Clinical data: A 17-year-old girl was referred for evaluation of a nodule discovered by herself for 3 weeks.

Palpation: a very firm nodule with uneven surface in the left lobe.

Functional state: euthyroidism (TSH-level 1.89 mIU/L).

Ultrasonography: The thyroid was echonormal and had a small insignificant moderately hypoechogenic lesion in the right lobe and a hypoechogenic nodule in the left lobe. The latter contained numerous microcalcifications and coarse calcification, as well. The intranodular blood flow was a little bit increased. We found an enlarged lymph node in the left side of the neck.

Cytological picture: There was no colloid in the background. Irregular clusters presented with nuclear crowding and overlapping, there were several typical papillary fronds. The thyrocytes were enlarged. I have found only a few grooves and one inclusion in the smear.

Cytological diagnosis: suspicion of papillary carcinoma.

Histopathology disclosed a hyperplastic nodule in the right lobe while a papillary carcinoma destroying the borders of the organ in the left lobe. Metastatic lymph nodes were found in both sides of the neck.

Comment. The tumor presents bulging and the capsule of the lobe is invisible.