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Tumors classified as being of smooth muscle origin by light microscopy were studied with the electron microscope. Their ultrastructure verified the diagnosis in all of the seven leiomyomas but in only eight of the twelve (66 percent) tumors that were finally classified as leiomyosarcoma. The discrepancy of the light microscopic and ultrastructural findings in these four sarcomas may be due to sampling problems likely to be encountered in poorly differentiated tumors or simply the failure of development of specific ultrastructural features in the face of a characteristic growth pattern at the light microscopic level. Among other tumors that have been considered to be of smooth muscle origin--hemangiopericytoma, glomangioma, and cardiac myxoma--only the glomangioma showed ultrastructure features identical to those of smooth muscle.

In two of 182 patients with verified primary hyperparathyroidism, microscopical hyperplasia was present in all parathyroid glands that were normal in size or only slightly enlarged. All parathyroid glands in another two patients showed microscopical hyperplasia and varied from a normal size of 190 mg. In seven additional patients, microscopical hyperplasia was present in one, several, or all parathyroid glands, which varied in weight from normal to 350 mg. Familial hyperparathyroidism or multiple endocrine neoplasia was evident in five of 11 patients. Contributing to difficulties was the experience in five patients in whom removal of mildly enlarged parathyroid glands corrected hypercalcemia, but definite microscopical abnormalities were not evident by routine histologic study of the glands. Thus, there appears to be a spectrum of abnormalities relative to size and microscopical changes in parathyroid glands of patients with primary hyperparathyroidism. The surgeon should be aware of these patterns of parathyroid hyperplasia that require a search for a fifth parathyroid gland and a subtotal parathyroidectomy.

Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammorgraphy and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contraleteral bipsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process.

The peculiarities of the type of liver cirrhosis that occurs in patients with cystic fibrosis of the pancreas depend on a number of factors. Two such factors, which have received little attention in the past, became apparent during a study of the livers of patients dying of this disease at the Henry Ford Hospital, Detroit. Firstly, the onset of the disease in fetal life may disturb the development of the bile duct system whose normal development is essential for normal structural relationships to be maintained in the liver. Focal lesions of intrahepatic biliary atresia will then complicate the histologic picture of "multi-lobular biliary cirrhosis". Secondly, scars formed in an infantile liver will considerably distort the subsequent growth of the liver, resulting in bizarre nodularity. Despite massive deformation large portions of the liver will still be composed of primary parenchyma that will enable normal liver functions as revealed by laboratory tests.