Hyalinizing trabecular tumor (HTT) is a rare thyroid tumor with an excellent prognosis, but its similarity to papillary thyroid carcinoma (PTC) complicates diagnosis. The study analyzed 21 cases of HTT and 10 cases of PTC, supplemented by a literature review. The HTT cohort included 18 women and 3 men with a mean age of 51 years. Cytologically, HTT is distinguished from PTC by characteristic membrane/cytoplasmic Ki-67 staining, PAX8-GLIS3 gene fusion, and occasional polyploid cells. Histologically, the tumors are well circumscribed with trabecular or organoid growth, eosinophilic to granular cytoplasm, paranuclear yellow inclusions, and hyalinized stroma. Immunohistochemically, HTT expresses TG, TTF1, and CD56, while Ki-67 has a unique membrane/cytoplasmic distribution. Molecularly, PAX8-GLIS3 fusion, absent in PTC, without KRAS, NRAS, BRAF or PIK3CA mutations was detected in all HTT cases. An integrated approach with cytological, histological, immunohistochemical and molecular data is needed for accurate diagnosis and management, which can avoid unnecessary surgery.