Clinical presentation: a 56-year-old woman referred for a recurrent nodular goiter. The patient was operated on benign hyperplastic nodule for 13 years; lobectomy of the left lobe was performed. The patient had difficulties in swallowing.

Palpation: a nodule in the left thyroid. A small firm lesion was also palpable above the left thyroid.

Ultrasonography revealed a hyperechogenic nodule composed of multiple smaller lesions in the left thyroid. There was a moderately hypoechogenic lesion 4 cm above the left lobe.

First row of cytological images presents smear of the thyroid, while second row that of the aberrant tissue.

Cytology : benign colloid goiter with atypia in both localization.

Histopathology disclosed benign hyperplastic nodules both in the left lobe and in the aberrant thyroid tissue.

Comment. I think that the most important question in a cytological atypia is to what type of carcinoma might belong the atypia. If the atypia does not fit to any type of thyroid carcinomas with high enough risk, than it can be held for benign.