Clinical data: A 34-year-old woman visited us for a follow-up examination. She has been known harboring a nodular goiter for seven years. We met the patient previously twice, four and seven years before the present examination. On the first occasion aspiration cytology was performed from a nodule in the middle-central part of the right lobe which resulted in benign colloid goiter. On the second occasion the nodule did not increase in size. The patient had no complaints except for weight gain.

Palpation: a firm nodule in the medial part of the right lobe.

Functional state: euthyroidism (TSH 0.97 mIU/l).

Ultrasonography. The thyroid was echonormal. The lesion in the ventral middle part of the right lobe was unchanged. Another nodule was found in the ventromedial part of the right lobe. This lesion was not described on previous ultrasound reports. (Unfortunately, we did not record the ultrasound examinations of the patient, so we cannot exclude that we simply overlooked the lesion.) This newly detected lesion was hypoechogenic, contained microcalcifications and presented blurred borders.

Cytology resulted in papillary carcinoma.

A right lobectomy was planned but faced the macroscopic presentation of the tumor the surgeon performed a total thyroidectomy. Histopathology disclosed a solitary focus of papillary carcinoma with a maximal diameter of 7 mm. The tumor spread extrathyroidal into the adipose tissue.

Comment. Both nodules present more than 25% perimeter abutment. In addition to, the benign nodule bulges, as well. The integrity of the capsule cannot be clearly judged in the event of the benign lesion while is clearly discontinuous in the event of the malignant focus.