Well-differentiated papillary thyroid carcinoma (PTC), the most common endocrine malignancy, exists in multiple variants. Classical, conventional variant, follicular variant, and clear cell variant papillary thyroid tumors confer a low risk of metastasis or recurrence and have a good prognosis. PTC less than 1 cm in size are papillary thyroid microcarcinoma and confer a more benign phenotype. More aggressive and infrequent variants such as diffuse sclerosing variant (DSV), tall cell variant (TCV), columnar cell variant (CCV), solid variant (SV), or hobnail variant (HV), however, have a poor prognosis. Among these aggressive PTC variants, TCV is the most common. As its name suggests, tall cells distinctively have a height at least three times their width. TCV classification is ascribed to papillary thyroid tumors with 10-75% tall cells or tall cell features. The incidence for TCV is still under investigation and is cited to range from 1.3% to 13% of PTC. To diagnose papillary thyroid carcinoma, biopsy or cytology is typically done. Based on the findings, active tumor surveillance via ultrasound or thyroglobin levels, and or intervention is recommended. Accurate assessment of these variant pathologies is critical to treatment planning since the variants differ in their aggressiveness and prognosis. In this retrospective cohort study of our Roswell Park NCI-designated Comprehensive Cancer Center PTC patient population, we determined our TCV PTC incidence to be 13%, which is at the upper limit of the nationally reported TCV rate. Furthermore, we examined demographic, clinical, pathological, and radiological data to identify risk factors associated with the elevated incidence. Assessment of pathological staging of TCV compared to non-TCV PTC variants showed that TCV patients have more advanced staged disease at diagnosis (p=0.01). Microcarcinoma was less frequent among tall cell variant pathology, consistent with the aggressive nature of TCV PTC compared to the classical variant microcarcinoma (p<0.024). However, when diagnosed with tall cell variant of microcarcinoma, we manage it more aggressively which includes total thyroidectomy instead of lobectomy and potentially assessment for I131 treatment. Overall, the results of this study have the potential to have major implications in our practice and understanding of the incidence, prognosis, and management of TCV and microcarcinoma papillary thyroid carcinoma.