134 World J. Surg. Vol. 16, No. 1, Jan./Feb. 1992 Fig. 6. This lesion was from a 78 year old male whose home was Utirik, but he was reported to have been off that atoll at the time of the accident. There was a large multinodular goiter. A. The largest tumor (10 cm) displayed a variety of histologic patterns. This illustrates an area of questionable capsular invasion in a microfollicular adenoma (x20). B. Another area of the same tumor, showing microfollicular structure and possible capsular invasion (x75). C. A third area of the same tumor showing pleomorphic cells arising next to the capsule (x 100). 7 3.7. th .rs yo oy i an geae (een x ea See wegen Wee yt” Re ety: pare sae is acu SURF a8 nS , th: ory “ta ke er . Oi 3 FT ash Fig. 7. Samples of thyroid tissue from a aT, ae oe heed oe ke Le t KA’ Rongelap man exposed at age 7. He had displayed acute beta burns of the skin and suppression of blood elements. A bilateral subtotal thyroidectomy was doneat the first operation at age 22. A mass recurred and he underwent repeat surgery [3 years after the first operation. A. Tissue recovered at first operation in 1969. The thyroid contained a multitude of small nodules, the largest being 2.0 cm in diameter. Some grossly normal tissue was allowed to remain from both lobes. Diagnosis was adenomatous nodules with considerable radiation effect (x75). B. Tissue recovered at a second operation. Numerous masses up to 2 cm were found. This microscopic section came from the left upper pole where the largest previous lesion had been located. This shows what is believed by some to be penetration of the capsule whichtogether with the cellular features sug- gested to some observers that it might be classified as a follicular carcinoma. The lesion is classified as an atypical adenoma. The presence of postoperative scar tissue confused the issue of capsular developed in those who had retained somethyroid function and radioiodine in oral intake immediately after the accident. For Rongelap people in spite of equal exposure to fallout could be due to age, susceptibility to neoplastic change, orthe amount of none. whoharboredcells that retained a capacity for mitosis. The obvious differences in the effects on the thyroid in the instance, drinking rain water from catchments would provide a large amountof radioiodines while quenching thirst with uncontaminated coconut milk (a common practice) would provide wea SG ORE te invasion (x75).