Malignant change in a long-standing goitre was nearly three times more often follicular than anaplastic in type.
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Regardless of histological type half of the carcinomas had already metastasized to regional lymph-nodes by the time the patients were first seen.
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Excluding the papillary tumour group, half of the patients presented with distant metastases whether the cancer was differentiated (follicular) or not (anaplastic). 8. Iodine uptake was found most commonly in follicular carcinomas, but was occasionally encountered in other types. 9. The disease was localized to the neck under the age of 30. T h e absence of distant spread thus favours a more radical surgical attack on thyroid carcinoma in the young.
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There was a definite pattern of metastasis depending on the histological type of the tumour.
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In over one-third of the patients a correct pre-operative clinical diagnosis was not made. 12. T h e subsequent clinical course showed good correlation with the histological classification and grading of the tumours.
We are greatly indebted to Dr. I. Doniach, who not only gave advice on the pathological material but also discussed the paper with us. T h e photomicrographs were prepared by Miss Rayner Klein, the tables by Mr. Saunders, and the photographs by Mr. Bicknell, of the Postgraduate Medical School.