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. 2026 Jul 2;37(1):27. doi: 10.1007/s12022-026-09924-0

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© The Author(s) 2026

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Histologic and immunohistochemical features of canonical and noncanonical STRN::ALK-positive oncocytic thyroid tumors (a) Representative oncocytic thyroid carcinoma harboring a canonical in-frame STRN::ALK fusion. Upper panel: hematoxylin and eosin (H&E) staining demonstrating typical oncocytic morphology with abundant eosinophilic cytoplasm. Middle panel: diffuse cytoplasmic ALK immunoreactivity in tumor cells. Lower panel: adjacent normal thyroid tissue lacking ALK expression, serving as an internal negative control (b) Representative oncocytic thyroid tumor harboring a noncanonical out-of-frame STRN::ALK variant. Upper panel: H&E staining confirming oncocytic morphology. Middle panel: absence of ALK immunoreactivity despite confirmed genomic rearrangement by FISH. Lower panel: adjacent normal thyroid tissue negative for ALK expression. H&E images were obtained at ×200 magnification; immunohistochemical images were obtained at ×400 magnification