Clinical presentation: A 41-year-old woman was referred for evaluation of a nodule discovered on routine physical examination.

Palpation: The right lobe had a moderately firm nodule.

Ultrasonography revealed an echonormal thyroid. There was dominantly moderately hypoechoic nodule in the right lobe. Some parts of the lesion were deeply hypoechoic, and a few small cystic chambers were also within. The nodule presented with irregular shape and borders and had intranodular echogenic figures, primarily granules.

Laboratory tests: TSH 1.78 mIU/L, FT4 15.4 pM/L, anti-TPO 37 U/mL.

Aspiration cytology disclosed papillary cancer.

Total thyroidectomy was performed, histopathology resulted in T1b papillary cancer and nodular hyperplasia in the non-tumorous part of the thyroid.

Comment.

1. It is ambiguous how to interpret the echogenic figures. Although the presence of irregular shape and borders increases the likelihood that the echogenic granules are indeed microcalcifications, comet-tail artifacts must be also considered.

2. It is worth comparing the images recorded by using different settings. By using harmonization, we lose the details of very hypoechoic areas. Essentially, the latter seem to be anechoic.