Introduction: Adenoid cystic pattern in papillary thyroid carcinoma is a rare nding. Here w Case description: e present a case of a 62 years old female who came with the complaint of swelling in the midline of the neck since last 7 years. Local examination revealed a rm to hard mass of size approximately 8 x 6 cm in the midline of the neck which moved with deglutition. Another swelling of size 3.5 x 2.5 cm was found in the posterior scalp.MRI neck showed a lobulated mass measuring 7.1 x 6.4 x 8.0 cm in right lobe of thyroid, causing mass effect over adjacent larynx and trachea. MRI brain revealed a well-dened soft tissue mass lesion measuring 3.6 x 3.3 x 3.4 cm in right parietal bone causing lytic destruction of bony calvaria. Ultrasonography of whole abdomen revealed two well dened lesions in liver, suggesting possibility of metastasis/ hemangioma. On ne needle aspiration of neck swelling, cellular smears showing cells arranged in clusters, microfollicles, vague papillary pattern alongwith abundant hyaline globules, nuclear grooving and nuclear inclusions were present, suggestive of papillary thyroid carcinoma with adenoid cystic pattern. FNA of the scalp swelling showed similar features, suggestive of metastatic papillary thyroid carcinoma with adenoid cystic features. Discussion: Though rare, papillary thyroid carcinoma with adenoid cystic features should be differentiated from metastatic adenoid cystic carcinoma of larynx and salivary glands, which at times is challenging.