Clinical presentation: A 36-year-old man was referred for evaluation of a thyroid nodule detected on screening.

Palpation: no abnormality.

Functional state: euthyroidism (TSH 1.96 mIU/L).

Ultrasonography. The thyroid was echonormal. There were several hypoechogenic lesions in both lobes. Two of them were remarkable, one in the middle part of the left lobe that contained microcalcifications and another one in the lower pole of the left thyroid presenting both coarse and microcalcifications.

Cytology was performed from the nodule in the middle part of the left lobe and resulted in papillary carcinoma.

Histopathology disclosed papillary carcinoma.

Comments.

1. The malignant focus presents partly blurred, partly lobulated margins and has small irregularities which do not reach the level of pathological extent.

2. The larger (upper) nodule is an EU-TIRADS 5 lesion due to the irregular borders and microcalcifications while the smaller (lower) lesion is an EU-TIRADS 5 nodule due to the deep hypoechogenicity, nonparallel orientation and lobulated margins.