Figure 31. Two proliferative papillary adenomata that were considered benign on thebasisof 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 accompaniedby metastases in the cervical region. In one ( Figure 354) the cervical metastases were extensive although the primarylesion was relatively small. A total thyroidectomy and unilateral radical cervical lymph-node and upperanterior and posterior mediastinal dissection were performed in this case, and there has been noevidence of recurrence in 5 vears. The second case (B) wasalso treated by total thyroidectomy and regional lymph-node dissection. Only a single lymph node adjacent to the thyroid contained metastatic tumor althoughinvasion 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 showedconsiderableinfil- tration of adjacent normalthyroid tissue but was confined to the region of one superior pole and was not accompanied by positive lymph nodes. A totai thvroidectomy with regional lymph-node dissection was done. The regional lymph nodes did not contain metastases. There has been no evidence of recurrence in 5 years. The above 3 patients with carcinoma werefrom Rongelap, where the exposure to fallout was greatest. The fourth carcinoma (D) was a relatively un- differentiated adenocarcinoma ~ 2.5 cm in diam- eter. In manyareas it was solid cellular in charac- ter. The pleomorphic cells had breeched the capsule in manyplaces. The tumor was observed in vascular spaces but not in lymph nodes, and no distant metastases could be identified. The patient had presumablyreceived minimal radiation exposure on Utirik, an outlying island quite remote Figure 32. 4: A histologic preparation of a lesion that developed in an irradiated Marshallese thyroid ( x t4). 8: Autoradiograph, showing area of significant !4!I uptake to be in the ‘‘normal” extranodulartissue, in both upper corners of the section, and no uptake in the neo- plasm (diffuse stippling is background). This lesion was not considered malignant. (Same subject as Figure 31.)