Papillary cancer

Differential diagnostics - cystic nodule

Papillary cancers - Case 4

Follicular adenoma - Case 16

Note the presence of microcalcifications at the edge of solid part.

Various hyperechogenic granules are within the nodule.


Papillary cancers - Case 14	Follicular adenoma - Case 21	Benign hyperplastic nodules - Case 16


The main difference between the papillary carcinoma and the two benign cases lies in the vascular pattern. The former presents sign of a type 3 vascular pattern, while the latter shows type 2, i.e. perinodular blood flow.

Papillary cancers - Case 27

Follicular adenoma - Case 8

After evacuation of the seemingly simple cyst a small suspicious solid part appeared with microcalcifications.

The dorsal solid part was unchanged after evacuation of the cyst. It is also suspicious because of the hyperechogenic granules.

Papillary cancers - Case 37

Benign hyperplastic nodules - Case 11

The shape of the solid part has no relevance. Compare the appearance of hyperechogenic granules in these cases. The hyperechogenic granules are more bright in the case of papillary carcinoma compared to benign nodules. Nevertheless, this difference does not have enough practical value.

Papillary cancers - Case 42

Benign hyperplastic nodules - Case 34

The presence of microcalcifications and the type 3 vascular pattern increased the possibility of being this nodule malignant.

The lack of vascularization on Doppler mode has no relevance in the differential diagnostic of nodular goiters.

Papillary cancers - Case 10

Benign hyperplastic nodules - Case 13

The only suspicious sign in the maliginant case is the macrolobulation of the solid part. Both cases belong to the peripheral-type of cysts. The vascularization is just the opposite of what we expect: the malignant nodule presents a type 2 perinodular while the benign lesion does a type 3 intranodular vascular pattern.

Taking all into account, the sonography is not able to differentiate between benign and malignant cystic nodules in general. However, the combination of lack of microcalcifications and the type 3 vascular pattern, and the presence of a halo significantly decreases the risk of malignancy. Another important consideration: the echogenicity of the solid part is optically influenced by the presence of the cystic fluid. It means that in contrast with solid nodules, the echogenicity of the solid part in mixed nodule has no relevance. Malignancy can be found with equal probability in a mixed nodule with echonormal and hypoechogenic solid parts.