Clinical presentation: A 31-year-old woman was referred for evaluation of a nodular goiter which has been known for a few months.

Palpation: a large moderately firm nodule in the right lobe and in the isthmus.

Functional state: euthyroidism (TSH 0.98 mIU/L).

Ultrasonography. The thyroid was echonormal. A large, peripheral-type cystic nodule occupied almost the entire right lobe. It contained microcalcifications. There was no intranodular vascularization. The left lobe presented several small cystic lesions.

The nodule was aspirated three-times. The images of two smears are presented. Cytological diagnosis: papillary carcinoma.

Histopathology disclosed papillary carcinoma in the right lobe. The tumor presented gross extrathyroidal extension and infiltrated the esophagus. There were benign hyperplastic nodules in the left thyroid.

Comments.

1. As regards the ultrasound presentation, there were two features which increased the risk of malignancy: the presence of microcalcification and the peripheral-type of the cyst. On the other hand, two other features decreased the likelihood of carcinoma: the cyst presented blunt angle and the vascularization was not increased.

2. Although the upper cytological images are clearly diagnostic, the lower images may be more edifying. In significant proportion of cystically degenerated papillary carcinomas, we gain only small fragments of cells, and it is very difficult to give a correct diagnosis.

3. The tumor' contour was abutting, and the capsule of the lobe was discontinuous.

 

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