Clinical presentation: A 42-year-old woman was referred for aspiration cytology. She was examined because of 'lump in the throat' feeling two years ago. Laboratory investigations revealed euthyroidism, the anti-TPO level was elevated (880 U/mL). On repeat examination a hypoechogenic lesion was detected on ultrasound.

Palpation: Both lobes were firm, no nodule was palpable.

Functional state: euthyroidism with minimally elevated TSH: TSH 4.36 mIU/L, FT4 15.2 pM/L.

Ultrasound. The thyroid was minimally hypoechogenic and had several tiny more hypoechogenic areas. The largest of these islets was located in the central-dorsal part of the left lobe. Although this lesion had irregular borders, the presentation was almost the same as the smaller areas. The lesion showed nonparallel orientation. The vascularization was not specific.

Aspiration cytology resulted in suspicion of papillary carcinoma.

A left lobectomy was performed. Histopathology disclosed Hashimoto's thyroiditis and papillary carcinoma which was unifocal and was 5 mm in maximal diameter.

Two years after the surgical procedure the patient is under psychological and neuropsychiatric surveillance. Despite huge efforts of me and other colleagues the patient cannot be convinced about the true nature of her disease.

Comments.

1. Naturally, we can reveal minute difference between the focus of papillary carcinoma and the other lesions. On the other hand, such a pattern is very common in Hashimoto's thyroiditis. On my opinion, it would be a bad attitude if we drew the consequence that practically every Hashimoto's patients with hypoechogenic areas should be evaluated cytologically.

2. It's been a long time to call certain subtypes of papillary carcinomas other than carcinoma. We cause a very huge psychological harm to a great proportion of patients by neglecting the problem of papillary microcarcinomas. Moreover, the denomination of this entity as carcinoma, might be a professional failure from a clinical oncological point-of-view; simply because overwhelming majority of these lesions does not behave as a cancer usually does.