Papillary carcinoma is the most common malignant tumor of the thyroid. It has a variable macroscopic appearance that differs according to the variant microscopic morphologies and the presence or absence of degenerative changes. The histologic variants can be challenging to the pathologist, and some are of clinical significance because of prognostic implications. In this short review, we discuss an approach to papillary carcinoma, the diagnostic dilemmas and controversies, and the ancillary studies that are helpful in resolving them, including immunohistochemistry and molecular studies.