Clinical data: A 40-year-old woman requested an evaluation of a nodule discovered by herself several weeks ago.

Palpation: a firm nodule in the right lobe.

Laboratory tests: TSH 1.30 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a hypoechoic nodule in the ventral part of the right lobe. The lesion had irregular, lobulated margins and microcalcifications. The intranodular blood flow was extremely increased.

The cytological pattern was unusual, see the footnotes to the images. Wash-out thyroglobulin level yielded 1882 microgram/L while serum calcitionin was below 0.59 pM/L. Cytological diagnosis was suspicion of thyroid cancer of follicular origin.

Total thyroidectomy was performed.  Histopathology disclosed poorly differentiated insular cancer.