Clinical data: A 64-year-old woman was operated on a sigma carcinoma. On PET-CT scan a positive thyroid nodule and a lymph node in the left supraclavicular region were found.

Palpation: There was a hard nodule in the left lobe.

Functional state: euthyroidism with TSH 1.90 mIU/L.

Ultrasonography. The thyroid was echonormal. There were two hypoechogenic nodules, one in the right and another one in the left lobe. The former was regular in shape and presented no blood flow, while the latter presented coarse and microcalcifications. Enlarged lymph nodes without a regular hilum were detected in the left submandibular and supraclavicular regions.

Cytology of the nodule in the left lobe and that of one lymph node resulted in papillary carcinoma.

Total thyroidectomy was performed. Histopathology disclosed papillary carcinoma both in the right and in the left nodules. The latter gave metastasis into the ipsilateral lymph nodes. Both nodules spread into the capsule of the thyroid but did not break through.

Comments.

1. It is worth comparing the benign nodule in the right with the malignant one in the left lobe. The former is a typical benign appearing nodule while the later presents three different intranodular hyperechogenic figures.

2. There are two different patterns on the same smear. The cells come from benign and from malignant part of the nodule in the left lobe.

3. The acoustic shadow hinders the correct judgment of features which could suggest extrathyroidal extension in the event of the left focus.