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.)

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