We report a case of primary secretory carcinoma of the thyroid with high-grade features to highlight cytologic and histologic clues to the diagnosis. The diagnosis of primary secretory carcinoma of the thyroid is challenging both due to the fact that it has only recently been described and because of its morphologic overlap with papillary thyroid carcinoma (PTC); however, differentiating secretory carcinoma from PTC is crucial both for prognostication and treatment purposes.
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