+7
from the areas of the more heavily exposed groups.
Three other subjects from this island with the same
exposure have had surgical excision of noduies
which proved to be benign adenomas.
A fifth lesion that was papillary (the size of a
match head) was found in a subject from an island
where the exposure was intermediate (Ailingnae);
several other individuals exposed there have de-
veloped benign lesions after a latent period some-
pathologists are unable to reach a firm opinion as
to a diagnosis of malignancy. Someofthese lesions
ultimately proved to have been malignantas evidenced by a distant metastasis some years alter re-
movalof the primary lesion. It seems that a neoplasm must reach somesignificantsize beforeit
can unequivocally satisfy the criteria for a diag-
nosis of malignancy even though smaller lesions
may have cellular characteristics that suggest
what longer than for those exposed on Rongelap.
After review of this papillary lesion by eleven pathologists,* opinion is divided as to whetherit
should be considered malignant (Figure 344); we
have recordedit in ourstatistics as benign in view
of the majority opinion.
A few lesions of the thyroid fall into an uncer-
malignant capabilities. In clinical practice many
lesions are of sufficient size that the criteria for
malignancy arereadily fulfilled. Among the Marshallese patients most of the thyroid nodules either
were detected by palpation whenscarcely 1 cm in
“Drs. S. Warren, W. Meissner, and M.A. Legg, New England
Deaconess Hospital; J.D. Reid, Cleveland Metropolitan Gen-
usuai criteria upon which a diagnosis of malig-
tain category in which even the most experienced
eral Hospital: T. Winship (deceased); L.B. Woolner, Mayo
Clinic: L.V. Ackerman, SUNYat Stony Brook; R.V. Rosvoil,
Emory University; and S. Robbins, A. Vickery, and B. Castleman, Massachusetts General Hospital.
Aye
s
AVE
Set8
yy
eg: Psat
ical cellularity were so small that perhaps they
had not yet had an opportunity to manifestail the
nancy maybe based. Figures 33C and 34A show
one such minute lesion. This emphasizes the im-
portance of the early diagnosis and treatmentof
Marshalleselesions.
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diameter or were found coincidentally to removal
of palpable adenoma. Manylesions showing atyp-
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_ Figure 34. Examples of very minute neoplasms, only a few mmin diameter and completely éncapsulated but composed of cells whose pattern suggests thatif the lesions were larger they might
display fearures prompting a suspicion of malignancy. In both examples shown (4, x 162, sub-
ject No. 8, 1972; B, x 91, No. 36, 1969) evidence of blood vessel or lymphatic invasion is lack-
ing, and the capsule, which was very thin, was not breeched. Theentire lesion of 4 is shown in
Figure33C, where its size can be compared with that of surrounding normalfollicles. Both these
examples are from thyroids that had no frankly malignant lesions elsewhere in them.