Globally, breast cancer ranks among the most common malignancies and has a high mortality rate. Invasive breast carcinoma of no special type (IBC-NST) presents a heterogeneous group with variable prognosis. Identifying reliable biomarkers is crucial for improving treatment strategies and predicting outcomes. This study investigates the immunohistochemical expression of parathyroid hormone-related protein (PTHrP) and ezrin in IBC-NST and their correlation with clinicopathological features and overall survival. This retrospective study analyzed 160 paraffin-embedded tissue samples, including 123 IBC-NST and 37 normal breast tissues, collected from patients treated at Menoufia University Hospital during the period from January 2018 to January 2022. Immunohistochemical staining for PTHrP and ezrin was performed, and expression levels were quantified using the H score. PTHrP expression was significantly higher in IBC-NST than in adjacent DCIS and normal tissues (p < 0.001). High PTHrP percent of expression was associated with metastasis (p = 0.009), bone metastasis (p = 0.012), and lymphovascular invasion (p = 0.037). Ezrin expression was also significantly elevated in IBC-NST, with higher H score values correlating with high tumor grade (p = 0.002), high N stage (p = 0.045), advanced AJCC stage grouping (p = 0.0043) and metastasis (p = 0.001). A significant positive correlation was observed between PTHrP and ezrin expression (rs = 0.341, p < 0.001). Kaplan-Meier analysis showed that high ezrin expression, in terms of intensity (p = 0.007) and H score (p = 0.002), was linked to poorer survival. The study highlights the significant roles of PTHrP and ezrin in breast cancer progression. Elevated levels of these proteins are associated with more aggressive disease, suggesting their capability as prognostic indicators and treatment targets in breast cancer. Additional studies are required to investigate their interaction and collective influence on breast cancer metastasis and treatment.

Background Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder characterized by diverse symptoms and lesions impacting the esophagus and adjacent regions, resulting from the backward flow of stomach contents into the esophagus. Eosinophilic esophagitis (EoE) has become a significant alternative diagnosis for persons with persistent GERD symptoms. This study aims to assess the prevalence of EoE in Egyptian patients who inadequately react to GERD treatments. Methods Esophageal tissue samples were collected from all patients exhibiting persistent GERD symptoms. EoE was identified based on esophageal mucosal biopsies showing at least 15 eosinophils per high-power field (HPF) and symptoms suggestive of esophageal dysfunction, following the exclusion of other causes of eosinophilia. Results Thirty hundred patients with persistent GERD symptoms were included in this study. These patients were divided into two groups: those diagnosed with EoE (n = 12) and those without this condition (n = 288). Dysphagia (p = 0.012), occult blood in stool (p = 0.024) and H. pylori antigen (p = 0.013) were significantly in favour of patients with eosinophilic oesophagitis and these factors were predictors of eosinophilic oesophagitis (p < 0.05). Conclusion The prevalence of eosinophilic esophagitis (EoE) among Egyptian patients with refractory GERD was found to be 4%, indicating that EoE is relatively uncommon type of esophagitis. EoE showed a notable association with dysphagia, occult blood in stool and Hpylori infection which are considered predictors of this type of esophagitis.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors affecting the digestive tract, comprising approximately 0.1–3

Colorectal cancer (CRC) is the most common gastrointestinal malignancy with a complicated behavior including relapse, metastasis, and development of resistance to chemotherapeutic drugs. Silent information regulator 2 homologue 1 (SIRT1), signal transducer and activator of transcription 3 (STAT3), and yes-associated protein (YAP) are cancer-related genes that have unclarified actions and even controversial roles in many human cancers including CRC. The current study aimed to evaluate the prognostic roles of SIRT1, STAT3, and YAP in CRC. Hundred and 13 CRC archival blocks were processed by TMA technique and immunostained with SIRT1, STAT3, and YAP antibodies. SIRT1, STAT3, and YAP are expressed in both tumor and stromal cells. SIRT1 expression in both the epithelial and stromal compartments was associated with favorable prognostic parameters, including longer overall and recurrence-free survival. In contrast, the epithelial and stromal expression of both STAT3 and YAP1 was associated with poor prognostic parameters, including short overall and recurrence-free survival. STAT3 and YAP epithelial expression showed a positive correlation with one another, but a negative correlation with epithelial SIRT1. While SIRT1 stromal expression was inversely correlated with stromal YAP expression, STAT3 and YAP concurrent stromal expression demonstrated a positive correlation with one another. There is crosstalk between CRC tumor and stromal cells by the coparallel expression of molecules such as SIRT1, STAT3, and YAP. There is a synergism between the STAT3 and YAP pathways in CRC at the level of the tumor and stroma. The tumor microenvironment of CRC could modulate tumor behavior by expressing markers suppressing invasion, such as SIRT1 or enhancing invasion, such as STAT3 and YAP.

Background: After many recorded cases of acute pneumonia of unknown cause, the World Health Organization announced COVID-19 as the start of a new coronavirus disease pandemic in 2019. Angiotensin-converting enzyme-2 (ACE2) is reduced by a protease known as transmembrane serine type 2 in the host cell, which then activates the S protein of SARS-CoV-2 regulating coronavirus entry into the host cells.Aim: The aim of this study was to assess the immunohistochemical expression of ACE 2 in the skin of patients affected by COVID-19 with and without cutaneous manifestations and to correlate ACE2 expression with clinical and pathologic parameters.Methods: Skin biopsies were obtained from skin lesions of 25 patients presenting with cutaneous manifestations and from the left forearm of 22 patients without cutaneous manifestations. The specimens were processed for evaluation of histopathologic changes and ACE2 immunohistochemical evaluation.Results: Positive ACE2 expression was significantly higher in patients without cutaneous manifestations (96%) than those with cutaneous manifestations (72.7%). Positive ACE2 expression in the skin of affected patients was significantly associated with the presence of comorbidities, positive family history, high ABCD score, elevated lactate dehydrogenase, high D-dimer, rapid respiratory rate, and low oxygen saturation.Conclusions:The skin could be involved in COVID-19 infection in the form of inflammatory changes, such as pityriasis rosea-like lesions. Patients with COVID-19 who presented with cutaneous manifestations are usually less severe. The presence of ACE2 in the skin of patients with COVID-19 is an indicator of worse status. Patients with COVID-19 without skin manifestations showed higher positivity for ACE2, which may explain the severity of the cases.

Background: Gastroesophageal reflux disease (GERD) stands out as a highly common gastrointestinal ailment, marked by a variety of symptoms and lesions affecting both the esophagus and other areas, caused by the backward flow of stomach contents into the esophagus. Eosinophilic esophagitis (EoE) has emerged as an important alternative diagnosis in individuals experiencing persistent GERD symptoms. The purpose of this study is to evaluate how widespread EoE is among Egyptian patients who do not respond adequately to GERD treatments. Esophageal tissue samples were collected from all patients exhibiting persistent GERD symptoms. EoE was diagnosed when esophageal mucosal biopsies revealed a minimum of 15 eosinophils per high-power field (HPF), along with symptoms indicating esophageal dysfunction and ruling out other causes of eosinophilia. Results: In our latest study, we included 300 patients with persistent GERD symptoms. These patients were categorized into two groups: those diagnosed with EoE (n=12) and those without the condition (n=288). Dysphagia emerged as the predominant symptom in patients with EoE. The symptoms experienced by EoE patients closely resembled those of individuals with refractory GERD, with both groups reporting abdominal pain (100%, 87.5%) and heartburn (100%, 100%). Consequently, it is essential to conduct examinations and obtain biopsies from these patients to rule out EoE. Conclusion: The occurrence of EoE among Egyptian patients with persistent GERD symptoms was determined to be 4%. Ie is relatively rare in individuals with refractory GERD symptoms.

OBJECTIVE:This study aimed to evaluate the expression of Beclin 1 and HER2 proteins using immunohistochemistry in CRC tissues compared to colonic adenoma, and to investigate the correlation of their expression with clinicopathological parameters and survival outcomes in CRC patients.METHODS:The study utilized paraffin-embedded blocks from 17 colonic adenoma and 81 CRC cases. Immunohistochemical analysis was performed to assess the expression of Beclin 1 and HER2 proteins.RESULTS:The cytoplasmic expression of Beclin 1 was significantly higher in CRC tissues compared to adenoma specimens (P=0.051). High Beclin 1 expression was significantly associated with distal colon location (P=0.028). High HER2 cytoplasmic expression was significantly associated with vascular invasion (P=0.05), perineural invasion (P=0.03), and shorter overall survival (P=0.035).CONCLUSIONS:The findings suggest that Beclin 1 plays a role in colorectal carcinogenesis, with higher expression observed in CRC cases compared to adenoma cases.  Furthermore, HER2 carries poor prognostic impact in CRC cases.

BACKGROUND:Serine-Arginine (SR) proteins are a conserved family of proteins involved in RNA splicing and are reported to be over-expressed in multiple cancers. The aim of the study is evaluation of the expression of Serine arginine protein kinase 1 (SRPK1) and Minichromosome maintenance protein 2 (MCM2) in epithelial ovarian cancer (EOC) and their correlation with clinicopathological features, response to therapy, progression-free survival (PFS), and cancer-specific survival (CSS). METHODS:This study was carried out on surgical specimens of 65 patients diagnosed with EOC which were submitted to immunohistochemical staining by SRPK1 and MCM2 antibodies. RESULTS:About 89.2% of cases showed SRPK1 expression and its high expression was significantly associated with type II tumors and advanced stage. All cases showed nuclear immunoreaction for MCM2 with high expression in 49.2% of cases. There was a significant relationship between high values of SRPK1 H-score and percentage of MCM2. Postmenopause, type II pathology, advanced stage, absence of complete response to the treatment, resistance to platinum-based chemotherapy, and surgery done by a general surgeon were the factors affecting PFS. Response to treatment and platinum sensitivity were the most independent factors affecting patients' PFS. The factors associated with shorter CSS were suboptimal debulking, advanced stage, absence of complete response to the treatment, platinum resistance, and high SRPK1. High SRPK1 expression and platinum sensitivity were the independent factors affecting patients' CSS. CONCLUSIONS:SRPK1 is an unfavorable biomarker in EOC patients because of its association with aggressive histologic type, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, and worse survival. SRPK1 could promote the proliferation of EOC by up-regulation of MCM2.

Background KIF18A is a regulator of the cell cycle that stimulates the proliferation of cancer cells. The Wnt/β-catenin pathway is involved in different issues’ carcinogenesis and is being examined as a therapeutic target. The relationship between KIF18A and β-catenin in breast cancer was not previously investigated. Therefore, this work aims to study the immunohistochemical expression and correlation of KIF18A and β-catenin in breast-infiltrating duct carcinoma (IDC) and their relation to prognosis. Material and methods Slides cut from paraffin blocks of 135 IDC and 40 normal breast tissues were stained by KIF18A and β-catenin antibodies. KIF18A cytoplasmic or nucleocytoplasmic staining and β-catenin aberrant expression either nucleo-cytoplasmic or cytoplasmic staining were considered. Results Normal breast tissue and IDC showed a significant difference regarding KIF18A and aberrant β-catenin expression. High KIF18A and β-catenin H score values were associated with poor prognostic factors such as high grade, advanced stage, distant metastasis, high Ki67 status, and Her2neu-enriched subtype. There was a significant direct correlation between KIF18A and β-catenin as regards percent and H score values. Prolonged overall survival (OS) was significantly associated with mild intensity and low H score of KIF18A, and low β-catenin H score. Conclusions KIF18A could be involved in breast carcinogenesis by activating β-catenin. Overexpression of KIF18A and aberrant expression of β-catenin are considered proto-oncogenes of breast cancer development. KIF18A and β-catenin could be poor prognostic markers and predictors of aggressive behavior of breast cancer.

Background The search for objective factors that help in predicting the response of vitiligo treatment is very important. Objective We sought to evaluate the effect of NB-UVB phototherapy on both the alpha melanocyte stimulating hormone-microphthalmia-associated transcription factor (α-MSH-MIFT) axis, and isocitrate dehydrogenase 2 (IDH2) in non-segmental vitiligo (NSV). Methods This prospective clinical trial included 50 NSV patients and 50 healthy control subjects. α-MSH tissue levels as well as MITF and IDH2 immunostaining were assessed in normal and vitiliginous skin biopsies before treatment and then in the repigmented areas following 24 NB-UVB phototherapy treatment sessions using ELISA technique and immunohistochemical study, respectively. Results There was a significant negative correlation between baseline VASI scores and the tissue levels of α-MSH (p=0.006) and the expression of both MITF (p<0.00001) and IDH-2 (p= 0.001). The mean α-MSH tissue levels increased significantly after treatment (p<0.001). Tissue expression of both MTIF and IDH-2 was significantly upregulated following treatment (P-value <0.001). The percentage of improvement showed a significant positive correlation with the studied markers (p<0.00001). Conclusion α-MSH- MIFT axis and the antioxidant protein IDH2 are promising objective markers of non-segmental vitiligo severity, and are suggested as predictors of vitiligo response to treatment.

Introduction: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer with a poorly characterized immune microenvironment. Methods: We used a five-colour multiplex immunofluorescence panel, including CD68, CD4, CD8, CD20, and FOXP3 for immune microenvironment profiling in 93 treatment-naïve IBC samples. Results: Lower grade tumours were characterized by decreased CD4+ cells but increased accumulation of FOXP3+ cells. Increased CD20+ cells correlated with better response to neoadjuvant chemotherapy and increased CD4+ cells infiltration correlated with better overall survival. Pairwise analysis revealed that both ER+ and triple-negative breast cancer were characterized by co-infiltration of CD20 + cells with CD68+ and CD4+ cells, whereas co-infiltration of CD8+ and CD68+ cells was only observed in HER2+ IBC. Co-infiltration of CD20+, CD8+, CD4+, and FOXP3+ cells, and co-existence of CD68+ with FOXP3+ cells correlated with better therapeutic responses, while resistant tumours were characterized by co-accumulation of CD4+, CD8+, FOXP3+, and CD68+ cells and co-expression of CD68+ and CD20+ cells. In a Cox regression model, response to therapy was the most significant factor associated with improved patient survival. Conclusion: Those results reveal a complex unique pattern of distribution of immune cell subtypes in IBC and provide an important basis for detailed characterization of molecular pathways that govern the formation of IBC immune landscape and potential for immunotherapy.

Objective: Tumor border configuration, tumor budding and tumor stroma ratio are reliable histopathological parameters that play a central role in the invasion-metastasis cascade. This study aimed to investigate the prognostic impact of these parameters and a new combined score in colorectal cancer. Material and Method: A cohort of 103 colorectal cancer surgical specimens was retrospectively evaluated for tumor border configuration, tumor budding and tumor stroma ratio using H&E sections. A combined risk score was then constructed to divide cases into low risk-tumors and high risk-tumors. Results: Infiltrating tumor border, high tumor budding, low tumor stroma ratio and high combined risk score were associated with positive lymph node involvement, presence of metastasis, high tumor grade, lymphovascular invasion, poor overall survival and short recurrence-free survival. Infiltrating tumor border, high tumor budding and high combined risk score were associated with advanced T stage. High tumor budding, and low tumor stroma ratio were associated with perineural invasion. Infiltrating tumor border was associated with increased tumor size and conventional adenocarcinoma, high tumor budding and low tumor stroma ratio. Low tumor stroma ratio was associated with high tumor budding. On multivariate survival analysis, tumor stroma ratio was found to be an independent predictor for overall survival and recurrence-free survival. Conclusion: Tumor border configuration, tumor budding, tumor stroma ratio and the newly constructed combined risk score are potential predictors of outcome in colorectal cancer patients, suggesting that their incorporation in the routine histopathological evaluation could be useful in determining the prognosis of colorectal cancer cases.

Background The current therapies for vitiligo require long duration with often disappointing outcomes. 5-Fluorouracil (5-FU) is a chemotherapeutic agent approved for topical use in the treatment of several dermatologic conditions. Matrix metalloproteinase 2 (MMP2) is synthesized by keratinocytes during the epidermal remodeling process and has been found to help in melanocyte migration. Aim To investigate the efficacy and safety of flexible microneedling followed by application of 5-FU in vitiligo treatment and to evaluate the immunohistochemical expression of MMP2 in involved skin in vitiligo patients before and after treatment. Methods Twenty patients presented with vitiligo were planned to receive one session every 2 weeks for 12 weeks of microneedling followed by 5-FU application. Clinical response to therapy was evaluated by VASI score. Pre- and post-treatment biopsies were taken from vitiliginous patches for MMP2 immunostaining. Results Fifteen patients (75%) responded to therapy with observed side effects such as pain, erythema, and hyperpigmentation of margins. The clinical response was more in young patients and those who have short disease duration. MMP2 was significantly increased in post-treatment biopsy compared with the pretreatment one. Conclusions 5-Fluorouracil application after microneedling is effective in the treatment of vitiligo with 75% response, 60% patient satisfaction, and tolerable side effects. The improvement in vitiligo patients by microneedling and 5-fluorouracil could be due to upregulation of MMP2 in affected vitiligo specimens.

Background: Conjugated linoleic acid (CLA) has been shown in humans and animals to have anti-adipose effects. The current study aims to assess the prophylactic and therapeutic impact of CLA and its effect on recruited macrophage type using immunohistochemistry against CD68 and CD 163. Materials and Methods: Forty adult male albino rats of local strain were included in the study and divided into control, CLA-supplemented, obese, CLA-prophylactic obese, and CLA-treated obese groups. Biopsies from visceral fat of the investigated groups were obtained and assessed for histopathological changes and immunohistochemical staining for CD68 and CD163. Results: Obese group showed hypertrophied adipocytes and infiltration by inflammatory cells compared to other groups. The obese group showed a marked increase in the CD68 positivity compared with that in the control and CLA-supplemented groups. CLA-prophylactic and CLA-treated groups showed mild immune reaction with a significant decrease in CD68 positivity compared to the obese group. The obese group showed a significant decrease in the CD163 positivity compared with that in the control and CLA-supplemented groups. Conclusions: Adipose tissue in obese is characterized by inflammation with more M1 than M2 macrophages. CLA could direct the recruited macrophages toward the anti-inflammatory subtype (M2) which encourages its beneficial effects in prophylaxis from obesity.

Clear cell change has been demonstrated in many cutaneous entities; however, there have been only two reports of clear cell neurofibroma. We present the third case of this unusual subtype. A 25-year-old female presented clinically with a picture of neurofibromatosis Type 1 including multiple cutaneous nodules. Biopsy from one of these nodules revealed a normal epidermal covering and a dermal benign neoplastic growth formed of a mixture of spindle cells and clear cells showing vacuolated cytoplasm. The neoplastic cells showed round nuclei with prominent nucleoli. Immunohistochemical staining showed positivity to S-100 and CD68 with negative expression of calretinin, CK, Melan-A, HMB-45, CD34, and smooth muscle actin. Clear cell neurofibroma should be considered in dealing with clear cell cutaneous lesions, giving attention to characteristic clinical, histopathological, and immunohistochemical features. CD68 could be expressed in neurofibroma, and this should not be misinterpreted as a histiocytic lesion.

Background Colorectal cancer (CRC) represents the seventh commonest cancer in Egypt. Early detection of peritoneal metastasis is a major challenge in CRC management. The aim of this study was to assess the incidence of positive malignant cells in peritoneal lavage before and after resection of CRC. Patients and methods This prospective study was conducted from May 2020 to June 2022 and included 50 patients who underwent colorectal tumor resection. Intraoperative peritoneal lavage before and after tumor resection was done to detect intraperitoneal free cancer cells by conventional cytology. Results Preresection cytology was positive in four (8%) patients and negative in 46 (92%) patients. Postresection cytology was positive in five (10%) patients and negative in 45 (90%) patients. Positive preresection cytology was significantly prevalent in cases with mucinous carcinoma (P<0.031) and in cases with positive lymph node metastases (P<0.008). Positive postresection cytology in originally negative preresection one was significantly prevalent in the younger age group (P=0.046). There was more incidence of change of negative preresection cytology to positive postresection cytology whenever the tumor was located in the rectum than in cases of left or right tumor location. Conclusions Positive intraperitoneal free cancer cells are a prognostic factor of recurrence for patients treated for CRC, and it may be used as a criterion for selecting patients for further management.

The mechanism of transition of ductal carcinoma in situ (DCIS) to invasive cancer is elusive but recently changes in the myoepithelial cells (MECs) have been implicated. The aim of this study is to investigate the changes in gene profile of MECs in DCIS that could compromise their tumor suppressor function leading to promotion of tumor progression. Immuno-laser capture microdissection (LCM) was used to isolate MECs from normal and DCIS breast tissues followed by whole genome expression profiling using Affymetrix HGU-133 plus2.0 arrays. The data were analyzed using Bioconductor packages then validated by using real-time quantitative polymerase chain reaction and immunohistochemistry. Ingenuity Pathways software analysis showed clustering of most of the altered genes in cancer and cell death networks, with the Wnt/B-catenin pathway as the top canonical pathway. Validation revealed a 71.4% correlation rate with the array results. Most dramatic was upregulation of Fibronectin 1 (FN1) in DCIS-associated MECs. Immunohistochemistry analysis for FN1 on normal and DCIS tissues confirmed a strong correlation between FN1 protein expression by MECs and DCIS (P<0.0001) and between high expression level and presence of invasion (P=0.006) in DCIS. Other validated alterations in MEC expression profile included upregulation of Nephronectin and downregulation of parathyroid hormone like hormone (PTHLH), fibroblast growth factor receptor 2 (FGFR2), ADAMTS5, TGFBR3, and CAV1. In vitro experiments revealed downregulation of PTHLH in DCIS-modified MECs versus normal lines when cultured on Fibronectin matrix. This is the first study to use this in vivo technique to investigate molecular changes in MECs in DCIS. This study adds more evidences to the molecular deviations in MECs toward tumor progression in DCIS through upregulation of the tumor-promoting molecules that may lead to novel predictive and therapeutic targets.

Background: One of the most common types of gastrointestinal neoplasms is a GIST (gastrointestinal stromal tumourKi67 is a proliferation marker that can detect all but G0 proliferating cells.Objective: To evaluate Ki67 expression in GIST and its correlation with the clinicopathologic parameters including survival using immunohistochemical method.Patients and Methods: In this study, Ki67 immunohistochemistry was performed on sections cut from 56 formalinfixed, paraffin-embedded GIST.Diagnosis of GIST was confirmed by positive expression of C-kit in all cases except 5 negative cases that were positive for PDGFRA.Clinical data included age, gender, tumour location (gastrointestinal and extra gastrointestinal), tumour size, lymph node status, presence of distant metastasis, and patient status.The assessed pathological parameters included mitotic count, cell type (spindle, mixed spindle and epithelioid, epithelioid) and necrosis.Cases are divided into very low, low, moderate and high-risk groups according to National institute of health and 2006 risk stratification.Results: Ki67 expression ranged between 0.5-6.6 % with a median of 3 % and a mean±SD of 3.08±1.77%. 60.7% had low Ki67 labelling index (LI) (below the median, ≤3%), 39.3% had high Ki67 LI (above the median ≥3%).Ki67 LI was significantly correlated to mitosis (P=0.010),2006 risk stratification (P value=0.027)and with young patients (P=0.019).However, it has no correlation with the overall survival and rest of clinicopathological parameters. Conclusion:Ki67 could be included in risk stratification of GIST since its expression is correlated with GIST risk stratification.

ObjectiveTo evaluate the role of glutathione peroxidase (GPX1) in melasma.BackgroundMelasma is a common acquired disorder of hyperpigmentation. GPX1 is an intracellular enzymatic antioxidant, and its levels are used as a major parameter representing oxidative damage that occurs in melasma. However, the clear association between GPX1 expression and melasma remains unknown.Patients and methodsThis prospective case–control study was conducted on 20 cases having melasma and 20 normal age-matched and sex-matched healthy volunteers. All sections were immunohistochemically stained for GPX1 antibody.ResultsThere was significant difference between melasma cases and normal skin as regards GPX1 epidermal distribution (P = 0.001) and intensity (P = 0.005). Also there was a statistically significant association between epidermal intensity and distribution of GPX1 and the severity of melasma assessed by the modified Melasma Area and Severity Index (MASI) score. Moreover, there was statistically significant difference between epidermal intensity and distribution of GPX1 and the degree of dermal inflammation. Also, there was a tendency of melasma cases receiving hormonal therapy to show positive dermal expression of GPX1 than cases not receiving therapy (P = 0.07).ConclusionGPX1 was expressed diffusely in the epidermis of all control cases (100%), eight of them were of mild intensity and 12 were of moderate intensity while expressed in most of melasma cases in a focal form with mild intensity expression.

A prevalent autoimmune condition affecting the thyroid gland known as Hashimoto's thyroiditis (HT) is linked to a higher chance of developing thyroid cancer, especially papillary thyroid carcinoma (PTC) and primary thyroid mucosal-associated lymphoid tissue lymphoma. It is extremely rare for follicular thyroid neoplasms whether adenoma or carcinoma to develop in conjunction with Hashimoto's disease. In this case report, a left thyroid lobe large nodule was diagnosed by US as TIRAD IV. Cytology using fine-needle aspiration was done, and the case was designated as Thy3f (suspicious of follicular neoplasm). The patient underwent total thyroidectomy, gross examination revealed a large capsulated left thyroid lobe nodule and histological examination revealed minimally invasive follicular carcinoma on a background of Hashimoto's disease. The nuclear features of PTC were focal and immunostaining for CK19 was focal and weak. Furthermore, HBME1 IHC was negative and Glypican3 IHC showed focal weak cytoplasmic staining. In conclusion, rather than PTC and lymphoma, HT could coexist with other forms of thyroid neoplasms as follicular carcinoma.