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A case of meningioma with marked extracranial remote metastases is described. The patient was a 33-year-old female and was operated according to a diagnosis of parasagittal meningioma in both frontal lobes. Nine years later, however, she died of local recurrence and extracranial metastases in the lungs, liver, pancreas and vertebrae. Histologically, the tumor was diagnosed as angioblastic meningioma with high cellularity, some mitotic figures and abundant intersecting network of reticulin fibers frequently outlining vascular architectures.

A new aspirating and severing soft tissue biopsy needle that is small, disposable, relatively simple (3 components), and very thin-walled has been used percutaneously for many lesions of the chest, abdomen, pelvis, extremities, subcutaneous masses, and lytic spinal bodies. In the vase majority of instances, the tissue cores were sufficient for regular histologic cell block preparation. Among the 143 pulmonary biopsies, the diagnostic accuracy was 89 per cent. There were 16 cases of post-biopsy small pneumothorax, 6 cases of large pneumothorax, and 9 incidences of mild hemoptysis of no consequence. Of the 81 nonpulmonary biopsies, 71 (88 per cent) were diagnostically accurate; and there were no complications.

Histochemistry and electron microscopy have now enabled investigators to define precisely the oncocyte of salivary tissue. By these techniques, all oncocytes are characterized by a rich complement of mitochondria and most often by high oxidative enzyme activity. The routine light microscopic appearance of oncocyte, i.e., swollen and eosinophilic, is in large part due to its increased mitochondrial content but is non-specific and may be simulated by other cytoplasmic components such as endoplasmic reticulum, lysosomal bodies, secretory granules and other cell organelles. The term, oncocytoid, should be used for cells not fulfilling minimal his-tochemical requirements for the oncocyte.

Salmon calcitonin was administered intravenously at a dose of 5 MRC units per day to a patient with prostatic cancer and bone metastases during 20 days period. Serum calcium maintained pretreatment level during the period of administration with a slight decrease after cessation of the treatment. Urinary total hydroxyproline showed a gradual decrease during the treatment. Serum alkaline phosphatase increased gradually, and the elevated level continued even after cessation of the administration. Urinary phosphorus increased transiently after the initiation of the administration.When hexestrol was administered intramuscularly at a total dose of 765 mg, enlarged cervical lymph nodes and metastatic lung infiltration disappeared completely at the end of the treatment. Urinary hydroxyproline began to increase at the initiation of administration, and the high value was maintained during and after the hexestrol therapy.

Certain benign disorders are easily misinterpreted on histological examination as being malignant and thus often present quite a taxing challenge to the surgical pathologist. Such entities are being recognized and described with increasing frequency and more reliable histologic diagnostic criteria are being formulated in many instances. The purpose of this review is to list the most outstanding and especially the more recently discovered examples of these states and to draw attention to features of known diagnostic value. A list of selected references is provided.

Fourteen bone scans were performed in 7 patients with neuroblastoma using 18F and 99mTc-PP. Four patients had extraosseous uptake of 18F, 2 in regions radiographically calcific, and 2 in noncalcified sites. Two of these patients showed no extraosseous uptake by 99mTc-PP. In a third, extraosseous uptake of 99mTc-PP was seen in multiple calcific locations. 18F, 99mTc-PP, radiographs, and bone marrow biopsies all vary in the ability to detect bony metastases. This should be kept in mind when interpreting bone scans obtained with the newer agents.

A large chondrosarcoma, hypocalcemia, and hyperphosphatemia were found incidentally in a 44-year-old woman. Investigation of the etiology of the hypocalcemia excluded such factors as a dietary deficiency of calcium and/or vitamin D, acute pancreatitis, malabsorption, renal failure, hypoproteinemia, hypomagnesemia, idiopathic hypoparathyroidism, pseudohypoparathyroidism, and a calcitonin-producing tumor. The most likely cause of hypocalcemia appears to be calcium accretion by the tumor. In addition, evidence is presented to support an hypothesis that hyperphosphatemia resulted from temporary secondary hypoparathyroidism.

Twenty-seven patients with Ewing's sarcoma were evaluated by whole-body radionuclide studies, using 67Ga citrate and 18F or 99mTc polyphosphate. Correlative diagnostic radiography was performed on all patients. Gallium scanning, bone scanning, and roentgen rays were of equal usefulness in diagnosing the primary lesion. Skeletal metastases were evaluated most effectively with bone scanning, 12 of 13 cases being thus detected, whereas 8 of 13 were detected on gallium images and 4 of 13 on radiographs. Lung metastases were found in 7 of 8 cases with radiography but in only 1 of 8 gallium scans.

Visualization of normal vascular anatomy and tumor vascularity in 64 consecutive bone and soft-tissue arteriograms was markedly improved by means of selective high-volume injections, a vasodilator (Priscoline), geometric magnification, and subtraction. At least one tumor appeared to be avascular on the initial study but showed typical malignant features when studied with Priscoline. More vessels were seen, providing a more accurate anatomical picture. The size and extent of the lesion were accurately delineated in most cases. This technique facilitates more accurate angiographic diagnosis of malignancy and is invaluable in determining the proper landmarks for surgical removal.

Tumor scanning with 57Co-bleomycin was carried out in 46 patients with an overall accuracy of G6% in malignant tumors. There were no genuine false positive results in four benign lesions. Since 57Co-bleomycin is excreted rapidly through the kidneys, a high tumor-to-blood ratio is obtained a short time after injection. Although its long physical half-life may restrict its routine use, 57Co-bleomycin might provide a valuable adjunct in the work-up of malignant tumors when used in properly selected patients.

Twenty-two dogs with osseous haemangiosarcoma were examined in the University of Pennsylvania School of Veterinary Medicine from July 1952 to September 1972. A detailed case report of a primary haemangiosarcoma of the proximal humerus in a 21/2-year old spayed Irish Setter is given along with the salient features of twenty-one other cases. The three breeds most commonly involved were Boxers, Great Danes and German Shepherd Dogs. The ages ranged from 2–11 years with a median age of 6 years. The male to female ratio was 1·6:1·0. The proximal humerus and ribs were the bones most commonly affected. The long bone to flat bone ratio was 1·0:1·33. In some cases it was difficult or impossible to ascertain whether the haemangiosarcoma in bone was primary or metastatic. Histological grading appeared of little or no prognostic value. Resume. De juillet 1952 a septembre 1972, on a examine a l'Ecole de Medicine Veterinaire de l'Universite de Pennsylvanie, vingt-deux chiens atteints d'hemangiosarcome osseux. On donne un protocole detaille d'observation d'un cas d'hemangiosarcome primaire de l'humerus proximal chez un setter irlandais châtre avec les traits caracteristiques saillants de vingt et un autres cas. Les trois races les plus communes dont il s'agissait, etaient les Boxers, les Grands Danois et les Bergers Allemands. Les âges variaient de deux a onze ans avec une moyenne d'âge de six ans. La proportion mâle a femelle etait de 1·6:1·0. L'humerus proximal et les cotes etaient les os lesplus communement affectes La proportion de l'os long a l'os plat etait de 1·0:1·33. Dans certains cas, il etait difficile ou impossible de constater si l'hemangiosarcome de l'os etait primaire ou metastatique. Une gradation histologique a semble n'avoir que peu ou pas de valeur prognostique. Zusammenfassung. Zweiundzwanzig Hunde mit ossalen Hamangiosarkomen wurden in der Universitat der Pennsylvanischen Schule fur Veterinare Medizin in der Zeit von Juli 1952 bis September 1972 untersucht. Ein in Einzelheit gehender Krankenbefund von einem primaren Hamangiosarkom des Humerus proximalis in einem zweiundhalbjahrigen irischen Setter (dem die Eierstocke entfernt waren) wurde, zusammen mit den hervorstechenden Merkmalen von zweiundzwanzig anderen Fallen, veroffentlicht. Die drei Rassen, am Meisten einbegriffen, waren Boxer, danische Doggen und deutsche Schaferhunde. Ihr Alter belief sich von zwei bis elf Jahren mit einem Durchschnittsalter von sechs Jahren. Das mannliche zum weibliche Verhaltnis stand bei 1·6:1·0. Der Humerus proximalis und die Rippen waren die Knochen, welche am Meisten befallen waren. Die Rohrenknochen standen zu den Plattenknochen im Verhaltnis von 1·0:1·33. In einigen Fallen war es schwierig oder unmoglich zu ermitteln ob das Hamangiosarkom in Knochen primar oder metastatisch war. Histologische Einstufung schien von wenig oder keinem prognostischem Wert.

The maintenance of a normal serum calcium concentration requires a stable equilibrium between mineral in the skeleton and the extracellular fluid and the carefully integrated and balanced actions of parathyroid hormone (PTH), vitamin D, and, to a much lesser extent, calcitonin. The amino acid sequences of bovine, porcine, and part of human PTH have recently been determined. It has been recognized that some of the difficulties encountered in measuring PTH by radioimmunoassay in serum are due to the conversion of the hormone into fragments, to the variable specificity and sensitivity of the antisera used in these determinations, and to the presence of a previously unrecognized precursor in the synthesis of the hormone. Parathyroid hormone appears to stimulate its target tissues (bone and kidney) through the adenyl cyclase mechanism, and it has now been appreciated that factors other than calcium have regulatory control over the secretion of hormone. The metabolism of vitamin D has been elucidated, and the active metabolite, 1,25-dihydroxy-cholecalciferol, has been identified. Production of this compound in the kidneys is under feedback control so that vitamin D takes on the characteristics of a hormone. Future developments involve the synthesis of more active and shorter-acting metabolites of vitamin D, drugs that will be of considerable usefulness to the clinician. Despite many years of research and a number of interesting biochemical, physiologic, and clinical studies, the importance of calcitonin in human physiology has not yet been determined. Nevertheless, its measurement in blood is a useful diagnostic aid in medullary carcinoma of the thyroid. Multiphasic screening programs have disclosed a surprisingly high prevalence of hypercalcemia in a random population. In most instances, the differential diagnosis can be made by carefully collecting a data base and using conventional laboratory procedures. Nevertheless, the assay for PTH has proven useful for diagnosis in some patients, particularly in the preoperative localization of parathyroid adenomas. The path is cleared for the development of more meaningful hormone assays and additional prospective studies on the management of asymptomatic patients with hyperparathyroidism. This review is written at an exciting time when major advances are being made in our understanding of calcium homeostasis, and rapid changes are occurring in the spectrum of hypercalcemic disorders being presented to the physician. Many of these research developments are summarized in relation to the clinical problem.

Radiostrontium and 99mTc pyrophosphate accumulated in bone reacting to tumor invasion but not in the experimental bone tumor itself. Both 67Ga and 99mTc bleomycin were concentrated in the tumor as well as in the reacting bone. This discrimination of tumor affinity from skeletal delineation was illustrated by radioisotopic imaging in rabbits. The finding appears to imply that scanning with 67Ga and 99mTc bleomycin would be of help in early diagnosis of bone metastases and in delimiting fields of surgery and teletherapy in the absence of detectable radiographic abnormalities.

In 12 patients with disseminated prostate carcinoma, supraclavicular lymph node biopsy was performed. In 3 patients with palpable supraclavicular node, tumor cells were found in the lymph nodes. In the remaining 9 in whom there were no palpable nodes, unilateral left scalene lymph node excision biopsy revealed no evidence of tumor cells in the nodes in spite of diffuse bone metastasis. These findings suggest that unilateral scalene node biopsy did not provide additional information and has no advantage over the known parameters in staging of prostatic cancer.

Thirty patients with advanced refractory metastatic thyroid carcinoma received chemotherapy with adriamycin at a starting dose of 45 to 75 mg per square meter intravenously every three weeks. Eleven patients demonstrated a greater than 50 per cent decrease in the size of their metastases. Subjective improvement, particularly relief of pain from bony metastases, was also observed. Histologic cell types responding included medullary (solid) (three of five), papillary-follicular (three of 10), Hurthle cell (two of five), spindle and giant cell (two of nine) and unclassified thyroid carcinoma (one of one). Although the rate of disease progression in the responding and nonresponding patients was similar before the start of adriamycin, the median survival from this point on was significantly superior (p

A bronchial carcinoid tumor, found in a four and one-half year old boy, was resected at age six and recurred as an osteoblastic tibial metastasis 22 years later.

Summary Electron microscopic investigation of osteosarcomas from three mice, induced by the incorporation of 224 Ra, and an osteosarcoma metastasis from the liver of one of the animals revealed the presence of peculiar intracellular particles in all of the tumours. The particles were spherical, measured about 80 nm in diameter and consisted of two electron-dense, ring-shaped, membrane-like shells which concentrically surrounded an electron-lucent core. Nearly all of the particles with this doughnut-like ultrastructural appearance occurred in cisternae of the rough-surfaced endoplasmic reticulum (RER) of tumour cells. They were seldom observed in intracytoplasmic smooth-surfaced vacuoles or located freely in the cytoplasmic matrix. Crescent-shaped particles were occasionally found presumably in the stage of formation by budding into cisternae of the RER from its membrane component. The ultrastructure, size and formation of the particles, as well as their location in relation to intracellular structures, are similar to those described for type A viral particles. The significance of the virus-like particles, especially in relation to the pathogenesis of the malignant bone tumours, is not known at present.

T HE skeletal effects of radiation are dependent upon many variables, but the pathologic features are consistent. Radiation may cause immediate or delayed cell death, cellular injury with recovery, arrest of cellular division, or abnormal repair with neoplasia.‘* Fabrikant et al. administered bone-seeking isotopes to rats and caused changes similar to those seen in humans, namely growth and modeling disturbances, bone necrosis, and neoplasia.’ The effects of radiation in childhood are discussed elsewhere in this Seminar and hence are not included in this paper. Hypoplasia of the ilium and scoliosis secondary to abnormal vertebral configuration are characteristic roentgen features.21’23

The results of bone scanning using 87mSr in a series of 250 consecutive patients are analysed retrospectively. All patients had bone pain and the vast majority had proven primary malignancies. Analysis shows that if the scan and radiograph are in agreement the results are conclusive. Scanning will detect radiologically latent metastases in 17% of cases. Scanning appears to be more efficient than radiographs in the lower dorsal and lumbar spine and especially in the sacrum. Radiographs appear to be more efficient than scanning in the ischio-public region. There is some evidence that scanning detects metastases from lung primaries more often than metastases from breast primaries. It is suggested that a limited skeletal survey consisting only of a chest radiograph exposed to show the ribs adequately, together with A.P. and lateral views of the lower dorsal and lumbar spine, and an A.P. pelvis including the upper femora would detect 90% of radiologically visible metastases.

The present study demonstrates an increased prevalence of malignant lymphoma and multiple myeloma in survivors of the atomic bomb in Hiroshima exposed to 100 rad or more; a similar relationship is not evident in Nagasaki. This apparent discrepancy is tentatively attributed to known physical differences in the radiation spectrum emitted by the 2 bombs and/or biological differences between the inhabitants of Hiroshima and Nagasaki. Other observations of interest include the following: the risk of developing lymphoma or multiple myeloma appears to be greater in persons exposed at less than 25 years of age than in people who were 25 or more years old at the time of the bomb; the appearance time is shorter in the younger age group exposed to 100 rad or more in comparison with less heavily exposed persons, and also in comparison with heavily exposed persons in the older age groups. (auth)

A 25 year old patient with severe Factor IX deficiency was found to have bilateral pseudotumors arising from his pelvis.Localization of these tumors and assessment of response to therapy have been attempted by a combination of conventional radiology, radionuclide scanning and ultrasonography.An attempt has also been made to compare the characteristic ultrasonographic appearances of hemophilic pseudotumors with osteogenic sarcoma.

A number of abnormalities in skeletal scintigrams have been observed, which occur in areas of bone in the proximity of tissues that have been subjected to radiation therapy. It is thought that the effects observed were due to incidental irradiation of the bone areas during treatment. Explanations for the anomalies observed in the scintigrams have been suggested.

Bone scans with Technetium-99m (99mTc)-polyphosphate generally visualize the kidneys with reasonably good definition. As a result unsuspected renal abnormalities are not infrequently discovered incidental to the procedure. More attention to this aspect of the scan is warranted.

The piezoelectric constant of mature and immature bone (defined herein) has been measured in an effort to determine whether it varies with age. It was found that the average value of the piezoelectric constantd14 of femur from three week old calves was 58% of the value of femur from three year old bulls. The results were interpreted to indicate qualitative differences in the corresponding collagen matrices. Mature human tibia from males ranging in age from 21 to 53 years of age showed a small but significant increase ind14 with age. Some data concerning diseased human bone, and well-preserved human bone excavated in Peru are also presented.

A histological comparison has been made of the giant cells in 10 cases which had been diagnosed as central giant cell granuloma of the jaws and 10 cases diagnosed as giant cell tumor of long bone. The numbers of nuclei in each of 50 giant cells were counted in the 20 lesions. The giant cells were measured in order to compare their sizes in the respective lesions. It was found that the giant cells of the jaw lesions contained significantly fewer nuclei than those of the lesions in other bones. Secondly it was found that cells in the lesions of long bone have significantly larger dimensions than those in the jaw lesions. There was, however, an area of overlap. It was concluded that these data supported the view that giant cell tumor and giant cell granuloma are distinct entities. Some giant cell lesions of long bones are, however, morphologically indistinguishable from lesions of the jaws; and conversely giant cell lesions of the jaws are indistinguishable from some giant cell lesions of the long bones. It seems possible, therefore, that some jaw lesions are giant cell tumors and that some giant cell lesions outside the jaws are giant cell granulomas.

Three hundred twenty-eight cases of histologically confirmed malignant childhood neoplasms diagnosed at Pahlavi University-affiliated hospitals, covering the Fars Province, Southern Iran from January 1, 1963 to December 31, 1971 were reviewed. The age-, sex-, and site-specific incidence rates were compared to those of Denmark and Sweden. The five commonest childhood cancers in our region were: leukemias, nodal lymphomas, and bone, soft part, and ocular neoplasms, in that order. Our incidence rates for cancers of salivary glands, nasopharynx, nasal cavities and sinuses, small bowel, and lymphomas in both sexes generally exceeded those of Denmark and Sweden. The most persistent difference in incidence rate was noted in lymphomas. Soft part sarcomas and esophageal carcinoma in males also showed a higher incidence in our region. The significance of these findings is discussed.

✓ A case is reported in which bilateral subdural hematomas were caused by metastatic adenocarcinoma in the subdural membranes. This diffuse dural carcinomatosis was associated with widespread intravascular tumor growth and a marked vascular and fibrous proliferation, interpreted as a tumor-induced angiodesmoplasia. The hematomas resulted from separation and hemorrhage into this highly vascular abnormal areolar layer of the dura.

The kinetics and imaging characteristics of 99mTc-labeled stannous pyrophosphate were evaluated in 30 patients. Blood chemistries, urinalyses, serial blood activity measurements and 24-hour fractionated urine activity assays were obtained in selected patient studies. Digital gamma camera images were recorded on magnetic disk and quantitatively analyzed. Total body rectilinear scans were also recorded. Results indicate that 99mTc pyrophosphate is useful for bone imaging. Preparations yielded reproducibly high binding efficiencies; soft tissue clearance was rapid; no pharmacologic effects were observed; and count levels and contrast between lesion-involved bone and normal bone were adequate. Image quality was acceptable between 1 and 6 hours after administration. Abnormal areas were detected at all imaging times; however, the best image quality was usually observed in the delayed views.

Large quantities of carcinoembryonic antigen (CEA) were detected by the radioimmunoassay method and confirmed by the column chromatography and immunodiffusion methods in the bowel contents from nine subjects: two healthy volunteers, two patients with colostomies and one with ileostomy free of disease, three patients with colostomies who had metastases outside the gastrointestinal tract, and one patient with carcinoma of the rectum (in place) before resection. The quantities of CEA in the intestinal contents did not correlate with the plasma levels. This may indicate that CEA could be present in large amounts in the normal epithelial cells of the gastrointestinal tract and does not appear conspicuously in blood until abnormal conditions develop.

Reports in the early 1960's suggested the possible relationship between the humoral agents producing hypercalcemia in metastatic malignancy and the appearance of osseous metastases. Hartmann and Sherlock indicated that the use of corticosteroids possibly might alter the ease with which metastases to the gastrointestinal mucosa occur in breast carcinoma. The present study was an attempt to verify the previous observations of Pentimalli (1960) that hypercalcemia could produce bony metastases in rats. Using saline controls, ergosterol, methylprcdnisolone, and parathyroid hormone, no bony metastases could be demonstrated in rats implanted with Walker 256 sarcoma. It appears that these osteolytic substances at least within this model do not facilitate the appearance of metastases to bone.

M ULTIPLE MYELOMA is a neoplastic proliferation of plasma cells, generally originating in the bone marrow. These globulin-producing plasma cells may be immature (myeloma cells). Most of the clinical features are due to marrow infiltration and bone destruction by plasma cells. Multiple myeloma is most common in patients between 45 and 70 yr of age. The disease is characterized by bone pain, particularly in the back (with or without pathologic fracture), weakness, soft-tissue masses, renal insufficiency, neurologic symptoms, and frequent infections.“r6 Abnormal laboratory findings include anemia, hyperglobulinemia, hypercalcemia and hyperuricemia. The alkaline phosphatase is typically normal in uncomplicated cases. Serum or urine electrophoresis shows a characteristic M-type protein peak, and bone marrow study reveals an increase in plasma or myeloma cells.24 The natural history of myeloma is undergoing constant study.” The abnormal electrophoretic changes and even plasma cell proliferation in the marrow may be present for a long period before clinical or radiologic evidence of disease is found. Radiographically, the typical myeloma shows multiple small osteolytic lesions with sharp punched-out margins (Fig. 1). However, the roentgen appearance is extremely variable (Table l), and these variations will be emphasized in the following discussion.

The usefulness of hydroxyproline assays in the early diagnosis of bone metastases was investigated in 26 prostatic cancer patients. Patients with bone metastases detectable by the conventional X-ray technique or by radiostrontium had significantly higher mean serum hydroxyproline values, and they also excreted significantly more hydroxyproline in the urine than the patients without metastases. The patients for whom the external counting with radiostrontium showed metastases, but whose X-ray findings were negative, had elevated serum hydroxyproline values, while the excretion of hydroxyproline and the serum phosphatase concentrations ranged within the normal limits. Patients without metastases had normal serum hydroxyproline values, and their excretion similarly vaned in the normal range. After the introduction of androgen control therapy, the elevated values of hydroxyproline and serum phosphatases became normalized simultaneously over a period of 4 months. The results indicate that serum hydroxyproline a...

✓ Two cases of metastatic glioma with hypercalcemia are presented. Elevated serum calcium secondary to metastatic central nervous system tumors may be more common than is generally supposed, and the symptoms of hypercalcemia may be mistaken for those of increased intracranial pressure.

The quality of Tc-PP scans is best in younger patients. In all age groups quality is adversely affected by free TcO4-. This should be suspected if excessive background is present or marked accumulation is noted in the thyroid gland. Direct physician supervision of all studies is recommended. Symptomatic and roentgenographically positive areas may then be determined for special interpretative attention. Objects which attenuate activity should be removed or noted. Potential sources of superficial contamination (product spill, urine, saliva) must be known and considered when extraneous activity does not correlate with skeletal structures or clinical findings. Normal variations in skeletal uptake of Tc-PP include asymmetries between periarticular areas on the right and left, local increases due to physiologic calvarial thickening and uptake in persistently visualized sternal ossification centers. Apparent variations in the vertebral activity may be due to focal plane effects of rectilinear scanners. Hyperemia can cause diffusely increased Tc-PP localization in an entire extremity. This effect may completely obscure a lesion or obscure the extent of a lesion. Tc-PP excretion through the kidneys occasionally provides useful morphologic or functional information concerning the urinary tract which should be inspected on all scans. Abnormal soft tissue uptake occurs in a variety of conditions including healing wounds and some malignant tumors. A large percentage of patients over 40 years of age demonstrate localization of Tc-PP in the walls of the femoral vessels.

Summary Experience of 26 patients with carcinoma of the prostate treated by adrenal suppression with aminoglutethimide is reviewed. 60% of hormone resistant tumours showed some response. A fall in plasma testosterone beyond that achieved by oestrogens was not observed. A high incidence of side-effects was noted. A limited role for aminoglutethimide in the management of prostatic carcinoma is suggested. Our thanks are due to the Consultant Surgeons, St Peter's Hospitals who referred their cases to us for investigation. We acknowledge with thanks the help of Dr I. F. Sommerville and Mr M. D. Mansfield, Department of Clinical Endocrinology, Chelsea Hospital for Women, who performed testosterone assays. Aminoglutethimide was supplied by Ciba Laboratories Ltd, Horsham, Sussex. This work was supported by a grant from the St Peter's Research Trust.

Three patients had widespread skeletal metastases whose bone scans appeared to be normal. False negative scans were due to symmetrical increased radiopharmaceutical uptake in virtually all bones. Caution must be taken in the interpretation of bone scans in patients with malignant disease which tends to metastasize diffusely (e.g., from the breast, prostate and lung). False negative interpretations may be avoided by viewing at least one radiograph containing bone at the time the scan is interpreted, the most practical being the admission chest film.

A clinical survey is presented of 89 cases of carcinoma of the nasopharynx, seen at the Sheba Medical Centre in Israel. The age, histology and staging is analysed as well as the ethnic group incidence. There would appear to be a higher incidence among Eastern Jews: delay still seems to be the major factor in the low survival rates. An exceptionally high incidence of distant bone metastases among young patients was noted.

Eight per cent of all 18F bone scans and 11% of abnormal scans demonstrate solitary lesions. This review analyzes 100 solitary lesions and the correlation with radiologic, pathologic and clinical findings. Several interesting findings and patterns emerge. Metastatic tumor accounts for 54% of the solitary lesions of which less than half are apparent roentgenographically, requiring pathologic examination for confirmation of final diagnosis. Roughly one fourth of solitary lesions occur in the extremities. At least half were totally unsuspected clinically which shows the importance of scanning the entire skeleton. Etiology and location of the lesions are discussed.

The occurrence of a liposarcoma in a Greyhound is reported. The dog was presented with a swollen left hock which, on radiographic examination, was shown to be a tumour in the bone. Metastasis from the primary site or independent genesis led to the involvement of the metaphyseal areas of the long bones, the left caudal lumbar lymph node, the liver and the spleen. The neoplastic tissue was composed of cells ranging from undifferentiated sarcoma cells to well-differentiated vacuolated fat cells. Resume. On rapporte l'occurrence d'un liposarcome chez un levrier. Le chien s'etait presente avec le jarret gauche enfle, ce qui, d'apres un examen radiographique, s'etait revele etre une tumeur de l'os. La metastase du site primaire ou de genese independante a mene a l'implication des regions metaphysiques des os longs, du nœud lymphatique lombaire caudal de gauche, du foie er de la rate. Les tissus neoplastiques etaient composes de cellules variant de cellules de sarcome non-differenciees a des cellules bien differenciees de graisse vacuolaire. Zusammenfassung. Das Vorkommen von einem Liposarkom wurde in einem Windhund berichtet. Der Hund litt an einem geschwollenen linken Fesselgelenk, welches sich bei Ront-genuntersuchung ais ein Tumor im Knochen erwies. Metastase von der primaren Stelle oder un-abhangigen Entstehung fuhrte zu der Verwicklung von den metaphysischen Gebieten der langen Knochen, des linken kaudalen lumbalen Lymphknoten, der Leber und der Milz. Die neoplastischen Gewebe waren aus Zellen zusammengesetzt, die sich von nichtdifferenzierten Sarkomzellen zu gut differenzierten vakuolen Fettzellen erstreckten.

C57/BL mice were immunized against methylcholanthrene sarcoma and were challenged with second-tumor isografts injected into cortical bone to test the hypothesis that bone is an unusually privileged site where metastases are protected from immunologic destruction in the sensitized host. Results indicate that structural characteristics of bone do not protect metastatic tumor cells from destruction by immune lymphocytes. An alternative explanation for the failure of osseous metastases from renal cell cancer to regress may involve modification of surface antigens. Also, a review of important aspects and principles of tumor immunology is given.

✓ The authors report two cases of intracranial meningiomas that metastasized to organs outside the nervous system, and review 54 comparable cases from the literature. Apparently neither previous surgery nor pulmonary involvement is a prerequisite for metastasis.