnosis primarily relies on fine-needle aspiration(FNA),but the heterogeneity of Hürthle cells limits its accuracy.The integration of molecular marker detection and imaging modalities can improve diagnostic reliability.Surgical resection remains the cornerstone of treatment,with total thyroidectomy recommended in cases of large tumors or lymph node metastasis.The efficacy of radioactive iodine(RAI)therapy is limited due to poor iodine uptake.In recent years,multikinase inhibitors(MKIs)and immune checkpoint inhibitors have shown therapeutic potential in advanced or recurrent cases.Prognosis is closely correlated with tumor size,lymph node involvement,and vascular invasion,necessitating long-term surveillance with serum thyroglobulin measurement and imaging follow-up.Multidisciplinary team(MDT)management plays an essential role in optimizing individualized treatment strategies.Overall,diagnostic and therapeutic approaches for OCA are advancing toward precision and integration,with molecular studies and emerging targeted therapies offering new opportunities to improve survival and quality of life.