a a crue 3. Section of thyroid showing two benign papillary adenomas (hematoxylin-eosin stain, X14). Surgical Exploration of Thyroid Nodules Thyroid operations have been performed at the following times: three in 1964, three in 1965, five in 1966, three in 1969. er cE CES ae Bye . Co Ie a POT eo RiveGh 1968, and five in 4, Multiple clusters of what appear to be atypical proliferating cells in thyroid which contains several large discrete adenomas. Lesions were considered benign (hematoxylin-eosin stain, X20). over the surface of the gland similar to that which has been noted in thyroids which had been treated with large doses of '“'I for hyperthyroidism. Some of the recent patients had received small tracer doses of radioactive iodine the day before surgery so that the nodular hemorrhagic or in many instances tissue could be measured for radioactive content at the time of surgery. The discrete lesions in many instances showed '*'I uptakes which were different from the extra nodular tissue. Most of the discrete benign lesions showed less uptake than the extra nodular surrounding tissue (Fig 2). Measurement of radioactive iodine in the malignant there was increased fine vascularity it was compared with the surround- At surgery the gross appearance of most of the thyroids were lobulated but in addition contained grossly discrete masses (Fig 1). The benign thyroid lesions exhibited multiple nodules varying in size from a few millimeters to sev- eral centimeters. They varied from soft to firm in consistengy, and were cystic. It was noted in some that JAMA, Oct 12, 1970 @ Vol 214, No 2 5Gb20u4 tissue was found to be nil when ing more normal tissue. Microscopic examination of the benign lesions revealed marked variation in size of follicles. The cells of somefollicles appeared atrophic, while others were hyperplastic, which was reminiscent Of iodine deficiency goiter (Fig 3). In addition to the gross adenomatous masses in the 15 thyroids which were classified as benign there were multiple microscopic clusters of what appeared to be atypical proliferating cells here and there in the parenchyma of some of these thyroids (Fig 4 and 5). Microscopically the thyroid carcinomas were considered of lowgrade malignancy and varied in structure from papillary to mixed Thyroid Neoplasia—Conard et al 319