Clinical presentation: A 70-year-old man was referred for evaluation of a newly discovered lymph node in the left side of the neck and hoarseness. The complaints were started 3 months ago.

Palpation: The thyroid was not palpable. There was a not freely moveable lymph node lateral to the left thyroid lobe.

Functional state: euthyroidism with TSH-level 1.08 mIU/L.

Ultrasonography. The right lobe was intact, while there was a hypoechogenic nodule in the left lobe. The lesion had hyperechogenic areas and coarse calcifications. A lymph node was detected lateral to the left thyroid.

Cytological picture. There was no colloid in the background. The smear was extremely cellular. The cells form neither follicles nor papillary fronds, they occurred predominantly dissociated. There were many polygonal forms and multinucleated cells.

Cytological diagnosis: carcinoma. Probably medullary cancer.

Blood test for calcitonin: serum-level of calcitonin was 447 pM/L (normal value: 0-3.36).

Histopathology disclosed medullary cancer.