Clinical data: a 32-year-old woman came to regular a follow-up examination. A nodule in the right lobe was diagnosed 10 years earlier and another nodule in the left thyroid 5 years earlier. Aspiration cytology was performed three times during this 10-year period and resulted in a non-diagnostic report, cystic degeneration on each occasion.

Palpation: a firm nodule was palpable both in the right lobe and a nodule without any special finding in the left lobe.

Functional state: euthyroidism (TSH-level 1.63 mIU/L).

Ultrasonography revealed a hypoechogenic nodule with microcalcifications in the right and an echonormal nodule with cystic degeneration in the left lobe. The intranodular blood flow was increased in the right nodule. The dimensions of the right nodule increased from 13x13x14 mm to 13x16x14 mm over 10 years. The nodule in the left lobe appeared 5 years later and has increased from 12x11x16 mm to 18x16x19 mm over 5 years.

Cytological diagnosis: resulted in papillary cancer in both nodules.

Histopathology: papillary carcinoma in both nodules. There were numerous psammoma bodies in the right focus.

Comments:

1. There is only very limited experience with the natural course of a malignant thyroid lesion. If we suppose that the papillary cancer was already present in the right lobe for 10 years, this example proves that a papillary cancer may grow only extremely slowly, and the relatively stable size does not exclude the possibility of the malignant behavior of a nodule.

2. The left nodule which proved to be also a papillary cancer was echonormal. It is a very rare finding in the case of a (papillary) thyroid cancer.

3. It is worth analyzing the cytological pictures to understand the difference between inclusion as most important sign of papillary cancer and air vacuoles as artifacts.

 

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