Clinical presentation: A 42-year-old woman was referred for aspiration cytology. A multinodular goiter was discovered during evaluation of palsy of the left recurrent nerve. The original complaints resolved spontaneously after 3 months duration.

Palpation: a firm nodule in the right lobe.

Functional state: euthyroidism (TSH 2.65 mIU/L).

Ultrasonography. The thyroid was echonormal presenting small moderately hypoechogenic areas. There were two nodules in the right lobe. The upper one was minimally hypoechogenic, had a halo and contained microcalcifications. The lower nodule was a mixed hypoechogenic-echonormal lesion. Both nodules had irregular borders, the lower one presented irregularly increased vascular pattern.

Aspiration cytology was performed from both nodules in the right lobe. The cytological images of the upper nodule are demonstrated. Cytology resulted in suspicion of Hürthle-cell variant of papillary carcinoma.

Total thyroidectomy was performed. Histopathology disclosed papillary carcinoma corresponding to the nodule in the upper part of the right lobe, while hyperplastic nodule corresponding to the lower lesion. Hashimoto's thyroiditis was also present.

Comment.

1. The tumor did not present oxyphilic changes. The oxyphilic cells presented in the cytological images might arise partly from the extranodular part of the lobe which presented Hashimoto's thyroiditis.

2. The nodules present all three types of irregular margins, the borders are partly blurred and have lobulations and spiculations, as well.