Clinical presentation: A 53-yr-old woman was referred for evaluation of a nodular goiter which has been known for several years. The patient had no complaints suggesting thyroid disease, she was investigated because of hypertension.

Palpation: a firm nodule in the right lobe.

Laboratory tests: TSH 3.71 mIU/L, aTPO 111 U/mL.

Ultrasonography. The thyroid presented several hypoechoic areas corresponding to the underlying thyroiditis. There was a large nodule in the lateral part of the right lobe. Both the nodule and the smaller discrete lesions had irregular, lobulated margins.

Cytology was performed from the hypoechoic nodule and resulted in papillary carcinoma.

Histopathology disclosed papillary carcinoma and Hashimoto's thyroiditis. There were no pathological nodule in the left lobe.

Comment.

1. Regarding the nodule borders the hypoechoic nodule presented lobulated margins.
   
2. The tumor presented two signs of a possible extrathyroidal extension, the its contour was bulging and the capsule of the thyroid was discontinuous. However, the abutment did not reach 25%.