PMC8650693_01
Timeline of the case history.
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However, the pathology consultation in another hospital indicated Hurthle cell carcinoma (eosinophilic follicular carcinoma, poorly differentiated) and the immunohistochemistry results( Supplementary Figure 1 ) showed TTF-1 (+++), CK8/18 (++), PCK (+), VIM (+), TG (+), SYN (-), and CGA (-).
Hisopathological and immunohistochemical examinations. (A) 100 times. Dense eosinophilic cytoplasm, with red staining and large obvious nucleous. (B) 200 times. Large cell with abundant eosinophilic cytoplasm and a large hyperchromatic nucleus with a prominent nucleolus, obvious nuclear heteromorphism, and visible mitotic strutures. (C) 400 times. (D) The positive rate of Ki67 is 70%. (E) TTF-I positive. (F) CK19 negative. (G) TG negative. (H) PCK focal positive. (I) P53 part positive.
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The postoperative pathology ( Figure 2 ) indicated metastasis of thyroid Hurthle cell cancer, and the immunohistochemistry showed CK19 (-), P53 (+), PCK (+), Tg (-), TTF-1 (+) and Ki67 (+, 70%). The supplementary immuno-histochemical staining of the tumor tissue showed the PD-L1 expression is positive and the tumor proportion score is 80%(clone 22C3) ( Supplementary Figure 2 ).
Abdomen CT scans before and after one cycle of triple-combination therapy and two cycles of sintilimab treatment.
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Three months later, a CT scan showed more and larger nodules in both lungs, and newly enlarged nodules in the right adrenal gland ( Figures 3 ,  4 ). The CT scans showed that the multiple nodules in the lungs and the right adrenal gland were smaller than before ( Figures 3 ,  4 ). Though the chest CT showed lung inflammation ( Supplementary Figure 3 ), the patient had no symptoms.
Chest CT scans before and after one cycle of triple-combination therapy and two cycles of sintilimab treatment.
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Three months later, a CT scan showed more and larger nodules in both lungs, and newly enlarged nodules in the right adrenal gland ( Figures 3 ,  4 ). The CT scans showed that the multiple nodules in the lungs and the right adrenal gland were smaller than before ( Figures 3 ,  4 ).