. ae Te ee a F Ane a ane aan foe eI ir several other iuidividuals exposed there have developed benign Jesions after a latent period some what longer Unanfor those exposed on Rongelap. Alter review ofthis papillary lesion by cleven pas thalogists,® opinion is divided as to whether it should be considered malignant (Figure 34.0); we have recorded i in our statistics as benign in view of the majority opinion. A few lesions of the thyroid fall inte an uncer: hala category in which even the most experienced “Dn. S. Warren, W. Meissner, and MOA. Leu, New England Deaconess dlompetat: JRead, Chveland Metroputaan General Phaspieal; To Winship (deceamd). Lo Wooler, Mayo Chive; LV. Ackerman, SUNYat Stouy brook, RV. Rusvoll, Enuev Coiverity; and S. Robbins, A. Vickery, and Mb. Castle (an, Me husetis General Hospital. 7 ae @ © “a f ena ¢' nancy maybe based. Figures 33C and 34.4 show one such minute lesion. This emphasizes the importance of the carly diagnosis and treatment of Marshallese lesions, ‘ ef ete 56 AY Ea fr 3/o rm 6. e o OS Sd va , 1% dD, che. ‘a S I G e e Be g” Be, Le SOP 84 oe, 07 ot: 5 e gae twe,oNse} & oh : shallese patients most of the thyruid nodules cither were detecied by palpation when scarcely J cmin diameter of were fuund coincidentally to removal of palpable adenoma. Manylesions showing atyp= ical cellularity were so small that perhaps they had not vet had an opportunity to manifest all the usual critcria upon which a diagnosis of malig- Ms . “No ae ‘ aye reegd Eftne athe ' MIAae Ae a nog © EE Feat 3 ®) é ‘ wn< . tee « “i 4 we > 4 o a Te ae * os fg ee ey mle? PD ae ee Be SUGF at! Vey" is.tee pect we ieee, ae, e é "| ¢ 7. *. ™, orgs% * if = Vey Me OS, $4 yt e wr, © rE Ae 73 ee tae D7 ake att wat os Res , os otss’ $r 1s E. as, ah +, & Le ee eit a RS l AE 4” * GO NGte aE ’ by Met A r Et) 20% 837% 6 hae uiep ® “_ oO 5 F phon: 37 ay ny! MAA i . or 1: oe 4 Ka an th 7 ’ bes W.? eso sie @ wal Pe gyets: “eae ts ht ry} to at . $f ' malignancyare readilyfulfilled, Among the Mar- ee as oFBe, Figure 34. Examples of very ininute neoplasms, only a few min in diameter and completely encapulated but composed of cells whose patiorn suggests that if the lesions were larger theyaight displayfeatures prompung 4 suspicion of malignancy. ba both examples shown (4, x 102, sub- Jeet Now, UTZ; A, x OL, No. d6, 1060) evidence of blood vessel ov ivinphatic invasion is lacking. and the capsile, which was sery thin, was iat breeched, The cotirve lesion of 4 is shown in Piguie $C, where its size can be camped with that of surrounding nerinal fallickes, Boul these couples are fro dhs roids that had no frankly saalignant lesions clew here in them, Te me ete ee - ei me 8 tee tls | taeape geele Riel Ramen et me A ke Ra ee aA ny mele ae ke natch head) was found in a subject from an island where the expausure was intermediate (Ailingnae); pathologists are unable to reach a firm opinion as to a diagnosis of malignancy. Some of these lesions ultimately proved to have been malignantas evideneed by a distant metastasis some years alter removal of the primary lesion. Itscems that a neoplasm must reach some significant size before it can unequivocally satisfy the criteria for a diagnosis of malignancy even though sinaller lesions may have ccllulas characteristics that suggest malignant capabiiities. ln clinical practice many lesions are of suflicient size that Lhe criteria for ee ee fron the areas of the more heavily exposed groups. ‘Phree other subjects from this island with the same exposure have had surgical excision of nodules which proved ta be benign adenomas, A filth lesion that was papillary (the size of a