Figure 31. Two proliferative papillary adenomata that
were considered benign on the basis of histological examination ( x 49, subject No. 15, 1969). Other minute ade-
nomata from the samesubject are shown in Figure 334.
sisting of a solid cellular pattern. Both lesions were
accompanied by metastases in the cervical region.
In one (Figure 35A) the cervical metastases were
extensive although the primary lesion was relatively small. A total thyroidectomy and unilateral
radical cervical lymph-node and upper anterior
and posterior mediastinal dissection were performed in this case, and there has been no evi-
oa
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tele ghee,
carcinomawere from Rongelap, where the exposure to fallout was greatest.
The fourth carcinoma (D) wis a relatively undifferentiated adenocarcinoma ~2.5 cmin diameter. In manyareas it was solid celluijar in character. The pleomorphic cells had breeched the cap-
Aaae
thyroidectomy with regional lymph-nodedissection was done. The regional lymph nodes did not
contain metastases. There has been no evidence of
recurrence in 5 years. The above3 patients with
«
dence of recurrence in 5 years. The second case
(8) was also treated by total thyroidectomy and
regional lymph-node dissection. Only a single
lymph node adjacent to the thyroid contained
metastatic tumoralthough invasion to contiguous
blood vessels was noted. This subject has remained
free of recurrent disease for 10 years.
The third malignantlesion (C ) was a follicular
adenocarcinoma which showed considerableinfiltration of adjacent normal thyroid tissue but was
confined to the region of one superior pole and was
not accompanied by positive lymph nodes.A total
sule in manyplaces. The tumor was observed in
vascular spaces but not in lymph nodes, and no
distant metastases could be identified. The patient
had presumably received minimal radiation exposure on Utirik, an outlying island quite remote
Figure 32. A: A histologic preparation of a lesion that
developed in an irradiated Marshallese thyroid {x 14).
8: Autoradiograph, showingarea ofsignificant #311 uptake to be in the “normal” extranodular tissue, in both
upper corners of the section, and no uptake in the neoplasm (diffuse stippling is background). This lesion was
not considered malignant. (Same subject as Figure 31.)