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Vascular lesions in 21 women who died of thrombosis while taking various oral contraceptives and in 21 women who died of thrombosis but who had not taken the pill were examined. Routine histologic sections were available and 7 other special stains were prepared from tissues fixed in formalin. Three types of lesions developed in the pill group. First three-layered thrombi with underlying structural changes were found in 19 cases consisting of an organized revascularized basal layer with accumulated collagen and in some cases macrophages; a zone of fibrin with ingrown fibroblasts between and an unorganized laminated thrombus above. The underlying structures were thickened disrupted and filled with acid mucopolysaccharide. The second type of lesion present in smaller pulmonary vessels in 4 cases was proliferation of the endothelium and intima into a network of papillary projections. The third type of lesion was found in only one case: nodular thickening of the intima media and adventia of the pulmonary artery. These women all suffered from locally formed thrombi which developed over a period of days or weeks indicating primary changes in the blood vessels rather than emboli as the cause of death.

A series of nine tumors arising in the second portion of the duodenum has been presented. These tumors usually occurred in the fifth and sixth decades and clinically simulated peptic ulcer rather closely. Most of them were polypoid lesions not over 2.0 cm in diameter and were usually demonstrated on x-ray examination of the upper digestive tract. Histologic study invariably showed two elements to be present: one, a spindle cell component similar to the spindle cell portion of ganglioneuromas or neurofibromas; the second, and most often dominant element, nests of epithelioid cells indistinguishable from the Zellballen of nonchromaffin paragangliomas in more typical locations. Modified Bodian stains demonstrated a large number of neurites in the tumors and argyrophilia of many of the epithelioid cells similar to the findings reported in carotid body tumors and other paragangliomas. The histogenesis is considered, and our reasons for regarding these tumors as paragangliomas rather than ganglioneuromas or other suggested lesions are presented.

A clinical and pathologic analysis of 30 lipid cell tumors of the ovary shows that both adrenocortical-like and hilus-like cells are present in most instances and that attempts to separate them objectively into adrenal-like tumors, hilus cell tumors or stromal luteomas is often impossible. Inasmuch as there is no histogenetic basis for employing this terminology, such a separation is considered artificial and of no value in predicting either functional manifestations or clinical behavior. Therefore, lipid cell tumors are regarded as a specific entity and not a collection of different lesions. Lipid cell tumors are most often virilizing (77% of patients) and may be associated with Cushing's syndrome (10% of patients) or with evidence of estrogenic activity (23% of patients). Although these tumors usually are considered benign, six patients in this series died of recurrent or metastatic tumor. The clinically malignant lipid cell tumors tended to be larger than the benign ones, had involved contiguous pelvic structures at the time of operation in half of the cases, and occasionally exhibited sufficient cellular pleomorphism and mitotic activity to permit objective interpretation as malignant. On the basis of the authors' findings and the evidence available in the literature, the most likely origin of lipid cell tumors is from the specialized ovarian stromal cells within the medullary part of the ovaries.

The clinical and pathologic features of 26 neoplasms derived from gonadal stroma of hovine species were analyzed. Two types were identified-1 a typical granulosa tumor, the other having a Sertoli pattern. The 13 granulosa tumors occurred in adult animals, 2 of which exhibited nymphomania. Nine of the 13 had metastasized by the time of discovery. The Sertoli type of tumor also occurred in adult animals. Estrinizing effects were more common in these, as the endometrium had varying degrees of hyperplasia or thickening in 7 instances, and 1 animal had persistent estrus. None had spread beyond the ovary. The Sertoli type was thought to be more closely related to granulosa tumors than arrhenoblastomas because it was associated with estrinizing rather than virilizing effect, all of them lacked Leydig cells, some had overlapping microscopic patterns with granulosa tumors. and a Sertoli arrangement could be identified that was similar to areas in early graafian follicles and atretic follicles. They merit separation from granulosa tumors because of their distinctive histological pattern and because of their much more benign clinical behavior.

In 13 patients, a distinctive type of atypical polypoid endocervical hyperplasia was found. To our knowledge, this type of lesion has not been previously recognized. Such lesions have been observed [by us] with increasing frequency during the past two years and are important because they are sufficiently disturbing histologically to raise the question of carcinoma. Thus far, this variety of hyperplasia has been found only in women taking oral progestins, usually for purposes of contraception. Despite their resemblance to adenocarcinoma, the available data point to a benign interpretation. Whether these lesions are more than coincidentally related to use of oral progestins is unknown, but the association is striking and requires experimental evaluation of a possible relationship.

Benjamin, Ivy, Taylor, Herbert, and Spindler, James: Orbital and conjuctival involvement in multiple myeloma. Report of a case. Am J Clin Pathol 63: 811-817, 1975. Orbital and conjunctival involvement in multiple myeloma are rare. In most reported cases of multiple myeloma with orbital involvement proptosis has been the initial manifestation that has led to diagnosis of the disease. Our case represents and example of terminal involvement of the orbit and conjunctiva, causing proptosis. The minimal conjunctival changes were the first indication of neoplastic proliferation of plasma cells in this location and, presumably, the orbit.