Figure 31. Two proliferative papillary adenomata that were considered benign on the basis of histological examination ( x 49, subject No. 15, 1969). Other minute adenomata from the samesubject are shown in Figure 334. sisting of a solid cellular pattern. Both lesions were accompanied by metastdses in the cervical region. In one (Figure 354) the cervical metastases were extensive although the primary lesion was relatively small. A total thyroidectomy and unilateral radical cervical lymph-node and upperanterior and posterior mediastinal dissection were per- formed in this case, and there has been no evidence of recurrence in 5 years. The second case (B) was also treated by total thyroidectomy and regional lymph-node dissection. Only a single lymph node adjacent to the thyroid contained metastatic tumor although invasion 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 considerable infiltration 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 thyroidectomywith 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 carcinoma were from Rongelap, where the exposure to fallout was greatest. The fourth carcinoma (D) was relatively un- differentiated adenocarcinoma ~ 2.5 cm in diameter. In many areas it was solid cellular in character. 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 presumably received minimalradiation exposure on Utirik, an outlying island quite remote 2005142 Figure 32. 4: A histologic preparation of a lesion that developed in an irradiated Marshallese thyroid (x 14). 8: Autoradiograph, showing area of significant '51] uptake to be in the “normal” extranodular tissue, in both upper corners of the section, and no uptake in the neoplasm (diffuse stippling is background). This lesion was not considered malignant. (Same subject as Figure 31.)