Columnar cell variant of papillary thyroid carcinoma - a rare and clinically aggressive variant

24yr old female presented with an anterior neck lump for 3 weeks duration; was found to have solitary nodule on right lobe of the thyroid gland without palpable cervical nodes. She was biochemically euthyroid and Fine Needle Aspiration cytology (FNAC) of the solitary nodule revealed PTC with background autoimmune thyroiditis. She was diagnosed with Familial adenomatous polyposis coli; with a history of subtotal c o l e c t o m y f o r m o d e r a t e l y d i f f e r e n t i a t e d adenocarcinoma of the cecum (T4N1Mx) one year back. She underwent total thyroidectomy with level VI nodal clearance. Histopathology reveled columnar cell variant of PTC without Capsular or vascular invasion or excision margin involvement. She received radioactive Iodine treatment following surgery and was followed up at cancer institute. 9 months following the thyroid surgery she was found to have vertebral metastasis which was histologically confirmed as metastatic PTC deposit. Irrespective of oncological management she died 15 months following thyroid surgery.