Papillary thyroid carcinoma
- Lesion
The commonest thyroid cancer. It is diagnosed by the look of its nuclei and usually has an excellent outcome, even when it reaches neck nodes.
What it is
Papillary carcinoma accounts for the large majority of thyroid cancers. Its diagnosis rests on nuclear features, not on papillae: clear, overlapping, grooved nuclei with pseudoinclusions. It spreads through lymphatics to cervical nodes, often early, yet most patients do very well. Some variants (tall cell, hobnail, columnar, solid) behave more aggressively.
Structure
- Gross: solitary or multifocal, firm, grey-white, sometimes calcified or cystic; infiltrative or encapsulated.
- Branching papillae with fibrovascular cores covered by cuboidal cells.
- Nuclei as described above; the diagnosis can be made even when there are no papillae (follicular variant).
- Psammoma bodies and lymphatic invasion; cystic nodal metastases may be the first sign.
Markers
- Thyroglobulin
- TTF1
- PAX8
- BRAF V600E (VE1)
- Psammoma bodies
Clinical notes
- Painless nodule or enlarged cervical lymph node; hoarseness or dysphagia suggest invasion.
- Treatment: surgery, sometimes radioiodine; thyroglobulin is followed as a tumour marker.
- Microcarcinomas (under one centimetre) are often incidental and indolent.
Test yourself
Think of the answer, then tap the question to see it.
Which features make the diagnosis of papillary thyroid carcinoma?
The nuclear features: clear chromatin, nuclear grooves, pseudoinclusions and overlapping, not the papillae themselves.
What are psammoma bodies?
Laminated, concentric calcifications, formed by dystrophic calcification of dead tumour cells, typical of papillary carcinoma.
How does papillary carcinoma usually spread?
Through lymphatics to the cervical lymph nodes.
Elsewhere in DurgiPedia
- Pathologic calcification: dystrophic vs metastatic
- Pathways of spread and the usual metastatic sites
- Cytology: the Pap test, fine-needle aspiration and body fluids
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Papillary Thyroid Carcinoma (StatPearls (NCBI Bookshelf), 2025); Thyroid Cancer Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2025).
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Representative model, for educational purposes only.