consultant pathologists involved in that review who continue to evaluate prepared sections of recent thyroid lesions,* and the World Health Organization classification has been retained. Each year the exposed and comparison populations receive careful neck examinations by an endocrinologist or surgeon. Patientsof all exposure groups requiring thyroid surgery continue to have their operations performed by Dr. Brown Dobyns at Cleveland Metropolitan Hospital. A comprehensive presurgery medical evaluation she has a pituitary tumor, or, if so, whether or not it was the causeof herinfertility. Meningioma A 43-year-old woman (No. 2249) exposed on Utirik at age 15 had neurosurgery for a meningioma in 1982. The histology wasinterpreted at the, Armed Forces Institute of Pathology as being “atypical” (Figure 4). A summaryof her initial hospitalization is presented in Appendix III. Comment. Pituitary tumors are included under benign neoplasms of endocrine glands in the International Classification of Diseases (9th Revision, 1979). Because of unique characteristics related to anatomic placement, however, they have been included among the primary intracranial tumors in somestudies.” Clinically and at autopsy, no increase in pituitary adenomas has been found in Japanese atomic bombing survivors,* children who received x-irradiation of the scalp for T. capitis,” 36 workers in industries involving radioactive materials,”* or proton-exposed Macaca mulatta.*° Nevertheless, all the cited studies reported an excess of primary brain tumors, including meningioma (althougha correlation with radiation exposure was not always found). It is therefore premature to conclude that the two pituitary tumors and the meningioma diagnosed in exposed Marshallese have a common etiology because they are all intracranial. Nevertheless, this particular disease category clearly requires continued careful monitoring. One primarycentral nervous system tumor has occurred in the comparison population, an astrocytoma of the spinal cord diagnosed in 1982 in a 28-year-old unexposed Rongelap woman. is provided at the Hospital of the Medical Research Center, Brookhaven National Laboratory. Clinical followup of patients who have had surgery is carried out along the guidelines recommended by Dr. Jacob Robbins, Chief, Clinical Endocrinology Branch, the National Institutes of Health. The procedures used, apart from complete physical examinations provided annually, include thyroid scans, tests of thyroid function, and thyroglobulin determinations. Up to the present no mortality can be attributed to thyroid carcinoma in any of the operated persons, nor is there any evidence of residual malignantdisease. Thereis, of course, the morbidity associated with decreased thyroid function in persons who have hadsurgical removal of large amounts of thyroid tissue, whether benign or malignant. Thyroid hormone supplementation (Synthroid) is routinely supplied to those individuals. Thyroid hormone supplementation forall Rongelap-Ailingnae exposed, begun in 1965, has been continued. The reason for its use was to prevent the development of thyroid neoplasia. Thyroid nodules, however, have continued to occur over the years of surveillance, andit is not known if thyroid supplementation has delayed or prevented their development. A recent report suggests that such supplementation programs maybeineffective if begun more than a few years after radiation exposure.” Thereis, however, another reason for continuingthe current program, one that is based on the observation of subclinical hypothyroidism in a number of Rongelap individuals.’ This complication of their radiation exposure was detected only THYROID NEOPLASIA Methods. The thyroid nodule statistics in the 26-year report! were based on a reassessmentof all thyroid resections from 1963 through 1981. The signal contribution to that reassessment was provided by Dr. Donald Paglia (University of California, Los Angeles) who arranged a histopathologic classification which conformed to that of the World Health Organization.”’ This led to greater unanimity in diagnosis than had previously existed. The medical program is fortunate in having four eminent * Dr. L.V. Ackerman, Health Sciences Center, SUNY, Stony Brook, NY; Dr. W.A. Meissner, New England Deaconess Hospital, Boston, MA; Dr. A.L. Vickery, Massachusetts General Hospital, Boston, MA; Dr. L.B. Woolner, MayoClinic, Rochester, MN. co + wnt on csi 13