Figure 31. Twoproliferative papillary adenomatathat were considered benign on the basis of histological examination ( x 49, subject No. 15, 1969). Other minute adenomata from the same subject are shownin Figure 334. sisting of a solid cellular pattern. Both lesions were accompanied by metastases in the cervical region. In one (Figure 354) the cervical metastases were extensive although the primary lesion was relatvely 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 no evi- dence of recurrence in 5 years. 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 tumoralthoughinvasion 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 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 above 3 patients with carcinomawere from Rongelap, where the exposure to fallout was greatest. The fourth carcinoma (D) wasa relatively un- differentiated adenocarcinoma ~ 2.5 cm in diam- eter. In many areas it was solid cellular in charac- ter. The pleomorphic cells had breeched the capsule in many places. The tumor was observedin 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). B: Autoradiograph, showing area ofsignificant #311 uptake to be in the “normal” extranodulartissue, in both upper corners of the section, and no uptake in the neoplasm (diffuse stippling is background). This lesion was not considered malignant. (Samesubject as Figure 31.)