Clinical data: A 53-year-old woman was referred for evaluation of a nodular goiter detected on screening.

Palpation: The surface of the right lobe was uneven.

Functional state: euthyroidism (TSH 1.92 mIU/L).

Ultrasonography. The thyroid was echonormal. There was a hypoechogenic nodule, which presented irregular borders, microcalcifications, increased intranodular blood flow and cystic degeneration, in the right lobe.

Aspiration cytology was performed from the nodule and we gained a minimal amount of brown fluid. The cytological pattern itself was no reassuring.

We took the ultrasound presentation into account and gave a common ultrasound-cytological diagnosis of suspicion of papillary carcinoma.

Total thyroidectomy was performed. Histopathology disclosed papillary carcinoma.

Comment.

1. The cytological pattern itself was not enough to a definite carcinoma diagnosis. The complete lack of inclusion is a very rare phenomenon in the event of a papillary carcinoma. Moreover, there were only scattered number of nuclei with groove and there was no one typical papillary cluster on the smear. Although the nuclear crowding, the irregular chromatine structure and the mild pleomorphism are only weak signs of malignancy, the presence of all of these features are remarkable.

2. Combining the cytological data with the ultrasound presentation led to the combined ultrasound-cytological diagnosis.