[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Endocrine system](https://durgical.com/en/general-pathology/areas/endocrine/) › Papillary thyroid carcinoma

# 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.

Updated Nov 12, 2026

## Key points

- Nuclear features: optically clear (ground-glass, «Orphan Annie eye») chromatin, grooves, intranuclear pseudoinclusions, overlapping.
- Psammoma bodies: concentric calcifications in papillae; almost never seen in follicular or medullary carcinoma.
- Lymphatic spread to cervical nodes is common and has little effect on survival in young patients.
- Risk: ionising radiation in childhood is the classic risk factor.
- Aggressive variants: tall cell, hobnail, columnar cell, solid; diffuse sclerosing in young people.
- Age at diagnosis is a major prognostic factor (younger is better).

## 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.

## Memory aid

Papillary is read in the nucleus: empty eyes, grooves and holes; the papillae and sand bodies are just the decoration.

## 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.

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## Elsewhere in DurgiPedia

- [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Cytology: the Pap test, fine-needle aspiration and body fluids](https://durgical.com/en/general-pathology/cytology-the-pap-test-fine-needle-aspiration-and-body-fluids/)

## Connections

## Related 4

- [Thyroid cancer: genetics and radiation](https://durgical.com/en/general-pathology/thyroid-cancer-genetics-and-radiation/)
- [Follicular thyroid carcinoma and NIFTP](https://durgical.com/en/general-pathology/follicular-thyroid-carcinoma-and-niftp/)
- [Thyroid nodule and follicular adenoma](https://durgical.com/en/general-pathology/thyroid-nodule-and-follicular-adenoma/)
- [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/)

## Related conditions 2

- [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/)
- [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK536943/) (StatPearls (NCBI Bookshelf), 2025); [Thyroid Cancer Treatment (PDQ®)–Health Professional Version](https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq) (National Cancer Institute, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/papillary-thyroid-carcinoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/papillary-thyroid-carcinoma/