Clinical presentation: a 70-year-old man was referred for an evaluation of a newly discovered lymph node in the left side of the neck and hoarseness lasting for 3 months.

Palpation: no abnormality in the thyroid, while a not freely moveable lymph node was palpated left to the left thyroid.

Functional state: euthyroidism with TSH-level 1.08 mIU/L.

Ultrasonography: the right lobe was intact, while there was hypoechogenic nodule in the lobe with hyperechogenic areas and coarse calcifications. A lymph node was detected lateral to the left thyroid.

Cytological picture: there was no colloid in the background. Extremely cellular picture. The cells form neither follicles nor papillary fronds, they occurred predominantly dissociated. There were many polygonal forms and multinucleated cells.

Cytological diagnosis: carcinoma probably medullary cancer.

Blood test for calcitonin: serum-level of calcitonin was 447 pM/L  (normal value: 0-3.36).

Histopathology: medullary cancer.