Unusual presentation of a papillary thyroid carcinoma as a fully calcific nodule.

A 82-year-old women with a small nodular euthyroid goitre (NG) with positive thyroid autoantibodies was submitted to thyroid color flow doppler sonography (CFDS). A small diffuse hypoechoic goitre suggestive of Hashimoto’s thyroiditis was found, associated to a small (10 mm) hypoechoic hypervascularized nodule in the superior pole of the right lobe and a macrocalcification (20 mm) in the inferior pole of the same lobe, without signs of increased blood flow. 99mTechnetium (99mTc) thyroid scintiscan and fine needle aspiration cytology (FNAC) were performed. 99mTc scan showed a focal reduced uptake corresponding to the macrocalcification in the right lobe. FNAC examination from the hypoecoic nodule revealed cytological features (nuclear changes such as grooves and pseudoinclusions) of papillary thyroid carcinoma (PTC); only blood was obtained by FNAC from the macrocalcification. The patient was then submitted to total thyroidectomy. Histological examination confirmed that the small hypoechoic nodule was indeed a PTC; surprisingly, the macrocalcification was also represented by a fully calcific PTC. The presence of macrocalcifications associated with cystic degeneration is very frequent in aged NG. These features represent the common evolution in the natural history of most NG and are not considered suspect for malignancy. However this rare case shows that macrocacifications do not exclude the presence of malignant thyroid neoplasms