Clinical data: A 63-year-old woman was referred for an evaluation of a 'lump in the throat' feeling and weight gain.

Palpation: The thyroid was not palpable.

Results of blood tests: euthyroidism with TSH-level 3.71 mIU/L.

Ultrasonography. The thyroid was hypoechogenic. There were several hyperechogenic discrete lesions in both lobes.

FNAC was performed from lesions in the dorsal part of the lobes demonstrated on US images. There were only lymphocytes on the smear.

We suggested follow-up. The patient requested a second opinion in another hospital where a repeat FNAC was performed which resulted in papillary carcinoma. The cytological diagnosis was given by Dr. Balazs Jaray, MD (Semmelweis University, Budapest).

Intraoperative imprint smears are demonstrated in this case. Cytological picture: There is no colloid in the background. Heterogeneous lymphoid cells mixed with clusters of follicular cells exhibiting oxyphilic metaplasia. The only unusual sign is the presence of nuclear inclusions in a relatively great proportion of follicular cells. 

Histopathology: multifocal papillary cancer, Hashimoto's thyroiditis.