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.)