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Epidermoid carcinomas of the anal region may be treated by four procedures. Radiation plays a major role in the conservative management of these tumors. Lesions of the external margin may be treated satisfactorily by external irradiation with cobalt. It is possible to control a large number of anal carcinomas by fractionated interstitial Curie therapy. A combination of external irradiation and interstitial Curie therapy may be used to treat large and extensive lesions of the anal canal.

The chronic effects of nicotine were studied in male Fischer-344 rats over periods of 2 or 22 months. Nicotine (1000 μg base/ml/kg/day) was given sc in 6% gelatin, whereas control rats received 0.85 g/100 ml w/v NaCl in 6% gelatin. Nicotine-treated rats achieved and maintained a significantly lower (p < 0.01) weight gain than control animals, and the weight of several tissues in both control and nicotine-treated groups showed a change with age. There was no significant change in hemoglobin, or hematocrit, or mean corpuscular volume, hemoglobin, and hemoglobin concentration, or in red and white blood cell counts between control and nicotine-treated rats. Similarly, the differential white cell count did not differ between the 2 groups; however, an increasing percentage of neutrophil polymorphonuclear leucocytes and a decreasing percentage of lymphocytes was shown for both groups with age. Platelet number and morphology were not altered. Several neoplasms developed in the animals injected for 22 months. Two tumors, an adenocarcinoma of the lung and chromophobe adenoma developed in the 6 old control rats (33%), and 9 tumors (3 instances of pheochromocytoma, 4 cases of epidermoid carcinoma of the skin, 1 rat with leukemia and 1 animal with fibrosarcoma) developed in 8 of the old treated rats (29%). The incidence of Leydig cell hyperplasia differed significantly with lesions developing in 66% of the old control rats compared to 89% of the old treated rats (p < 0.05). It is possible that the physiologic age of the nicotine-treated rats was significantly greater than the controls, and thus the animals were at greater risk for the development of this lesion. Nicotine administration had no effect on the Ca2+-dependent myosin ATPase activity or on the lactic dehydrogenase activity and isozyme pattern from predominantly fast (gastrocnemius), slow (soleus) or cardiac muscles. Mg2+-dependent ATPase activity from soleus muscle myofibrils was considerably depressed after 22 months of nicotine treatment, whereas activity from cardiac and gastrocnemius muscles was unchanged.

The clinical and histologic status of cervical lymph nodes has been correlated with the results of treatment in 1,069 consecutive patients who underwent radical neck dissection as part of the initial treatment of a primary epidermoid carcinoma arising in either the oral cavity or oropharynx. The influence on “cure” rates of size, number, location, and fixation of involved nodes, correlated with the specific site of origin within the oral cavity, was evaluated in determinate patients with proved nodal metastasis. As the extent of lymph node involvement increased from solitary to multiple ipsilateral and to bilateral enlarged nodes, cure rates dropped progressively. Survival was not invariably decreased in those whose involved nodes were large or considered fixed, and there was considerable variance among examiners when size and fixation were evaluated. These data suggest that the N system of staging presently advocated might be improved. Rather than designating contralateral or bilateral node involvement as N2, this category might be reserved for those with multiple ipsilateral cervical node metastases. Those with contralateral and bilateral as well as so-called fixed metastases might better be relegated to the N3 category. The results of treatment were uniformly poor in the latter group of patients, provided the term “fixed” indicated immobility of involved lymph nodes and not merely the presumption that tumor had extended beyond the capsule of the node.

Epidermoid, small cell undifferentiated, and adenomatous types of bronchogenic carcinoma were all shown to be increased among uranium miners. This was done by use of calculations of expected numbers for each of the major histologic types. The predominance of the small cell undifferentiated histologic types, however, was so great that it appeared to be the only type whose frequency was elevated in earlier, relative distribution studies. The same three histologic types have been shown to be elevated among cigarette smokers, but with different relative frequencies. These findings are consistent with Kreyberg's hypothesis that small cell undifferentiated and epidermoid carcinomas of the lung are closely related, and are the principal types whose frequency is affected by inhaled carcinogens, even though adenocarcinomas are also increased to some extent.

A large mass was found in the incisor region of the mandible in an 8-hour-old female calf. It had papillary projections and infiltrating anastomosing cords and islands of oral epithelium with a peripheral row of columnar cells. There was excessive keratinization on the surface as well as in the center of cords. Histologically it resembled epidermoid carcinoma and epulis. This is probably the second report of a congenital ameloblastoma.

In a limited area on the southwest coast of Taiwan where artesian well water with a high concentration of arsenic has been used for more than 50 years, a high prevalence of chronic arsenicism has been observed in recent years. The total population of this endemic area is approximately 100,000. A general survey of 40,421 inhabitants of the area was made (19,269 males and 21,152 females). The overall prevalence rates for skin cancer, hyperpigmentation, and keratosis were 10.6, 183.5, and 71.0 per 1000, respectively, and for blackfoot disease (a local term), a peripheral vascular disorder resulting in gangrene of the extremities, especially the feet, 8.9 per 1000. The male-to-female ratio was 2.91:1 for skin cancer, 1.1:1 for hyperpigmentation and keratosis, respectively, and 1.99:1 for blackfoot disease. Generally speaking, the prevalence increased steadily with age in all four conditions. The association of blackfoot disease with hyperpigmentation, keratosis, and skin cancer was significantly higher than expected. The causal relationship between blackfoot disease and chronic arsenicism is emphasized. A total of 303 arsenical cancers in 184 patients (119 men and 65 women) were studied histologically; 143 patients (78 per cent) were older than 50 years. Of the 303 lesions, 57 were epidermoid carcinoma, 45 basal cell carcinoma (28 deep and 17 superficial), 176 intraepidermal carcinoma (23 type B keratosis and 153 classic Bowen lesions and its variants), and 25 combined forms. Bowen's variants included 10 with squamous whirls, seven with features of seborrheic keratosis, and 12 with horn formation. The combined forms were a mixture of superficial basal cell carcinoma, Bowen's lesion or its variants, and Jadassohn epithelioma. Among the 45 basal cell carcinomas, 10 revealed bizarre multinucleated giant cells and nuclear atypicalities, three in deep and seven in superficial layers. The cases of arsenical keratosis encountered were of both benign type A and malignant type B (intraepidermal carcinoma) forms. Among the 81 type A keratoses, 57 revealed no cellular atypy and 24, only mild changes. The fine structure in 30 classic cases of Bowen's lesion is briefly described and illustrated. A five year follow-up study of 422 skin cancer patients and 344 patients with blackfoot disease was made. Standard mortality ratios were calculated for both and the causes of death analyzed.

In a series of 247 consecutive patients with bronchogenic carcinoma treated with radiotherapy and/or chemotherapy, the over-all frequency of metastasis to the brain was 22.7%. These metastases were seen in 30.5% of patients with small cell carcinoma, 29.4% of patients with large cell anaplastic carcinoma, 25.4% of patients with adenocarcinoma, and 13.7% of patients with epidermoid carcinoma. Eighty percent of the brain metastases were diagnosed antemortem. Treatment included corticosteroids and radiotherapy to the whole brain with an intended dose of 5000 rads. Of the 41 patients who received some radiotherapy, 12 had a good response, and 13 a fair response. The median survival of all 45 patients with clinical evidence of metastases was 94 days, while the median survival of patients receiving at least 4000 rads cranial irradiation was 130 days from the onset of metastases. Brain metastases were the cause of death in 20 of the 45 patients whose metastases were diagnosed pre-mortem. The poor results of treatment of brain metastases which have become clinically apparent suggest that a controlled trial of elective brain irradiation in high-risk patients may be indicated.

The presence of tumor-specific antigens in a limited number of specimens of serous cystadenocarcinoma, mucinous cystadenocarcinoma, and solid epidermoid carcinoma of the human ovary has been demonstrated. Immunoelectrophoresis and immunodiffusion were employed to reveal the presence of the antigens and to relate the antigens of one tumor type to those of another. A maximum of four antigens per tumor sample was found. None of these antigens was found in normal ovary or normal human serum.

The manifestations and outcome of lung cancer in 449 patients have been correlated with the new WHO histologic classifications. The six main histologic groupings were: well-differentiated epidermoid, poorly-differentiated epidermoid, well-differentiated adenocarcinoma, poorly-differentiated adenocarcinoma, large cell undifferentiated, and small cell undifferentiated. The biologic behavior of the well-differentiated and poorly-differentiated groups seemed relatively similar for epidermoid carcinomas, but was substantially different for adenocarcinomas. Adenocarcinomas occurred most commonly among women, and were most likely to be detected either while asymptomatic or after manifest metastasis. Epidermoid carcinomas were most likely to present with a bronchoscopically visible mass, with the "primary" symptom of cough or hemoptysis, and with positive tests for sputum cytology. The mean age at diagnostic detection was similar in all six histologic subgroups, but the mean duration of pretherapeutic symptoms was longer in the epidermoid group than in the others. The epidermoid cancers had the lowest rates of pretherapeutic metastasis, the highest rates of operability and resectability, and the highest overall survival rates. The lowest rates of operability, resectability, and overall survival were in small cell undifferentiated cancers and in poorly-differentiated adenocarcinomas. A striking finding among inoperable patients was that six-month survival rates depended much more on symptom-anatomic stage than on histologic type.

At the times of routine on the cytologic diagno sis in the field of gynecology we may sometimes encounter with difficulties in discrimination of cells from severe dysplasia and carcinoma in situ. In other words parabasal dysplastic cells and malignant basal cells are several times hardly distinguishable from each other. Resently the classification of parabasal dysplastic cells into three types (A, B, and C type) was proposed by Tenjin and coworkers. By investigating of frequency of these cells appe ared in cervical smears from above epithelial lesions, they made an attempt to find out the correlation of these cells with histologic typing. The purpose of the present study is to investigate and to analyze more objectively their theories.One of the four populations used in this study was reserve cells, as representative of normal cells. The other populations consist of finely granular as well as coarsely granular dysplastic cells and epidermoid carcinoma cells.All measurements were carried out by means of APAMOS version 2 on Zeiss's SMP-05 scanning microscopephotometer connected on line to small laboratory computer (PDP 12). A measuring spot size of 1.0×1.0 micron was used, and all measure ments were taken at a wavelength 550 nm. At first, digitized mirrorimages of individual cells were printed out and a cut-off point was established on the histogram of extinction values. In these mirror images the boundary between nucleus and cytoplsm was on the cut-off point methode drawn. These models fitting with boundary are statistically and mathematically analyzed and investigated.The results may be summaried as follow:1) Statistical assessment of the anti-smoothness measure of optical density in nucleus (Anti-Smoo thness Variance Measure and Anti-Smoothness Standard Deviation Measure) shows, that no significant differences between each cell population were recognized.2) Assessment of complexity measure of chromatin contour: At first, the contour of different extinction levels was drawn. Let H denote the height of extinction level, S denote the area surrounded by contour and L denote the length of contour, then L2/S values of each extinction level (H) were obtained. Investigating L2/S values in a given cell, the value on height (H) of most complicated contour is appoximately at maximum of L2/S. It can be considered, that it is possible to predict the histologic type of epithelial lesion whichis present, when the distribution of the value H which maximizes L2/S and the Max.L2/S values of individual cells are investegated.3) In the process of calculation for complexity measure of nucleus it may be possible to recognize mathematically shape and number of chromatin granules.

Two cases of primary squamous-cell carcinoma of the endometrium are recorded. The first represented independent in situ lesions of endometrium and endocervix. These occurred in a patient with numerous sites of epidermoid carcinoma occupying the lower genital tract and perineum. The second case occurred as an invasive squamous-cell carcinoma of the endometrium in the absence of a neoplasm involving the cervix, thoroughly studied histologically.

Good palliation and, in some cases, apparent cures have resulted after surgical treatment of patients with extensive, localized epidermoid carcinoma occurring in the lower abdominal wall or prevesical space. Other localized neoplasms, such as radiation-induced sarcomas, also may be amenable to similar treatment. En bloc pubic resection and the scrotal skin transfer technique were used successfully to facilitate removal of an extensive, recurrent, epidermoid carcinoma in 1 patient and a necrotic radiation-induced fibrosarcoma in another. Principles of management include exploratory laparotomy to rule out the possibility of disseminated disease, and stint dressings and suction catheters placed beneath the scrotal flaps to prevent fluid accumulation.

It is extremely difficult to make an accurate diagnosis of lung cancer lesions less than 3 cm. in diameter with ordinary cytologic examination of sputum. In order to obtain cancer cells from peripheral small tumors, we developed a brushing method under x-ray television fluoroscopy, using minute linear and flexible brushes. The flexible brush is newly devised to secure remote control of the brush by adding a platinum joint to it. Twenty-seven of 31 cases of primary lung cancer were successfully diagnosed by the TV-brushing method. From postoperative histologic studies of two negative cases (of TV-brushing), it was recognized that normally visualized bronchi in the bronchogram, as a rule, were devoid of malignancy, and that TV-brushing must be performed in the non-visualized branches, "territoire muet." Therefore, utmost care must be given the technique and interpretation of the bronchogram prior to TV-brushing. One of the negative cases was adenoid cystic carcinoma originating in bronchial mucous gland. In consideration of a growth pattern of this tumor, it is extremely difficult to establish a diagnosis even with the TV-brushing method.

Images Figs. 1-5

EPIDERMOID carcinoma of the perianal skin and anal canal is a rare lesion. An initial pilot study using the pathological material available at Hartford Hospital (30 cases) prompted an in-depth study using the available material of the Connecticut State Tumor Registry (157 cases). Thirty-one Connecticut hospitals co-operated in making this study possible. Clinical Material Over a period of twenty-five years, a total of 157 cases were available for evaluation. There were 149 cases of squamous-cell carcinoma, 7 of the mixed basosquamous type and 1 case of carcinoma in situ. Age and Sex The ages ranged from twenty-seven to eighty-nine years, . . .

1. 1. A total of 35 patients with previous supravaginal hysterectomy subjected to cervicectomy during the 10 year period, 1948–1957, were reviewed. 2. 2. In 23 (66 per cent) patients, the supravaginal hysterectomy was performedaas a routine procedure. Leiomyoma uteri was the most common indication for hysterectomy. The responsibility of the gynecologist in following up the patients with retained uterine cervices and the importance of performing total hysterectomy are stressed. 3. 3. The time interval between the supravaginal hysterectomy and the discovery of malignancy of the cervical stump varied from 6 months to 20 years, averaging 8 years. Hence, there is no “age limit” with regard to cervicectomy. Patients with cervical stumps may necessitate cervicectomy at any age. 4. 4. Vaginal spotting and cervical prolapse were the two most common symptoms and convinced both the patient and the gynecologist that cervicectomy was indicated. 5. 5. Chronic cervicitis was the most frequent pathological finding. There were 13 such cases. Malignancy was suspected in 7 cases, and among these one proved to be an adenocarcinoma, Grade III. Four patients with biopsies positive for malignancy were subjected to cervicectomy. 6. 6. Vaginal cervicectomy was done in 23 (65 per cent) cases; the abdominal route was employed in 12 cases. 7. 7. There was no satisfactory correlation between the Papanicolaou smears and cervical biopsies. This study shows that in the presence of signs or symptoms pertaining to the retained cervix, a cervical biopsy is imperative to establish the diagnosis. 8. 8. Chronic cervicitis with or without prolapse of the stump was found in 63 per cent of patients. There were 5 cases of cervical malignancy. Two patients had epidermoid carcinoma in situ; one patient had epidermoid carcinoma, Stage I. A fourth patient had an adenocarcinoma, Grade III. The fifth patient had a leiomyosarcoma of the cervix, but it was not a recurrence. The pathological diagnosis after hysterectomy was leiomyoma uteri. 9. 9. The most common postcervicectomy complications were those of the urinary bladder. 10. 10. The incidence of cervical malignancy in this series of 35 women with retained uterine cervices was 14.3 per cent. In this series, the incidence of carcinoma of the cervical stump was 11.4 per cent. Among the 322 patients treated for cervical carcinoma during the 10 year period, 1948–1957, there were 4 cases which developed in cervical stumps. This gives an incidence of 1.2 per cent for cervical stump carcinoma in this series.

MALIGNANT growths of the hypopharynx present an unusual number of difficult therapeutic problems. Practically all being surgically inoperable, radiation therapy in some form becomes, of necessity, the only means of treatment. While most growths in this location fall within the general group of epidermoid carcinomas, they nevertheless vary widely in histologic structure, a fact which calls for considerable variation in the method and intensity of irradiation therapy for the individual case. Fortunately, they are as a group rather more radiosensitive than growths of similar histology in the oral cavity. In spite of this, the hypopharynx offers its own peculiar set of complicating factors. Hypopharyngeal growths are at best technically difficult of access. Close observation in some patients is difficult and trying; consequently, there is interference with proper cleansing during treatment procedures. Satisfactory and complete palpation is usually impossible—and palpation is frequently of greater value than d...

This study is based on 70 specimens of cancer of the cervix uteri obtained by operation at the Johns Hopkins Hospital. In each instance biopsy material was available for comparison with the histology of the parent tumor. The object of this study is to ascertain to what extent the cytomorphology of the biopsy material reflects the histologic picture of the parent tumor in so far as the predominating type of cancer cell is concerned. In 43 specimens of transitional-cell cancer , study of the biopsy material revealed in 13 (30.2 per cent) instances a histologic picture that did not satisfactorily reflect the cytomorphology of the parent tumor. In 4 of these 13 specimens the biopsy material erroneously indicated a spindle-cell type of cancer and in the 9 remaining specimens it was impossible to define a predominant variety of cancer cell. In 6 specimens of spinal-cell cancer it was impossible from a study of the biopsy material to definitely determine the predominant type in 3 (50 per cent). In one of these the biopsy incorrectly indicated a transitional-cell cancer. There were 11 specimens of spindle-cell cancer available for study. In 4 of these (36.4 per cent of 11) the biopsy material did not indicate the predominant cell type of the parent tumor. In the group of cancers where the spinal- and trasitional-cell types occurred in about equal proportion it was found that the biopsy material in 4 (40 per cent) of the 10 specimens available for study did not bear out the findings in the parent tumor in that they indicated a predominance of transitional cells. Observations were made on the occurrence of epithelial pearls, mitoses, nucleoli and giant cells in both biopsy and parent tumor material.

Deoxyadenosine and uridine in millimolar concentrations inhibit reversibly the multiplication of herpes simplex virus in a human epidermoid carcinoma line of cells (H.Ep. No. 2) by blocking RNA synthesis. This emerges from the following: 1. (1) The nucleosides inhibit RNA synthesis as measured in pulse-labeling experiments. 2. (2) The nucleosides block the synthesis of thymidine kinase (ATP: thymidine 5′-phosphotransferase, EC 2.7.1.21), a virus-induced enzyme, when added to cell suspensions immediately after infection. The enzyme continues to be made if the cells are treated 4 h after infection, i.e., after the onset of synthesis of the enzyme. 3. (3) The nucleosides block the synthesis of viral DNA when added to cell suspensions immediately after infection; viral DNA synthesis is not appreciably affected if the nucleosides are added after 6 h, i.e., after the onset of viral DNA synthesis. 4. (4) The nucleosides block viral multiplication if added immediately after infection. Virus multiplication continues albeit the yield is reduced if the nucleosides are added at 6 h, i.e., after the onset of synthesis of viral DNA and viral capsid protein. 5. (5) The inhibition is reversed by withdrawing the nucleosides and not by addition of one or more of the ribose or deoxyribose nucleosides.

1. Variation of nuclear DNA content was studied quantitatively in the cervicovaginal epithelium of spayed C3H mice during chemical (benzpyrene) carcinogenesis. 2. The mean DNA content of basal nuclei in hyperkeratotic epithelium is higher than in normal diestrous epithelium but not significantly different from that of fully matured (estrous) squamous epithelium. The increase of the DNA value of the basal nuclei which follows carcinogenic treatment is a benzpyrene (estromimetic) effect correlated with increased cell activity. 3. The basal nuclei of dysplastic epithelium show hyperdiploid and hypotetraploid mean values. Compared with healthy, fully matured or hyperkeratotic epithelium, a significant increase of the DNA content of the nuclei is observed. 4. Basal elements of incipient, large, and transplanted squamous cell carcinoma have tetraploid or hypertetraploid mean DNA values. Their spread, as shown in the histograms, is characteristic of neoplastic tissues. 5. Keratinization of either normal or pathologic (and neoplastic) squamous epithelium is accompanied by the decrease of the nuclear DNA content. 6. During chemical carcinogenesis the DNA value of the squamous epithelium undergoes a progressive increase which parallels the histomorphologic degree of “severity” of the lesions. 7. Feulgen histophotometry is a valuable diagnostic tool.

Seven subungual epidermoid carcinomas (CA) and 4 subungual keratoacanthomas (KA) of the hand are reported, and the literature is reviewed. Subungual CA is a very slow-growing tumor that masquerades for years as a chronic infection, whereas subungual KA grows rapidly, is more destructive locally, and clinically appears to be a tumor of some type. The average age of patients with CA was 64, but only 49 for patients with KA. About two thirds of the CA demonstrated roentgenographic evidence of osseous involvement, whereas all cases of KA produced pressure erosion of the distal phalanges. Neither tumor metastasizes. KA might spontaneously resolve if permitted to run its natural course. The treatment of choice for CA is probably a conservative amputation and for KA, curettage.

Summary Primary or idiopathic hypertrophy of the pyloric muscle in the adult is a well established entity. Anatomically, a focal or localized form may be distinguished from the better documented and more frequently occurring circular or generalized type. A case of the former is presented, and an inclusive classification is proposed. The pertinent literature is briefly reviewed.

Carcinomas of the skin of the eyelids are frequently diagnosed in a relatively early stage; they may become serious therapeutic problems, however, depending upon the character and the adequacy of the treatment that is first instituted. Carefully planned curie therapy or a surgical excision and subsequent plastic repair are capable of controlling these tumors; but, while no greater certainty of control of the lesion is offered, the functional and esthetic results of such hazardous or elaborate procedures are far from comparable with those which are obtained by the judicious application of roentgen therapy. Incidence In the first six years of work, 1,343 consecutive basal-cell carcinomas, 439 epidermoid carcinomas, and 2 adenocarcinomas of the skin of the face, which had received no previous treatment, were observed in the Ellis Fischel State Cancer Hospital; 12 per cent of the basal-cell carcinomas and 1 per cent of the epidermoid carcinomas arose from the skin of the orbit. This report is based on 168 con...

Primary neoplasms rarely originate in the patella, and metastases to the patella are even less frequent. The latter is probably explained by the scant blood supply of this sesamoid bone. Carcinomatous synovitis of one knee was an early manifestation of pulmonary carcinoma in a 67-year-old man. This was associated with rapid, complete lysis of the patella; no other osseous metastases were evident. Il es rar que neoplasma primari occurre in le patella Metastases ad le patella es ancora minus frequente. Le secunde de iste constatationes se explica probabilemente per le magre provision de sanguine ad iste osso sesamoide. Synovitis carcinomatose de un genu esseva un del manifestationes precoce de carcinoma pulmonari in un masculo de 67 annos de etate. Isto esseva associate con le rapide e complete lyse del patella. Nulle altere metastases ossee esseva evidente.

An account of two cases of carcinoma in a pharyngeal pouch is followed by a review of the radiographic appearances of the condition. The differential diagnosis from food residues is discussed.