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A unique benign clear cell tumor of the thyroid is described. The lesion was composed of swollen thyroid acinar cells distended by large membrane-bound vesicles. This picture was identical to the "balloon cell" change seen in nevi and melanomas. Only balloon cells with many relatively normal-appearing mitochondria but few membranous organelles were noted in all blocks of this tissue. On fine-needle aspiration biopsy smears, oncocytes and transitional cells with oncocytic and clear cell features were also observed. On the basis of the light and electron microscopic findings, the described vesicles are probably degenerative as in nevi and melanomas and are associated with membranous organelles. The observation of oncocytic areas indicates the strength of fine-needle aspiration biopsy as a sampling technique. There is no evidence that these vesicles are of mitochondrial origin as in some clear cell thyroid lesions. Clear cell lesions of the thyroid are a heterogeneous group and may be benign, malignant, or metastatic.

A case of epithelioid hemangioendothelioma of the anterior mediastinum in a 40-year-old woman is presented. It showed typical features described in such tumors, but in addition there were foci of osteoclast-like giant cells that were not previously reported in this lesion.

An elderly patient who had nephrotic syndrome for many years was found to have mesangial expansion and thickening of the glomerular capillary basement membranes (GBMs) on light microscopy. Electron microscopy (EM) showed tubular structures measuring 24 to 27 nm in the mesangium and the subepithelial areas. Congo red staining for amyloid was negative. This case represents another instance of congo red-negative amyloidosis-like glomerulopathy.

A case of null cell acute lymphoblastic leukemia (ALL) terminating in malignant histiocytosis (HMR) is discussed. The patient was a 22-year-old man who presented in January 1976 with ALL. Cell surface markers on the bone-marrow blasts showed that 1% formed rosettes with sheep erythrocytes (T cells) and 4% showed immunofluorescent staining for immunoglobulin; terminal transferase levels were elevated, confirming the diagnosis of null cell ALL. The patient was treated intensively with a combination of chemotherapy and cranial irradiation. One year after diagnosis, he was maintained in partial relapse (10-15% blasts). His terminal episode was characterized by pancytopenia. The bone marrow was replaced by malignant histiocytes. Cell surface membrane staining for cytophilic antibody was positive, whereas terminal transferase levels were in the range of nonlymphoid malignancies.

A peritoneal mesothelioma was induced by asbestos in a hamster, and was established in serial transfer to new hosts by injection of peritoneal effusion containing tumor cells. Biologically and histopathologically, this tumor is similar to its human counterpart. Three drugs were tested for efficacy using this model. Survival time was used as the only parameter of response and was compared with survival time of controls. Survival time increased 25 to 50% after short regimens of doxorubicin or 5-fluorouracil. Survival time increased up to 308% after long-continued treatments with cyclophosphamide. No cures were achieved.

The histochemical distribution and quantitative chemical and histochemical changes in acid phosphatase activity were studied in rat pituitary and thyroid glands in various phases of secretory activity. The histochemically determined enzyme activity paralleled hormonal secretion. This could be confirmed chemically for the thyroid. The acid phosphatase activity appeared to be localized in the Golgi apparatus in these organs.

A case is reported of metastatic basal cell carcinoma presenting with multiple neurologic deficits 20 months after excision of the primary lesion with good local control. Many features associated with the development of metastasis from basal cell carcinoma were not present in this case.

Case HistoryA 53-year-old man with chronic lung disease presented with fever. Physical examination revealed a nodular lesion of the forehead, said to have developed over 2 months It was ulcerated, measured 2 cm in diameter, and extended to but did not involve the cranial bone. Liver and bone scans showed multiple metastases. CA T scan of abdomen revealed retroperitoneal adenopath y. Another primary site was not found. The forehead lesion and a liver nodule were biopsied.

A solid glycogen-rich clear cell carcinoma of the breast is described. Its distinction from other breast tumors with a clear cell component is discussed. The previously reported example of glycogen-rich clear cell carcinoma of the breast and our case both were positive for estrogen receptors, and neither showed axillary nodal involvement or distant spread. It is suggested that glycogen-rich carcinoma may behave in a less aggressive fashion than either infiltrating ductal or lobular carcinoma of the breast.

Two primary neuroendocrine skin carcinomas, one bronchial carcinoma, and one typical medullary thyroid carcinoma have been shown by immunohistochemical and electron microscopy to contain two or more immunoreactive peptides as well as melanosomes and premelanosomes. Of the battery of antisera tested, somatostatin was the only material present in all four tumors; calcitonin and ACTH were present in three of the four neoplasms. Neurosecretory granules on the one hand and melanosomes on the other were more readily identifiable in separate cells. However, in at least 2 cases, individual cells were thought to contain both types of structures. Of the various explanations possible, we choose to interpret these tumors as complex neuroendocrine carcinomas comprising cellular populations capable of synchronous production of immunoreactive peptides and melanin. since melanocytes are members of the dispersed neuroendocrine (APUD) system, these observations may not appear entirely surprising. Note-worthy, however, is that melanin synthesis seemingly remains a synchronously available option to neoplastic neuroendocrine cell populations of possibly diverse histogenesis that are actively engaged in the production of multiple hormonal peptides. We consider that these phenomena represent yet another facet of neoplastic multidirectional differentiation. It is possible that the determination of immunoreactive peptides as "markers" may play a future role in the diagnosis, therapy, and prognosis of these and similar tumors and in the study of the dysplasias that may precede them.

Fibrous mesotheliomas of the scrotal sac are described. Similar tumors have been previously reported as fibromas and pseudofibromas and have been considered to be non-neoplastic, reactive, fibrous lesions. Ultrastructural evidence for a mesothelial origin for these tumors is presented. The value of ultrastructural study in the classification of tumors arising in or on mesothelial lined surfaces is stressed.

Seventy-seven patients with extensive small cell carcinoma of the lung were initially treated with the same combination chemotherapy consisting of cyclophosphamide and doxorubicin. All cases were retrospectively subdivided according to their histological subtype as proposed by the World Health Organization Lung Cancer Classification (WHO): the classic lymphocyte-like (oat cell), type 21 , and intermediate cell, type 22 . Type 21 has an objective response rate of 43% and type 22 a response rate of 23% . Analysis of the data revealed that the median survival for WHO type 21 was 30.4 weeks; whereas median survival for type 22 was 17.2 weeks (P = 0.04 ). This difference in subtype response was also seen when response was corrected for Karnofsky initial performance status 40–70 but not for performance status 80–100 . Type 21 small cell carcinoma appears to offer a higher response rate to chemotherapy and a longer survival than type 22 .

Endocardial tumors in the rat found in association with intrathoracic implantation of durable fibrous materials are reported here for the first time. In Osborne-Mendel female rats, endocardial tumors occurred in 3 of 50 rats associated with the implantation of fiberglass greater than 5 micron in length and 1-3 micron in diameter, in 1 of 15 rats associated with fiberglass of 0.03 X 3 micron, and in 1 of 15 rats associated with pulverized glass fiber. The intrathoracic administrations of pulverized chrysotile, of cigarette smoke condensate and crocidolite, and of coarse cotton lint, and of intravenous injections of air particulate extract were associated with endocardial tumor in 1 of 15 rats each. The dimensions of the durable fibers associated with endocardial tumors were similar to those of carcinogenic asbestos. Endocardial tumors were not observed in concurrently studied control rats.

A fibroproliferative lesion arising anterior to the lower end of the scapula and containing polymorphic often fiberlike deposits of weakly elastinophilic fibrillary material is described. It is compared on the light and ultrastructural level to a typical elastofibroma. The fibrillary material seen in this tumor strongly resembles that which surrounds the strongly elastinophilic deposits in the typical elastofibroma and from which the elastin is thought to be derived. It is concluded that elastin-producing tumors form a continuum; at one end of which lies the tumor we have designated pre-elastofibroma and at the other, the typical elastofibroma.

Kidneys of 27 consecutive autopsied patients with bronchogenic carcinoma without clinical renal disease were studied by electron microscopy and immuno-histochemistry for the presence of glomerular deposits. Two patients had subepithelial electron-dense deposits compatible with immune complexes but failed to stain histochemically for immunoglobu-lin; most cases (19 of 27). including the two with complexes, demonstrated subendothelial deposition of fibrin. No tissue samples had histochemically detectable immunoglobulin. From this study it is suggested that renal immune complexes in lung cancer are rare.

We have reviewed the clinical course and histologic findings in 84 patients with stage I and II squamous carcinoma of the mouth floor. We concluded that lesion thickness may offer a useful method for predicting the probability of cervical metastasis in node negative (N0) patients. Moreover, surface area of the lesion did not correlate with subsequent nodal disease, whereas thickness did. Elective node dissection appears to be strongly indicated in any patient with a N0 lesion measuring more than 1.5 mm in thickness.

ONE HUNDRED years ago Fizeau 1 first reported traumatic rupture of the common bile duct followed by jaundice. Subsequently this clinicopathologic entity was recognized as a syndrome characterized by an initial onset of shock of short duration followed by a symptom-free interval and gradual appearance of abdominal pain, vomiting, and jaundice. Although this syndrome is fairly characteristic and can occur after abdominal trauma in this mechanized age, it is rarely considered. Most of the reported cases were not clinically recognized and the patients succumbed to the bile peritonitis. This report concerns a fatal case of ruptured common bile duct, revealing at necropsy severe retroperitoneal bile seepage extending into the scrotum without evidence of bile peritonitis. Case Report A 49-year-old white male alcoholic was admitted for the first time to the Bronx Municipal Hospital Center on Feb 6, 1963, with complaints of swollen scrotum, anorexia, weight loss, and darkening of the

A case of hemorrhagic pericarditis as a systemic manifestation of rheumatoid arthritis is described which is apparently the second reported. Pericarditis is a frequent autopsy finding in rheumatoid arthritis. It represents a rare cause of death which developed in both instances following the withdrawal of steroids.

The tissue distribution of enzymatic activities in intestinal metaplasia stomachs exhibiting chronic gastritis was compared histochemically with that of the small intestine in man.

Cells with large, dark, clumped nucleus-like bodies are occasionally observed in routine vaginal cytologic preparations. They resemble tumor cells, but often on closer scrutiny are found to have thick cell walls like those of plant cells, and are identical to structures found in gum guar and lubricating jelly which contains gum guar. The composition of every product should be marked clearly on the container. Lubricating jellies which contain cellular material should not be used for cytologic preparations.

Reports of multiple and infraductal coarctations are appearing more frequently in the literature as interest in the treatment of cardiovascular disease grows. A case with 4 distinct coarctations is presented.

Granular cells resembling the cells of true myoblastoma have been observed in various sites of previous trauma (usually surgical). They may be differentiated from myoblastoma cells in routine light microscopic sections, with simple histochemical procedures, and with electron microscopic studies. The granules are dense bodies with acid phosphatase activity (lysosomes). Most cells resemble histiocytes, but some have a prominent endoplasmic reticulum and many mitochondria. Others have basement membranes, marked surface activity, a fibrillar system with condensations resembling that in smooth muscle, glycogen and desmosomal connections. These observations suggest their derivation from multipotential cells capable of forming either fibroblasts or smooth muscle cells.