Thyroid cancer is the most common endocrine cancer in the world. This malignancy occurs primarily in young and middle aged adults, with approximately 122,000 new cases per year worldwide. The most common type of thyroid malignancy is papillary thyroid carcinoma (PTC), accounting for approximately three quarters of cases. Spreading of cancer and cancer recurrence after surgery in PTC is principally via lymph node (LN) metastases. Thus, management of patients with thyroid cancer requires a better understanding of the underlying molecular mechanisms of lymphovascular spread of the tumour. The high incidence of LN metastases in thyroid cancer thus makes it a potentially useful model to study angiogenic mechanisms common to many cancer types. The follicular variant of papillary thyroid carcinoma (FVPTC) presents a type of papillary thyroid cancer that has created continuous diagnosis and treatment controversies among clinicians and pathologists. This research has described the nomenclature, the clinical features, diagnostic problems and the molecular biology of FVPTC. It is important for clinicians to understand this entity as the diagnosis and management of this group of patient may be different from other patients with conventional PTC (CPTC). The literature suggests that FVPTC behaves in a way similar, clinically, to conventional papillary thyroid carcinoma. However, there are some genotypic differences which may characterise this neoplasm. These parameters may account for the phenotypic variation described by some scientists in this type of cancer. Further understanding can only be achieved by defining strict pathological criteria, in-depth study of the molecular biology and long term follow-up of the optional patients with FVPTC.