Clinical data: a 27-year-old woman was sent for aspiration cytology. She was operated on papillary carcinoma for 6 months. A total thyroidectomy and radioiodine therapy was performed. On whole body scintigraphy a node in the right supraclavicular region was detected.

Palpation: a hard node in the right supraclavicular region.

Functional state: euthyroidism on daily 125 microgram levo-tiroxine (TSH 2.83 mIU/L)

Ultrasonography: there were no thyroid parenchyma in the thyroid beds. A moderately hypoechogenic mass with hyperechogenic patches was found in the right supraclavicular region (second row of images) and a reactive-type lymph node in the left submandibular area (first row of images). The former did not presented a regular hilum.

Cytological diagnosis: papillary carcinoma.

The patient was reoperated and a modified right neck dissection was performed.

Histopathology. Papillary carcinoma metastatisizing to the lymph node. 3 of the removed 8 nodes contained tumor.

Comment. The patient was initially operated on by a non-experienced thyroid surgeon who missed the adequate neck dissection.