Clinical data: A 26-year-old woman was referred for evaluation of a rapidly increasing mass in the right side of the neck.

Palpation: a hard mass involving the right thyroid and the isthmus.

Functional state: euthyroidism (TSH 4.22 mIU/L).

Ultrasonography. The thyroid was echonormal. There was a large, moderately hypoechoic mass in the right lobe and the isthmus. The lesion presented bulging into the subcutaneous tissue. The nodule had increased, chaotic-type vascular pattern and microcalcifications. The borders were lobulated.

The cytological examination resulted in non-diagnostic report.

Wash-out thyroglobulin exceeded 478 ng/mL, serum-thyroglobulin level was 79 ng/mL, serum calcitonin was below 0.59 pM/L.

Our combined clinical-ultrasound-cytological diagnosis was primary thyroid carcinoma of follicular cell origin with gross extrathyroidal extension. We have suggested total thyroidectomy.

Histopathology disclosed a T4 papillary carcinoma with metastases to the lymph nodes in both sides of the neck.

Comments.

1. This is a very rare case in which we can clearly say on ultrasound presentation that the tumor presents gross extrathyroidal extension.

2. Considering the chaotic, extremely increased vascularization, it is not surprising that we could not yield material adequate to cytology.