50 year old patient with a previous papillary carcinoma of the thyroid on left treated with hemithyroidectomy, now presents with a new right sided nodule.

Patients with papillary thyroid cancer have an elevated risk for secondary primary cancer. Male gender and older age are recognized risks ¹.  

FNA

Smears reveal numerous cohesive fragments of follicular epithelium present mainly as loosely cohesive sheets attached to delicate branching capillaries or as densely cellular syncytial aggregates. Most of the follicular cells have ovoid, mildly pleomorphic irregular nuclei with fine chromatin and indistinct micronuclei. Many nuclei have nuclear grooves and a minor portion show nuclear inclusions. Some polygonal cells with dense "squamoid" cytoplasm are present. Colloid is scanty. A few fragments of follicular epithelium have follicular cells with scant cytoplasm, round nuclei and compact chromatin. This may represent sampling of adjacent benign epithelium. The features are sufficient for a diagnosis of papillary thyroid carcinoma.