- Email: [email protected]
p16 expression in cutaneous squamous cell carcinoma (cSCC) of the head and neck
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PATHOLOGY 2017 ABSTRACT SUPPLEMENT
associated with bone marrow suppression in patients with severe catabolism. It is important to recognise histopathologically (a) to distinguish the process from other causes of marrow hypoplasia and (b) because it may assist in the diagnosis of underlying systemic disease. We describe the case of a 20-year-old female with anorexia nervosa and BMI of 11 who presented with community acquired pneumonia. Laboratory studies revealed pancytopenia (haemoglobin 92 g/L, white cell count 0.9×109/L, platelets 46×109/L), electrolyte abnormalities and liver derangements. Bone marrow aspirate and trephine revealed GMT which was diffuse throughout the biopsy. GMT may be underreported, being usually focal rather than diffuse. The triad of morphological changes are (i) fat cell atrophy with decreased number and size variation, (ii) mild-to-moderate haematopoietic cell hypoplasia, and (iii) an infiltrate of amorphous gelatinous material that is light-blue to pale-pink on H&E, finely granular, and—in contrast to marrow oedema—Alcian blue positive. GMT is associated with various systemic diseases including severe infection, malnourishment, malignancy, alcoholism, and chronic heart failure. Treatment focuses on the underlying cause and resolution of this distinctive entity is varied. References Böhm J. Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Pathol 2000; 24: 56–65. Singh S, Gupta M, Singh G, et al. Gelatinous transformation of bone marrow: a prospective tertiary study, indicating varying trends in epidemiology and pathogenesis. Indian J Hematol Blood Transfus 2016; 32: S358–60. Bain BJ, Clark DM, Wilkins BS. Bone Marrow Pathology. 4th ed. Oxford: Wiley-Blackwell, 2010; 152–3.
RETROSPECTIVE ANALYSIS OF NAIL LESIONS: 7 YEARS EXPERIENCE AT CHANGI GENERAL HOSPITAL, SINGAPORE Hema Salkade, Sim Chee Seng Department of Laboratory Medicine, Changi General Hospital, Singapore Aim: All nail lesions from January 2010 to October 2016 were analysed retrospectively and categorised as concurrent or nonconcurrent cases. Methodology: 43 cases were reviewed including 48 biopsies and 3 amputations. Sections were stained with HE stain. Special stains and immunostains included PAS, GMS, Masson Fontana, Melan-A, HMB45, S100, Ki–67, SMA, h-Caldesmon and Desmin. Results: Out of 43 cases, 40 cases (93%) showed diagnostic concurrence while 3 cases (7%) were non-concurrent. 88% of cases were benign including onychomycosis (n = 10), viral wart (n = 7), melanocytic lesion (n = 5), glomus tumour (n = 2) and others. There was one case of atypical melanocytic proliferation and two cases of melanomas. Squamous cell carcinoma (n = 3; 7%) was the commonest cancer encountered. The non-concurrent cases included onychomycosis (n = 2) and glomus tumour (n = 1). Repeat special stains (n = 2) and culture studies (n = 5) were required to confirm the fungal infection. Two melanocytic lesions turned out to be atypical melanocytic proliferation and melanoma in situ on repeat biopsy. Discussion: Onychomycosis (23%) was the commonest condition seen. GMS/PAS stains and culture studies should be done on all cases of infective nail diseases. Prolonged longitudinal melanonychia should be investigated histologically. Repeat
Pathology (2017), 49(S1)
biopsy at appropriate site should be performed in melanocytic lesions with clinical suspicion of malignancy. LYNCH SYNDROME: REPORT OF A CASE WITH UNUSUAL PRESENTATION IN THE BREAST Nassim Saremi1,2, Lloyd McGuire1, Daniel De Viana3, Alfred King Y. Lam2,4 1 Helix Pathology, Gold Coast, 2Cancer Molecular Pathology in School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, 3Breast Care, Premion Building, Gold Coast, and 4Anatomical Department, Pathology Queensland, Gold Coast University Hospital, Gold Coast, Qld, Australia Background: Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer) is an autosomal dominantly inherited disorder of cancer susceptibility caused by germline mutations in the DNA mismatch repair (MMR) genes as indicated by microsatellite instability.ThecancerdevelopedinHNPCCisusuallycoloncancer.Other cancers noted included cancers of endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain and skin. Breast cancer in HNPCC is uncommon. We aim to present an unusual case of HNPCC withbreastcancer as itsclinical presentation. Method: A 33-year-old lady presented with a right breast lump. Ultrasound examination revealed a 50 mm ill-defined irregular hypoechoic nodule. Her father was known to have HNPCC. However, she did not have a history of colon cancer. Fine needle aspiration showed that the mass is malignant. She underwent modified radical mastectomy with sentinel lymph node biopsy. Histopathology examination revealed a triple negative breast carcinoma in a background of micro glandular adenosis. The carcinoma is proven to be microsatellite instability positive as it is negative for MSH2 and MSH6 on immunohistochemistry. Conclusion: In 1995, a case of MMR-deficient breast cancer in an individual carrying a germline mutation in an MMR gene was noted. Until now, to the best of our knowledge, a total of 42 such cases have been reported in the literature and ours is case 43. The case illustrates that albeit rare; breast cancer could be a presentation of HNPCC. It is clinically important to identify patients with HNPCC, so that they can benefit from targeted life-saving cancer surveillance strategies. P16 EXPRESSION IN CUTANEOUS SQUAMOUS CELL CARCINOMA (cSCC) OF THE HEAD AND NECK Laveniya Satgunaseelan1, Hyerim Suh2, Sohaib Virk2, Bruce Ashford3,4,5,7, Trina Lum1, Marie Ranson3,4, Jonathan Clark6,7, Ruta Gupta1,6 1 Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, 2University of New South Wales, Sydney, 3University of Wollongong, Wollongong, 4 Illawarra Health and Medical Research Institute, Wollongong, 5 Illawarra Shoalhaven Local Health District, Wollongong, 6The University of Sydney, Sydney, and 7Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia Background: Metastatic carcinoma of unknown primary is a common presentation in the neck. Australia has the highest rate of cutaneous SCC (cSCC) in the world, with head and neck
ABSTRACTS
cSCC (HNcSCC) being known to present with cervical metastases. The objective of the study was to evaluate the incidence of p16 expression in HNcSCC and analyse its association with prognostic factors and survival outcomes. Design: p16 immunohistochemistry was performed on tissue microarrays of 166 patients in the Sydney Head and Neck Cancer Institute database with HNcSCC (2000–2013) and on whole sections (n = 51) following histopathology review. Results: 53 (31.9%) cases showed strong, diffuse nuclear and cytoplasmic p16 expression. p16 expression significantly increased with increasing histological grade (p = 0.005). No significant difference was seen in the rate of nodal involvement (p16 positive 73.1% vs p16 negative 81.7%, p = 0.21), extranodal spread (p16 positive 22.6% vs p16 negative 26.5%, p = 0.59), or other conventional histopathological parameters. p16 expression was not associated with disease-specific or disease-free survival. Conclusion: p16 expression is seen in nearly 32% of HNcSCCs, particularly poorly differentiated HNcSCC. Thus HNcSCC should also be considered during the evaluation of squamous cell carcinoma of unknown primary in the neck, particularly in regions with high prevalence of HNcSCC. REINTRODUCING HISTOPATHOLOGY TEACHING TO MEDICAL STUDENTS USING ONLINE RESOURCES PROVIDED BY THE BEST NETWORK Mohit Shahi1, Archana Sudarsan1, Anthony Brown1, Peter T. Simpson1,2, Sunil R. Lakhani1,2,3, Nicholas J. Hawkins1 1 Discipline of Molecular and Cell Pathology, Faculty of Medicine, University of Queensland, Brisbane, 2The University of Queensland, UQ Centre for Clinical Research, Brisbane, and 3 Pathology Queensland, The Royal Brisbane & Women’s Hospital, Brisbane, Qld, Australia Purpose: Formal histopathology teaching was absent from the University of Queensland (UQ) medical program for many years. Re-establishment of this element of learning into the curriculum required development of a short module that was computerbased, resource-efficient, and student-accessible. Methods: A series of online modules were developed using an adaptive e-learning platform (smartsparrow.com) and virtual microscopic images from Slice (BEST Network). Practicals covered key processes in pathology as seen at the microscopic level, and highlighted clinicopathological correlates (inflammation; healing and chronic inflammation; thrombosis, embolism and infarction; neoplasia). These were delivered to a cohort of ~500 medical students. Analysis of student outcomes was available via the e-learning platform. Results: Interim analysis indicated that students valued the opportunities to learn histopathology in a formal setting and to learn/revise at their own pace. They achieved a significant improvement in their understanding of the materials after the lesson, valued online feedback provided within the lesson, and felt that the approach increased their opportunities for individualised learning. Conclusions: An understanding of disease is greatly supported by a simple understanding of pathological processes. Findings suggest that these practicals can be introduced simply and successfully into programs where they have not previously existed and with the help of technology, this goal can be achieved.
S87
COLITIS CYSTICA PROFUNDA IN ASSOCIATION WITH COLONIC ADENOCARCINOMA: A CASE REPORT Amandeep Singh, Leonardo Santos Department of Anatomical Pathology, South West Area Health Pathology Service, Liverpool Hospital, NSW, Australia Background: Colitis cystica profunda is a rare benign intestinal lesion that affects the rectum and rarely the colon. It is associated with numerous conditions including inflammatory bowel disease, rectal prolapsed and diverticulitis. It is categorised into localised and diffuse forms according to extent of involvement. Clinically and radiographically, it mimics colonic malignancy and can be associated with colonic adenocarcinoma. Case presentation: A 72-year-old man underwent laparoscopic right hemicolectomy for a biopsy proven hepatic flexure adenocarcinoma. Macroscopically, a partially ulcerated discoid tumour measuring 45 mm in maximum dimension was identified in the distal ascending colon. A separate 15 mm firm polyp was located proximally. Histologically, the main tumour was confirmed to be a moderately differentiated adenocarcinoma extending into the mesenteric fat. The polyp showed a 12 mm adenocarcinoma which infiltrated into the muscularis propria with presence of intramural cystically dilated glands lined by benign epithelium consistent with colitis cystica profunda. Discussion: Colitis cytica profunda is a rare lesion. The localised form is associated with solitary rectal ulcer syndrome and the diffuse form is observed in inflammatory conditions. Although rare, colitis cystic profunda is a mimicker of an adenocarcinoma, and if diagnosed, the pathologic specimen should be meticulously examined to rule out an associated adenocarcinoma. Reference Qayed E, Srivivasan S, Wehbi M. A case of colitis cystic profunda in association with diverticulitis. Am J Gastroenterol 2011; 106: 171–3.
AN 18F-FDG AVID LUNG NODULE DIAGNOSED AS METASTATIC HÜRTHLE CELL CARCINOMA BY CYTOLOGY – A CASE REPORT Brendan Stagg1, Peter Shin2, Clive Hoffmann2, Brendan Dougherty3, Gabrielle Cehic4, George Tallis5, Craig James6, Caroline Connell7, Sonja Klebe1,8, Alisa Kruger1 1 Anatomical Pathology Department, SA Pathology, Flinders Medical Centre, Adelaide, 2Breast and Endocrine Unit, Department of Surgery, Flinders Medical Centre, Adelaide, 3 Respiratory and Sleep Services, Flinders Medical Centre, Adelaide, 4Nuclear Medicine Department, Flinders Medical Centre, Adelaide, 5Endocrine SA, Tennyson Centre, Adelaide, 6 Clinpath Pathology, Adelaide, 7Adelaide Radiotherapy Centre, Adelaide, and 8Molecular Medicine and Pathology, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Adelaide, SA, Australia Introduction: Hürthle cell carcinoma is an uncommon variant of follicular carcinoma of the thyroid. Hürthle cells are oncocytic cells characterised by cellular enlargement with abundant eosinophilic and granular cytoplasm. Hürthle cell carcinoma is characterised by the presence of capsular or vascular invasion. Case report: An adult male presented with a thyroid nodule and FNA demonstrated suspected Hürthle cell carcinoma. After total thyroidectomy, histological examination showed Hürthle cell
PATHOLOGY 2017 ABSTRACT SUPPLEMENT
associated with bone marrow suppression in patients with severe catabolism. It is important to recognise histopathologically (a) to distinguish the process from other causes of marrow hypoplasia and (b) because it may assist in the diagnosis of underlying systemic disease. We describe the case of a 20-year-old female with anorexia nervosa and BMI of 11 who presented with community acquired pneumonia. Laboratory studies revealed pancytopenia (haemoglobin 92 g/L, white cell count 0.9×109/L, platelets 46×109/L), electrolyte abnormalities and liver derangements. Bone marrow aspirate and trephine revealed GMT which was diffuse throughout the biopsy. GMT may be underreported, being usually focal rather than diffuse. The triad of morphological changes are (i) fat cell atrophy with decreased number and size variation, (ii) mild-to-moderate haematopoietic cell hypoplasia, and (iii) an infiltrate of amorphous gelatinous material that is light-blue to pale-pink on H&E, finely granular, and—in contrast to marrow oedema—Alcian blue positive. GMT is associated with various systemic diseases including severe infection, malnourishment, malignancy, alcoholism, and chronic heart failure. Treatment focuses on the underlying cause and resolution of this distinctive entity is varied. References Böhm J. Gelatinous transformation of the bone marrow: the spectrum of underlying diseases. Am J Surg Pathol 2000; 24: 56–65. Singh S, Gupta M, Singh G, et al. Gelatinous transformation of bone marrow: a prospective tertiary study, indicating varying trends in epidemiology and pathogenesis. Indian J Hematol Blood Transfus 2016; 32: S358–60. Bain BJ, Clark DM, Wilkins BS. Bone Marrow Pathology. 4th ed. Oxford: Wiley-Blackwell, 2010; 152–3.
RETROSPECTIVE ANALYSIS OF NAIL LESIONS: 7 YEARS EXPERIENCE AT CHANGI GENERAL HOSPITAL, SINGAPORE Hema Salkade, Sim Chee Seng Department of Laboratory Medicine, Changi General Hospital, Singapore Aim: All nail lesions from January 2010 to October 2016 were analysed retrospectively and categorised as concurrent or nonconcurrent cases. Methodology: 43 cases were reviewed including 48 biopsies and 3 amputations. Sections were stained with HE stain. Special stains and immunostains included PAS, GMS, Masson Fontana, Melan-A, HMB45, S100, Ki–67, SMA, h-Caldesmon and Desmin. Results: Out of 43 cases, 40 cases (93%) showed diagnostic concurrence while 3 cases (7%) were non-concurrent. 88% of cases were benign including onychomycosis (n = 10), viral wart (n = 7), melanocytic lesion (n = 5), glomus tumour (n = 2) and others. There was one case of atypical melanocytic proliferation and two cases of melanomas. Squamous cell carcinoma (n = 3; 7%) was the commonest cancer encountered. The non-concurrent cases included onychomycosis (n = 2) and glomus tumour (n = 1). Repeat special stains (n = 2) and culture studies (n = 5) were required to confirm the fungal infection. Two melanocytic lesions turned out to be atypical melanocytic proliferation and melanoma in situ on repeat biopsy. Discussion: Onychomycosis (23%) was the commonest condition seen. GMS/PAS stains and culture studies should be done on all cases of infective nail diseases. Prolonged longitudinal melanonychia should be investigated histologically. Repeat
Pathology (2017), 49(S1)
biopsy at appropriate site should be performed in melanocytic lesions with clinical suspicion of malignancy. LYNCH SYNDROME: REPORT OF A CASE WITH UNUSUAL PRESENTATION IN THE BREAST Nassim Saremi1,2, Lloyd McGuire1, Daniel De Viana3, Alfred King Y. Lam2,4 1 Helix Pathology, Gold Coast, 2Cancer Molecular Pathology in School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, 3Breast Care, Premion Building, Gold Coast, and 4Anatomical Department, Pathology Queensland, Gold Coast University Hospital, Gold Coast, Qld, Australia Background: Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer) is an autosomal dominantly inherited disorder of cancer susceptibility caused by germline mutations in the DNA mismatch repair (MMR) genes as indicated by microsatellite instability.ThecancerdevelopedinHNPCCisusuallycoloncancer.Other cancers noted included cancers of endometrium, ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain and skin. Breast cancer in HNPCC is uncommon. We aim to present an unusual case of HNPCC withbreastcancer as itsclinical presentation. Method: A 33-year-old lady presented with a right breast lump. Ultrasound examination revealed a 50 mm ill-defined irregular hypoechoic nodule. Her father was known to have HNPCC. However, she did not have a history of colon cancer. Fine needle aspiration showed that the mass is malignant. She underwent modified radical mastectomy with sentinel lymph node biopsy. Histopathology examination revealed a triple negative breast carcinoma in a background of micro glandular adenosis. The carcinoma is proven to be microsatellite instability positive as it is negative for MSH2 and MSH6 on immunohistochemistry. Conclusion: In 1995, a case of MMR-deficient breast cancer in an individual carrying a germline mutation in an MMR gene was noted. Until now, to the best of our knowledge, a total of 42 such cases have been reported in the literature and ours is case 43. The case illustrates that albeit rare; breast cancer could be a presentation of HNPCC. It is clinically important to identify patients with HNPCC, so that they can benefit from targeted life-saving cancer surveillance strategies. P16 EXPRESSION IN CUTANEOUS SQUAMOUS CELL CARCINOMA (cSCC) OF THE HEAD AND NECK Laveniya Satgunaseelan1, Hyerim Suh2, Sohaib Virk2, Bruce Ashford3,4,5,7, Trina Lum1, Marie Ranson3,4, Jonathan Clark6,7, Ruta Gupta1,6 1 Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, 2University of New South Wales, Sydney, 3University of Wollongong, Wollongong, 4 Illawarra Health and Medical Research Institute, Wollongong, 5 Illawarra Shoalhaven Local Health District, Wollongong, 6The University of Sydney, Sydney, and 7Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia Background: Metastatic carcinoma of unknown primary is a common presentation in the neck. Australia has the highest rate of cutaneous SCC (cSCC) in the world, with head and neck
ABSTRACTS
cSCC (HNcSCC) being known to present with cervical metastases. The objective of the study was to evaluate the incidence of p16 expression in HNcSCC and analyse its association with prognostic factors and survival outcomes. Design: p16 immunohistochemistry was performed on tissue microarrays of 166 patients in the Sydney Head and Neck Cancer Institute database with HNcSCC (2000–2013) and on whole sections (n = 51) following histopathology review. Results: 53 (31.9%) cases showed strong, diffuse nuclear and cytoplasmic p16 expression. p16 expression significantly increased with increasing histological grade (p = 0.005). No significant difference was seen in the rate of nodal involvement (p16 positive 73.1% vs p16 negative 81.7%, p = 0.21), extranodal spread (p16 positive 22.6% vs p16 negative 26.5%, p = 0.59), or other conventional histopathological parameters. p16 expression was not associated with disease-specific or disease-free survival. Conclusion: p16 expression is seen in nearly 32% of HNcSCCs, particularly poorly differentiated HNcSCC. Thus HNcSCC should also be considered during the evaluation of squamous cell carcinoma of unknown primary in the neck, particularly in regions with high prevalence of HNcSCC. REINTRODUCING HISTOPATHOLOGY TEACHING TO MEDICAL STUDENTS USING ONLINE RESOURCES PROVIDED BY THE BEST NETWORK Mohit Shahi1, Archana Sudarsan1, Anthony Brown1, Peter T. Simpson1,2, Sunil R. Lakhani1,2,3, Nicholas J. Hawkins1 1 Discipline of Molecular and Cell Pathology, Faculty of Medicine, University of Queensland, Brisbane, 2The University of Queensland, UQ Centre for Clinical Research, Brisbane, and 3 Pathology Queensland, The Royal Brisbane & Women’s Hospital, Brisbane, Qld, Australia Purpose: Formal histopathology teaching was absent from the University of Queensland (UQ) medical program for many years. Re-establishment of this element of learning into the curriculum required development of a short module that was computerbased, resource-efficient, and student-accessible. Methods: A series of online modules were developed using an adaptive e-learning platform (smartsparrow.com) and virtual microscopic images from Slice (BEST Network). Practicals covered key processes in pathology as seen at the microscopic level, and highlighted clinicopathological correlates (inflammation; healing and chronic inflammation; thrombosis, embolism and infarction; neoplasia). These were delivered to a cohort of ~500 medical students. Analysis of student outcomes was available via the e-learning platform. Results: Interim analysis indicated that students valued the opportunities to learn histopathology in a formal setting and to learn/revise at their own pace. They achieved a significant improvement in their understanding of the materials after the lesson, valued online feedback provided within the lesson, and felt that the approach increased their opportunities for individualised learning. Conclusions: An understanding of disease is greatly supported by a simple understanding of pathological processes. Findings suggest that these practicals can be introduced simply and successfully into programs where they have not previously existed and with the help of technology, this goal can be achieved.
S87
COLITIS CYSTICA PROFUNDA IN ASSOCIATION WITH COLONIC ADENOCARCINOMA: A CASE REPORT Amandeep Singh, Leonardo Santos Department of Anatomical Pathology, South West Area Health Pathology Service, Liverpool Hospital, NSW, Australia Background: Colitis cystica profunda is a rare benign intestinal lesion that affects the rectum and rarely the colon. It is associated with numerous conditions including inflammatory bowel disease, rectal prolapsed and diverticulitis. It is categorised into localised and diffuse forms according to extent of involvement. Clinically and radiographically, it mimics colonic malignancy and can be associated with colonic adenocarcinoma. Case presentation: A 72-year-old man underwent laparoscopic right hemicolectomy for a biopsy proven hepatic flexure adenocarcinoma. Macroscopically, a partially ulcerated discoid tumour measuring 45 mm in maximum dimension was identified in the distal ascending colon. A separate 15 mm firm polyp was located proximally. Histologically, the main tumour was confirmed to be a moderately differentiated adenocarcinoma extending into the mesenteric fat. The polyp showed a 12 mm adenocarcinoma which infiltrated into the muscularis propria with presence of intramural cystically dilated glands lined by benign epithelium consistent with colitis cystica profunda. Discussion: Colitis cytica profunda is a rare lesion. The localised form is associated with solitary rectal ulcer syndrome and the diffuse form is observed in inflammatory conditions. Although rare, colitis cystic profunda is a mimicker of an adenocarcinoma, and if diagnosed, the pathologic specimen should be meticulously examined to rule out an associated adenocarcinoma. Reference Qayed E, Srivivasan S, Wehbi M. A case of colitis cystic profunda in association with diverticulitis. Am J Gastroenterol 2011; 106: 171–3.
AN 18F-FDG AVID LUNG NODULE DIAGNOSED AS METASTATIC HÜRTHLE CELL CARCINOMA BY CYTOLOGY – A CASE REPORT Brendan Stagg1, Peter Shin2, Clive Hoffmann2, Brendan Dougherty3, Gabrielle Cehic4, George Tallis5, Craig James6, Caroline Connell7, Sonja Klebe1,8, Alisa Kruger1 1 Anatomical Pathology Department, SA Pathology, Flinders Medical Centre, Adelaide, 2Breast and Endocrine Unit, Department of Surgery, Flinders Medical Centre, Adelaide, 3 Respiratory and Sleep Services, Flinders Medical Centre, Adelaide, 4Nuclear Medicine Department, Flinders Medical Centre, Adelaide, 5Endocrine SA, Tennyson Centre, Adelaide, 6 Clinpath Pathology, Adelaide, 7Adelaide Radiotherapy Centre, Adelaide, and 8Molecular Medicine and Pathology, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Adelaide, SA, Australia Introduction: Hürthle cell carcinoma is an uncommon variant of follicular carcinoma of the thyroid. Hürthle cells are oncocytic cells characterised by cellular enlargement with abundant eosinophilic and granular cytoplasm. Hürthle cell carcinoma is characterised by the presence of capsular or vascular invasion. Case report: An adult male presented with a thyroid nodule and FNA demonstrated suspected Hürthle cell carcinoma. After total thyroidectomy, histological examination showed Hürthle cell