129 j!.M. Dobyns and B.A. Hyrmer: Thyroid Neoplasms and Hydrogen BombFallout Fig. 2A. Tissue section (*75) of thyroid carci- noma(arrow). B. The radioautograph prepared from the tissue section shown in A, demonstrating no blackening on the film in the area corresponding to the position of the carcinoma. The normal tissue took up the iso- tope. There were several other minute carcinomas in both lobes. Table 2. Histologic findings among the exposed and unexposed Marshallese.* Exposed Unexposed Rongelap & Ailingnue Utirik Controls Rongelap Controls Utirik Moredistant atolls Total Number 86° 30 159 25 668° 12 473 2 354 8 Histology ndings Benign Atyp Ca Benign Atyp Ca Benign Atyp Ca Benign Atyp Ca Benign Atyp Ca 19 § 6 14 1 19 6 2 4 0 1 ‘I 2 4 2 operated % Ca of total 6.97% 6.28% 0.60% 0.21% 0.56% “The atypical lesions listed here do not include the many atypical lesions associated with carcinomain the same gland. "Includes 4 exposed in utero. “Amongt he Rongelap controls, 1 carcinoma wasfound in the original 86 matched controls who were known to have been on Majuro remote to the fallout. The remaining 3 carcinomas were found in Rongelapese who were from otheratolls and not among those evacuated from Rongelap. Atyp: atypical; Ca: carcinoma. and therefore not reported until 24 hours after the operation was completed. Furthermore, it was clear that the first operation must be adequate because a second operation in the face of scar tissue is more hazardous than the first. Therefore, a very complete procedure was undertaken provided it could be done without risk. Of 23 cases ultimately classified as carcinoma, a positive diagnosis was made onfrozen section in 14 patients. In 3 cases a suspicion of carcinoma wasreported atthe time of surgery. In 6 patients the initial diagnosis was benign adenomabut later the lesion (or another less conspicuous one) was judged to be carcinoma. There wasa total of 80 thyroid explorations in 77 Marshallese natives because of palpable thyroid nodules; 55 patients were ef 3 wR : i mae — 26 | AES known to have been exposed and 22 patients were unexposed (Tables 2 and 3). A total of 23 cases of carcinoma were found (Figure 3). In 14 cases the dominant mass was the carcinoma. In 9 patients the dominant mass was a benign mass that led to operation and an incidental finding of a carcinoma elsewherein the gland. In 2 other cases multiple and very atypical lesions were found at second operations. There have been 27 total or near-total thyroidectomies in the exposed and unexposed patients where there was a presumptive diagnosis of carcinoma at surgery. A near total thyroidectomy rather than total thyroidectomy was some times done because one or more of the parathyroids were intimately bound to the thyroid capsule. This made it necessary to preserve a