Clinical data: a 36-year-old woman was referred for aspiration cytology. She was examined because of her weight gain. Ultrasound examination revealed a nodule in the right thyroid.

Palpation: a firm nodule in the right lobe.

Functional state: euthyroidism (TSH 0.87 mIU/L).

Ultrasonography: the right thyroid was echonormal. There was an echonormal, partly cystic nodule in the ventral part of the lobe. The nodule displayed both perinodular and intranodular blood flow.

Cytological diagnosis: suspicion of papillary cancer.

Histopathology: papillary cancer based on the whole nodule aspirated. There were metastatic foci in the contralateral lobe and in the left lymph nodes of the neck. Focal lymphocytic thyroiditis.

Comments.

1. This is one of the two examples in our practice in which papillary cancer was presented in an echonormal nodule.

2. There were two circumstances which hindered the definitive cytological diagnosis of papillary cancer. Firstly, the echo structure of the nodule. Secondly, the presence of lymphoid cells on the smear which raised the possibility of Hashimoto's thyroiditis. In the event of thyroiditis, the diagnostic value of inclusion is less.