ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS Production of Hepatic Tumors in White Rats by 3 : Kbenzpyrene, C

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ABSTRACTS EXPERIMENTAL STUDIES; ANIMAL TUMORS Production of Hepatic Tumors in White Rats by 3 : kBenzpyrene, C. OBERLING, P. GU~RIN,AND M. GUBRIN. La production de tumeur hkpatique par le 3-4 benzopyrhe chez le rat blanc, Compt. rend. SOC.de biol. 130: 417-419, 1939. Small fragments of 3 : 4-benzpyrene were implanted in the livers of 10 rats, 8 of which survived more than a year. Hepatic tumors developed in the injected regions in two rats. One tumor, in a rat which died in the sixteenth month, was a histiocytic sarcoma and was transplanted through five generations; the other, in a rat which died in the twenty-fifth month, was also a histiocytic sarcoma. L. FOULDS

Experimental Brain Tumors, M. ASKANAZY.Experimentelle Hirngeschwulste, Wien. klin. Wchnschr. 50: 816-822, 1937. Three observations on experimental intracranial tumors are recorded. Peritoneal sarconiata in the rat, elicited by intraperitoneal injections of benzpyrene in olive oil or beef suet, were transplantable in the brains of homologous animals. Intracerebra1 implantation in the rabbit of fetal tissue combined with inoculation of 0.25 C.C. of a 0.48 per cent solution of benzpyrene in olive oil, concurrently and twenty-two days later, was followed by development of a chondroma, measuring 5 x 6 mm., in the lateral ventricle in one animal that died eight weeks after the beginning of the experiment. A cerebellar chondroma, measuring 13 x 7 mm. with areas suggestive of chondrosarcoma, was observed in a second rabbit after eight months. The animal had received two injections within one month of 0.5 C.C. of benzpyrene alone (concentration not stated) in suet in the direction of the convexity to the base of the brain. Two photographs of transplanted cerebral sarcomata, and photomicrographs of secondary and primary experimental intracranial neoplasia are included. MILTONJ. EISEN

Induced Brain Tumors, 0. MARBURG.Zur Frage der kunstlichen Hirntumoren, Wien. klin. Wchnschr. 50: 1509-1511, 1937. Preliminary observations are recorded on the production of cerebral neoplasia in rabbits by a combination of injury and blockage of the reticulo-endothelial system with trypan blue. Animals in the first series received heavy blows on the skull over the cerebellum at the age of eight days. After an unspecified interval minimal proliferation developed in the subependymal zone. In a second series the point of a cautery was inserted into the brain substance. A small cyst was observed in the inferior horn of the lateral ventricle in one animal sacrificed after thirteen months. A portion of the cyst wall was bordered by a tumor-like proliferation of glial cells. Five photomicrographs are included. MILTONJ. EISEN

Further Observations on Filterable Tumours Induced in Fowls by Injection of Tar, J. MCINTOSHAND F. R. SELBIE. Brit. J. Exper. Path. 20: 49-63, 1939. McIntosh previously described the propagation of five sarcomas induced in fowls by injections of tar and the transmission of three of them by cell-free filtrates (Brit. J. Exper. Path. 14: 422, 1933. Abst. in Am. J. Cancer 21: 111, 1934). Five additional tumors induced by tar are now dkscribed; four were transmitted by tumor emulsions and two of these by cell-free filtrates. One of the primary tumors, a fibrosarcoma, gave rise only to leukemic tumors in the first transplanted generation; both leukemic and sarcomatous elements were present in the growths of the second generation and subsequently only sarcoma was found. A similar sequence of events was observed in a sub- strain of one of the tumors described in the earlier paper. The association of fowl 119 120 ABSTRACTS tumors with leukosis is attributed to the presence of two viruses, the result of transmission being dependent on their relative virulence and on the site of inoculation. The tumor agent can be carried in a leukemic lesion without producing a sarcoma. The behavior of induced tumors is variable; since other workers have propagated only a few chemically induced tumors, their failure to demonstrate cell-free transmission may be due to chance. The technic of transplantation may be important. Dilute emulsions of young, actively growing tumors should be injected into 10 to 20 chickens. It seems that these fowl tumors can be trained to require fewer cells for their transmission so that the filtrable agent takes a more active part. The consistent inactivity of Berke- feld filtrates of a few induced tumors may be due to variation in the relation of the virus to the tumor cells, to a decrease in virulence, to the presence of an inhibitory substance in the filtrates, or to the virus being too large to pass through Berkefeld filters. Active virus can be demonstrated in a large proportion of chemically induced tumors and it is concluded that tar-induced sarcomas of fowls are virus tumors and that the carcinogenic agents used for induction play no part in the subsequent malignant process. Photographs, photomicrographs, and references are included. L. FOULDS

Growth of Spontaneous Mouse Tumours and of Tumours Induced by 1 : 2 : 5 : 6- Dibenzanthracene, N. DOBROVOLSKA~A-ZAVADSKA~AAND I. NEKHOROCHEFF. Essai d’une dtude quantitative de la croissance de tumeurs spontanbes et de tumeurs provoqubes par le 1 : 2 : 5 : 6-dibenzanthradne chez la souris, Compt. rend, SOC.de biol. 130: 693-696, 1939. Forty spontaneous mouse tumors and ten sarcomas induced by dibenzanthracene were measured in three dimensions twice a week. The cube root of the product of three dimensions was plotted as ordinate against time as abscissa. A straight line throughout the period of observation was obtained for 29 tumors and a straight line terminating in a downward curve or abrupt fall, attributable to necrosis, ulceration, etc., for a further 15 tumors; irregular curves were obtained for 6 tumors. For the majority, therefore, the growth of the mean diameter per day was constant. The value of the constant, varying in different tumors, probably depended on histologic structure and localization and on the age of the host. The observed limits were 0.1-0.45 mm. per day for mammary adenocarcinomas and 0.24-0.77 for the sarcomas. L. FOULDS Effect of a Tar Pellet on the Gallbladder of the Rabbit, D. DONATI. Studio sul com- portamento della colecisti del coniglio in seguito alla introduzione di calcoli di catrame cancerigeno, Ann. ital. di. chir. 16: 41-52, 1937. Pellets of equal dimensions consisting of cement or cement and tar were introduced into the gallbladders of rabbits. In both instances a preliminary inflammatory reaction occurred after ten days and gradually subsided. Connective-tissue repair resulted. Tar pellets stimulated progressive hyperplastic changes in the mucosa after one month. At five months, when the experiment was concluded, the lesion suggested adenomatous proliferation, but the author found no evidence of malignant alteration, such as was recorded by Leitch (Brit. M. J. 2: 451, 1924) and others. The mucosal reaction in the control animals was slight. Photomicrographs are included. MILTONJ. EISEN The Photodynamic Activity of the Urine of Mice Treated with Blastogenic Hydrocarbons, J. C. MOTTRAM.Proc. Roy. SOC.London, ser. B 126: 560-566, 1939. It was reported previously that a number of carcinogenic agents make the skin of mice photosensitive and have a photodynamic action on protozoa (Nature 140: 933, 1937. Lancet 1: 1156, 1938. Absts. in Am. J. Cancer 32: 291,1938; 35: 280,1939). It is now recorded that mice to which carcinogenic hydrocarbons were administered se- creted a photodynamic substance in the urine; the substance was present for two days after painting benzpyrene on the skin and for at least a month after subcutaneous injection of benzpyrene in olive oil. Seventeen polycyclic compounds were administered to mice; the carcinogenic compounds caused the excretion of photodynamic substances but the non-carcinogenic compounds did not. The close correlation between blastogenic activity of the hydrocarbons and the presence of photodynamic substances in the urine EXPERIMENTAL STUDIES ; ANIMAL TUMORS 121 suggests that similar substances should be sought in the urine of cancer patients. The observations indicate that the blastogenic hydrocarbons are those which the tissues are able to convert into photodynamic derivatives, which are probably water-soluble oxidation products. L. FOULDS Effects Induced in Pregnant Rats by Injection of Chemically Pure Carcinogenic Agents, J. M. WOLFEAND W. R. BRYAN. Am. J. Cancer 36: 359-368, 1939. Daily subcutaneous injections of 1 : 2 : 5 : 6-dibenzanthracene, 3 : 4-benzpyrene, or 1 : 2-benzanthracene in rats, begun on the first day of pregnancy, caused profuse vaginal hemorrhage beginning on the tenth or twelfth day, having its origin in the lateral margin of the placenta. The uterine epithelium extending over the decidua reflexa was destroyed in most instances, resulting in a passage of blood into the uterine lumen. There were cessation of growth of the fetus and a progressive destruction and resorption of all fetal and placental tissue. This pathologic process was usually completed by the eighteenth day of pregnancy. Photomicrographs are included and four references are given. Variations in the Inhibitory Power of Carcinogenic Hydrocarbons according to Solvent, E. MORELLIAND A. DANSI. Nature 143: 1021, 1939. The inhibitory action of carcinogenic hydrocarbons on the growth of transplantable tumors (see Haddow: Nature 136: 868, 1935. Abst. in Am. J. Cancer 26: 620, 1936) has been studied. In the case of the Walker rat carcinoma, there is a total suppression of this inhibitory power when 3 : 4-benzpyrene is dissolved in fats obtained by extraction from rat tissues instead of in lard. A marked diminution in the inhibitory power occurs under similar circumstances with 1 : 2 : 5 : 6-dibenzanthracene. A. F. WATSON

Photo-oxides of Carcinogenic Hydrocarbons, J. W. COOK,R. MARTIN,AND E. M. F. ROE. Nature 143: 1020, 1939. Cook and his colleagues report the preparation of a number of photo-oxides of carcinogenic hydrocarbons. Oxygen was passed through a dilute solution of the hydrocarbon in carbon disulphide exposed to the light of a 200-watt gas-filled lamp. The solution was kept cool by immersion in a bath of running water. After about four hours the blue fluorescence had disappeared and the solvent was removed under reduced pressure in the dark. The resulting photo-oxide was crystallized from carbon disulphide. The melting points of the new compounds made available and the hydrocarbons from which they were obtained are as follows: Parent Hydrocarbon M.P. of Photo-oxide 9 : 10-dimethyl-1: 2-benzanthracene...... 193-194' C. 5 : 9 : 10-trimethyl-1 : 2-benzanthracene...... 212-213' C. 6 : 9 : 10-trimethyl-1 : 2-benzanthracene...... 205-206' C. 5 : 6 : 9 : 10-tetramethyl-1 : 2-benzanthracene...... 228-229' C. 9 : 10-dimethyl-1 : 2 : 5 : 6-dibenzanthracene...... 222-223' C.

Two of the parent hydrocarbons (6 : 9 : 10-trimethyl-1 : 2-benzanthracene, m.p. 157-158" C., and 5 : 6 : 9 : 10-tetramethyl-1 : 2-benzanthraceneI m.p. 132-133" C.) have not been described previously and details of their synthesis are promised in a future publication. It was found diffcult or impossible to isolate photo-oxides of 1 : 2 : 5 : 6-dibenzanthracene, 3 : 4-benzpyrene and 1 : 2-benzanthracene. The various,water-insoluble derivatives described have been made available in order to test the suggestion that oxides of this nature are intermediate products in carcinogenesis by the hydrocarbons, although it is admitted that lack of correlation between the carcinogenic activity of a compound and its ability to form a photo-oxide does not lend support to this view. The ultra-violet absorption spectrum of the photo-oxide of 9 : 10-dimethyl-1 : &- benzanthracene, the most rapidly acting carcinogenic hydrocarbon known, is described. A. F. WATSON 122 ABSTRACTS

Growth Substances and Carcinogenic Agents, E. BORST. Ueber Wuchsstoffe und kanzerogene Substanzen, Wien. klin. Wchnschr. 50: 1379-1383, 1937. General remarks on the action of the carcinogenic agents. MILTONJ. EISEN

Ultraviolet Rays and the Production of Tar Cancer, 0. TEUTSCHLAENDER.Bedarf der Teer zur Hautkrebserzeugung ultravioletter Strahlen? Klin. Wchnschr. 16: 1284- 1285, 1937. Ultraviolet Rays adthe Production of Tar Cancer, W. BUNGELER. Bedarf der Teer zur Hautkrebserzeugung ultravioletter Strahlen? Klin. Wchnschr. 16: 161 7-1618, 1937. Btingeler demonstrated the carcinogenic action of ultraviolet light in conjunction with subcutaneous injections of photosensitizing agents as tar, eosin, and hemato- porphyrin (Ztschr. f. Krebsforsch. 46: 130, 1937, Abst. in Am. J. Cancer 34: 277, 1938). When tar is applied locally to the skin of the mouse, however, Teutschlaender found no significant variation in tumor production in animals maintained under normal conditions, in total darkness, or exposed to the action of natural or artificial sunlight. Biingeler retorts that the critical remarksof Teutschlaender are not applicable to his experiments. The combined action of ultraviolet light and subcutaneous injections of small quantities of photosensitizing substances in carcinogenesis was studied, rather than local effects of tarring. [Rusch and Baumann (Am. J. Cancer 35: 55, 1939) have recently demonstrated the carcinogenic activity in mice of ultraviolet light alone,] MILTONJ. EISEN Attempted Modification of the Development of Mammary Adenocarcinoma in Mice by Thyrottopic Hormone, A. LACASSAGNE.Essai d’une hormone thyrbotrope en vue de modifier l’apparition de l’adho-carcinome mammaire chez la souris, Compt. rend. SOC.de biol. 130: 591-593, 1939. Five weekly injections of thyrotropic hormone into adult female mice of the RIII strain did not reduce the incidence of mammary cancers or delay their appearance. Similarly, five injections of the hormone into male and female mice aged fifteen days to one month, which received also an injection of estrone, had no effect on the development of mammary cancer. In these experiments, therefore, the antagonism between the action of thyrotropic hormone, and that of estrone, on the breast tissue, as recorded by Cramer and Horning (Lancet 1: 72, 1938. Abst. in Am. J. Cancer 33: 284, 1938) was not observed. L. FOULDS

Protective Action of the Ovary Against Tumor Production by Estradiol Benzoate, A. LIPSCHUTZAND L. VARGAS(FILS). Action protectrice de l’ovaire contre la tumorigenbse par le benzoate d’oestradiol, Compt. rend. SOC.de biol. 130: 596-599, 1939. The authors previously recorded the production of uterine and extra-uterine connective-tissue tumors in castrated female guinea-pigs by subcutaneous injections of estradiol benzoate (Compt. rend. SOC.de biol. 129: 519, 524, 810, 1938; 130: 9, 1939. Absts. in Am. J. Cancer 36: 123,461, 1939). During the first two months or longer, the production of tumors was found to be less constant and less intense in intact than in castrated animals. Subsequently the protective action of the ovaries ceased. L. FOULDS The Mammary Gland of the Rhesus Monkey under Normal and Experimental Condi- tions, S. J. FOLLEY,A. N. GUTHKELCHAND s. ZUCKERMAN.Proc, Roy. SOC.London, ser. B 126: 469-491, 1939. The authors record observations on the development of the mammary gland in normal monkeys and in monkeys injected with sex hormones. There was no histologic evidence of abnormal mammary growth in six monkeys which had received injections of estrone over periods of 365 to 938 days, the total dose varying from 23.01 to 287.8 mg. It is pointed out that longer periods, relative to the life span, are necessary for the produc- EXPERIMENTAL STUDIES; ANIMAL TUMORS 123

tion of mammary carcinoma in mice by injections of estrone and that it cannot be concluded that pathological mammary changes would not occur in monkeys after more prolonged periods of injection. Nevertheless, the authors feel that their results provide some reassurance regarding the possible dangers of estrogenic therapy in women. L. FOULDS

Influence of Colchicine on Experimental Rat Sarcomas, R. E. J. TEN SELDAMAND U.. SOETARSO.I>e werking van colchicine op enkele experimenteele rattensarcomen, Geneesk. tijdschr. v. Neder1.-Indig 78: 3187-3196, 1938. The effect of colchicine on the growth rate of rat sarcoma as evidenced by the number of mitotic figures was investigated. Some of the animals had grafted Cysticercus liver sarcomas, others primary benzpyrene sarcomas, and still others transplanted benzpyrenc . tumors. Some of the tumor strains were of rapid and others of slow growth. Of each type some small and some older and larger tumors were used. A biopsy was taken from one side of the neoplasm and 0.2 mg. of colchicine was then injected subcutaneously. Eight hours later a second biopsy was taken from the opposite side. The sections of each biopsy were examined microscopically and the average number of mitotic figures per oil immersion field was ascertained, 60 fields being counted in each. The growth factor for each tumor was computed by dividing the number per field in the second biopsy by the number in the first. For some unknown reason the first 12 animals used died within twenty-four hours and there was no significant difference in the number of mitoses. Fresh colchicine was then obtained and there was no further trouble. Twenty-six animals were used and in many instances there was a greatly increased number of mitoses after the injection of colchicine. The growth indices varied from 1.27 to 7.01, the majority being between 3 and 6. The figure was about twice as high in the rapidly growing tumors as in the more slowly growing ones, and was twice as high for the small earlier tumors as for the older and larger ones. According to these results the colchicine method of stimulation should not be applied in human cancer. [Nevertheless, the action of colchicine is not prolonged and in the hands of others it has not produced a gross increase in growth rate of animal tumors.-E~.] Several tables and four photomicrographs are included. EDWARDHERBERT

Effect of Ascorbic Acid upon the Hemorrhage Produced by Bacterial Filtrate in Trans-

, planted Tumors, H. R. ANDERVONTAND M. B. SHIMKIN.Am. J. Cancer 36: 451- 459, 1939. Ascorbic acid was found to prevent the appearance of hemorrhage and resultant regression of transplanted tumors treated with bacterial filtrate. The reaction between the ascorbic acid and the filtrate was proportional to the amounts used. It was independent of the route of injection and of the pH of the ascorbic acid but was apparently related to its reducing power. It is postulated that bacterial filtrate, by lowering sud- denly the ascorbic acid content of the tumor, weakens its fragile capillaries, with resultant hemorrhagic extravasation. References are furnished.

Effects of a Lipoid Antigen on the Brown-Pearce Rabbit Carcinoma, J. ;TEFL. Uber die Wirkung eines Lipoid-Antigens auf das Brown-Pearcsche Kaninchencarcinom, Klin. U'chnschr. 16: 1501-1503, 1937. i Lipoid Antigens in the Treatment of Tumors, P. RONDONI. Zur Frage der Lipoid- Antigene bei der Tumorbehandlung, Klin. Wchnschr. 16: 1818, 1937. Group lipoid antibodies may be produced in an animal by parenteral administration of a mixture of lipoid and heterologous proteins. Injection in rabbits of an antigen consisting of vitamin D in oil and bovine serum albumin inhibited the development of the Brown-Pearce carcinoma. Progressive generalized tumor growth occurred in only 2 of 9 animals receiving two or three injections of 0.3 to 1 C.C. of the antigenic mixture subcutaneously, beginning one to three weeks after transplantation, in contrast to extensive fatal neoplastic disease in all 8 controls. An :iltenil)t is made to associatc I lit' apparent immunity to a transplantable tumor produced by the combined lipuid-protein 124 ABSTRACTS antigen and a hypothetical sterol nature of the unknown agent of cancer, based upon the accepted structural relationship of the carcinogenic hydrocarbons to the sterols. Earlier observations by Rondoni (Ztschr. f. Immunitatsforsch. 49: 91, 1926) are recalled, stressing the possible r61e of physico-chemical changes in the cell lipoids in the etiology of cancer. Auto-lipoid antibodies or changes in the lipoid metabolism of cells produced in rabbits by the injection of a combination of homologous organ lipoids and hog serum exerted an inhibiting effect on the reaction of the ear to tar, MILTONJ. EISEN Neoplasm Studies. V. The Effect of Carbohydrate on the Accumulation of Granulo- cytes in Various Mouse Tumors, R. CHAMBERSAND C. G. GRAND. Am. J. Cancer 36: 369-382, 1939. The injection into a tumor of substances, such as starch and cellulose, which are 1)o”itively chernotactic to blood granulocytes may cause an extensive accumulation of granulocytes and a consequent widespread necrosis involving the entire tumor. The percentage of complete regression for the more rapidly growing transplantable tumors (sarcoiiia 180 and carcinoma 63) was about 40 per cent. For the more slowly growing spontaneous and methylcholanthrene-induced tumors it was somewhat higher, Tumors which did not regress showed either no accumulation of granulocytes or a restricted accumulation walled off by a fibrous capsule. Areas of spontaneous necrosis showed no attraction for granulocytes either iiz vivo or in vitro. Photomicrographs are reproduced and references are appended.

Radioactive Phosphorus as an Indicator of Phospholipid Metabolism. VI. The Phos- pholipid Metabolism of Neoplastic Tissues (Mammary Carcinoma, Lymphoma, Lymphosarcoma, Sarcoma 180), H. 13. JONES, I. L. CHAIKOPF,AND J. H. LAWRENCE. J. Biol. Chem. 128: 631-644, 1939. Chaikoff and his colleagues have previously (J. Biol. Chem. 122: 169, 1937-38; 126: 493, 1938; 127: 211, 1939) described a method of using radio-active phosphorus for determining the phospholipid turn-over of tissues. In continuation of these studies bimilar measurements have been niade for four mouse tumors-a mammary carcinoma, a lymphoma, a lymphosarconia, and sarcoma 180. The following conclusions were reached. (1) The phospholipid metabolism of the four tumors was not uniform either in height or type of activity. (2) Cell type is not the factor determining the level of the phospholipid activity in a tumor. (3) Judging by the speed with which labeled phospholipid is deposited after the injection of Pa2, the phospholipid turnover of tumors bears a greater resemblance to that of the more active tissues, such as liver, kidney, and intestine, than to that of less active tissues like muscle or brain. (4) The phospholipid content of the liver is depressed when large tumors are present in mice, particularly during the early period following the P32administration. The phospholipid activity of the liver in normal as well as in tumor-bearing mice is several times greater than the highest activity observed in tumors. A. F. \?’ATSON

Intracutaneous Immunization against Experimental Carcinoma of the Stomach, A. BESREDKAAND I,. GROSS. l?pithblionia expbriinental de I’estomac. Imniunisation par voie intracutanke, Ann. Inst. Pasteur 62: 253-259, 1939. Implantation of the Brown-Pearce rabbit tumor directly into the wall of the stomach ~w~ducedlocal tumors in 31 out of 32 normal rabbits and in 1 out of 15 rabbits in which tumors produced by intracutaneous inoculation had regressed. [The title of this paper is grossly misleading. It is an abuse of terms to describe Ihown-Pearce tumor growing in the stomach as a carcinoma of the stomach. The authors have shown that rabbits in which intracutaneous Brown-Pearce tumors have regressed are resistant to subsequent implantation of the same tumor in the stomach or elsewhere, an observation which is not new in principle. Fewer papers of this kind would he published if intending authors would first make a diligent study of Woglom’s critical review of resistance to transplantable tumors in Cancer Review 4: 129, 1929.1 I,. FOULUS EXPERIMENTAL STUDIES ; ANIMAL TUMORS 125

Chemotherapy and the Cancer Problem, M. OESTERLIN. Zusamrnenhange in der Chemotherapie im Hinblick auf das Carcinom-Problem, Klin. Wchnschr. 16: 1598- 1601, 1937. Chemical and biological relationships were detected between trypanocidal quinoline derivatives, which are effective against T. brucei, the causative agent of nagana, and the carcinogenic hydrocarbons. Active quinoline derivatives generally present a green fluorescence. When injected intravenously in animals with trypanosomiasis, they are absorbed by the nucleus and blepharoplast of the parasite. Fluorescence, however, appears only in the blepharoplast, as a result of an augmentation of the lactic acid content in this region. When quinoline compounds are injected into mice with the Ehrlich ascites cancer, the proliferative capacity and lactic acid content of the neoplastic fluid are increased. The carcinogenic polycyclic hydrocarbons present a bluish or violet fluorescence in ultraviolet light and were found by the author to possess a specific affinity for T.brucei, exerting subsequently a destructive action on the agent of nagana. [Sarcoma production in mice by a moderately trypanicidal compound, styryl 430, presenting a reddish fluorescence, has been reported by Browning, Gulbransen and Niven (J. Path. & Hact. 42: 155, 1936. Abst. in Am. J. Cancer 28: 151, 1936).] MILTONJ. EISEN

Can Terrestrial Rays Produce Cancer? 11. H. BEITZKE. Konnen durch Erdstrahlen Krebse erzeugt werden? 2. Mitteilung, Wien. klin. Wchnschr. 50: 26-29, 1937. Beitzke, on the basis of his previous observations on mice exposed to the action of terrestrial rays, denied completely their supposed carcinogenic activity (Wien. klin. Wchnschr. 48: 959, 1935. Abst. in Am. J. Cancer 25: 666, 1935). An additional' experiment is now reported purporting to support the contention of some investigators regarding the importance of the rays. One half of a group of 450 white market mice were placed in the path of active rays. There were three essential differences from the earlier studies: 85 per cent of the animals were females in contrast to a previous equal division of sexes; they were placed directly on the zinc bottoms of the cages to obviate a possible insulating action of bedding material; the ground wires from the cages were soldered to water pipes instead of being attached, as formerly, to the heating system of the laboratory. One half of the mice were protected from the rays and served as controls. An unspecified number of animals died during the period of observation. Breast cancer developed in 13 animals under the influence of terrestrial rays for a period of fifteen and a half months, and in 3 controls. [It is not stated clearly at what age the tumors were observed, in which group the earliest tumor occurred, or whether this appeared after four weeks or in the fourth month of the experiment.] Leukemia was observed in 7 of 145 exposed animals that died during a three-month period when special care was exercised in detecting changes in the hematopoietic system. The occurrence of this complication in control mice is not mentioned. The paper is accompanied by a photograph of a tumor mouse and 2 photomicrographs. [Miescher and Schaaf (Schweiz. med. Wchnschr. 17: 1286, 1936. Abst. in Am. J. Cancer 34: 592, 1938) found terrestrial rays to be without effect on the incidence of skin tumors in mice subjected to the action of tar.] MILTONJ. EISEN

Genetics of Non-epithelial Tumor Formation in Mice, C. C. LITTLE,W. S. MURRAY,AND A. M. CLOUDMAN. Am. J. Cancer 36: 431-450, 1939. This study is based upon 343 non-epithelial tumors occurring in 2247 mice of 2 inbred strains (dba and (2.57 black) and their F1 and F2hybrids. The genetics of non- epithelial tumor formation was found to differ from that of mammary tumors. No simple mendelian phenomena were discernible, and the authors conclude that if any type of mendelism is involved, it must include multiple factors and a strong influence of the internal environment. There would seem to be an equal influence of the male and female parent in determining the incidence and location of non-epithelial tumors among hybrids. In the type of tissue and cell affected there is a slight indication of a greater maternal influence. The hybrids showed an increase of uterine sarcomas and non-epithelial mammary 126 ABSTRACTS tumors as compared with either parent race, which suggests the possibility that endocrine imbalance may be an important etiologic factor in these neoplasms. References are appended.

Occurrence of Lpnphosarcoma in Rats, C. S. MCEUEN. Am. J. Cancer 36: 383-385, 1939. A lymphosarcoma apparently originating in the ileocecal lymph nodes, metastasiz- ing readily, and rapidly killing its host, is described. Photographs of the primary growth and metastatic deposits and a photomicrograph are included.

THE CANCER CELL

Origin of the Cancer Cell by a Process of “ Cancerization of Normal Cells,” J. LART- SCHNEIDER, Krebszelle, ihre Entstehung durch ‘I Kanzerisation der Nornialzelle,” Wien. klin. Wchnschr. 50: 1734-1735, 1937. General remarks on the histogenesis of cancer cells. MILTONJ. EISEN

CLINICAL AN D LABORATORY OBSERVATIONS ; MISCELLANEOUS CASE REPORTS Constitutional Significance of Senile Warts in the Origin of Cancer, C. H. BEEK. uber die konstitutions-pathologische Bedeutung der senilen Warzen fur die Krebsent- stehung, Klin. Wchnschr. 16: 1581-1583, 1937. Ra16 and Korpkssy in a monograph entitled Warzen, Papilloma und Krebs (J. A. Barth, Leipzig, 1936) express the opinion that a statistical relationship exists between the incidence of senile warts and neoplastic disease. According to these writers, although malignant alteration in warts rarely occurs, their presence appears to denote a constitutional predisposition to epithelial proliferation as manifested by a tendency to the development of cancer, leukoplakia of the esophagus, and intestinal polyps. Beek calls attention to the fact that whereas the incidence of cancer is greater in individuals with senile warts than in those without senile warts, the difference in percentage is not statistically significant, and therefore could not be accepted as proof that the conditions are associated. The number of cases of senile warts and polyps of the colon is too small for adequate statistical analysis. Senile warts, leukoplakia of the esophagus, and cancer all increase in frequency with age. Hence the relationship of these conditions is an apparent one. After the age of fifty-five to sixty-five, when the increase in incidence of each condition is less pronounced, no significant difference in the number of cases of cancer or leukoplakia was observed in persons with or without senile warts. MILTONJ. EISEN

Trauma and Malignant Disease, G. MYLIUS. Unfallwirkung und bosartiges Gesch- wulstwachstum, Monatschr. f. Unfallh. 43: 545-560, 1936. Eighteen cases of cancer are described in which a relationship to trauma was claimed by the patient. The series included 4 cases of bone sarcoma, 2 cases each of cancer of the stomach, bronchial cancer, and cancer of the breast, and one each of the following: neurogenic sarcoma, sarcoma of the soft tissues of the thigh, sarcoma of the prostate, osteitis fibrosa (erroneously diagnosed as sarcoma on superficial evidence), cancer of the head of the pancreas, cancer of the rectum, malignant epithelial tumor of the base of the brain, a malignant tumor of the testicle. The injury in most cases was due to a blow or to a fall. Careful inquiry failed to reveal evidence of an etiologic relationship to the malignant tumors, but in the following cases the possibility of an accelerating influence on the rate of tumor growth was admitted: cancer of the stomach and of the head of the pancreas, the neurogenic sarcoma, and the sarcoma of the soft tissues. MILTONJ. EISEN GENERAL CLINICAL AND LABORATORY OBSERVATIONS 127

Blood and Serum Cholesterin in .Normal Persons and in Cancer Patients of Different Age Groups, 0. BOKELMANNAND 0. M~HLEOCK.Untersuchungen iiber den Chol- esteringehalt des Blutes und Serums bei Gesunden und Krebskranken verschiedener Altersklassen, Klin. Wchnschr. 16: 854-856, 1937. X comparison of the cholesterin content of the serum and whole blood of 92 patients with cancer of the cervix and 150 normal female subjects is recorded. The free and esterified form was diminished in the serum of patients between forty and seventy years of age, with advanced cancer. The total cholesterin averaged 192 to 232 mg. per cent in cancer, as compared to 218 to 260 mg. per cent in normal controls. No change was observed in the values in whole blood. Patients between twenty and forty yeais of age with malignant disease had normal serum cholesterin. MILTONj. EISEN

Immunological Studies of Tuberculous Caseous Material, Pus, and Cancer, I,. HIRSZ- FELD AND W. HALBER. Beitrage zur Immunbiologie des tuberkulosen Kases, des Eiters und des Krebses, Klin. Wchnschr. 16: 878-882, 1937. Non-specific antigenic substances were demonstrable in tuberculous caseous necrosis of human or animal origin, purulent matter, necrotic tissue. of infarcts of the spleen and kidney, and various types of human carcinoma, by group tests for complement fixation and precipitin antibodies in immu'ne sera produced in rabbits by intravenous injection of saline or alcoholic extracts of the above materials. The absence of organ and species specificity is thus associated with a constitutional specificity of tissue in which necrobiotic or regressive changes either predominate or form an essential part of the pathological process. MILTONj. EISEN

Rble of Tumors in the Regulation of Biologic Phenomena, T. v. VEREEBLY. Die Rolle der Geschwiilste in der Regelung der Lebensvorgange, Wien. klin. Wchnschr. 50: 847-852, 1937. A general discussion on the biologic manifestations produced by certain functioning tumors of the sex glands and glands of internal secretion. MILTONJ. EISEN

Tumors of the Base of the Skull, P. M. VAN WULPFTENPALTHE. Tumoren aan de schedelbasis, Geneesk. tijds. v. Neder1.-Indie, 78: 3196-3204, 1938. Also in Nederl. tijdschr. v. geneesk. 82: 5366-5371, 1938. Three cases are reported. The first patient was a man forty-five years of age with a squamous-cell epithelioma of the left middle ear which extended along the base of the skull and destroyed all the left cranial nerves except the first and second. The second was a woman of forty-five with evidence of cranial nerve involvement. No tumor was found and on the basis of a positive Wassermann reaction antisyphilitic treatment was given. Eighteen months later a small tumor was discovered high up in the nasopharynx. In the third case, in a woman of fifty-three, the diagnosis was made on the basis of signs referable to the sixth, fifth and eighth nerves and radiographic evidence of bone destruction at the base of the skull. A careful search revealed no tumor. Three photomicrographs, a drawing, and several references are given. EDWARDHERBERT, JR.

Contribution to the Pathology of Fascia and Associated Tissues, G. W. GUNTHER. Zur Pathologie der Faszien und der ihnen verwandten Gewebe, Beitr. z. klin. Chir. 166: 32-41, 1937. A case is recorded of a fibroma or fibrosarcoma of low-grade malignancy occupying the inferior and medial surface of the right foot in a man of thirty-four years. The mass was first observed at the age of ten years and attained its present dimensions slowly in succeeding years. Roentgen therapy was without effect. The involved foot was amputated. The tumor appeared to be intimately associated with the plantar fascia, but did not invade the surrounding tissues. It contained numerous areas of liquefaction necrosis, hyalinization, and calcification. A photograph of the gross specimen, 2 roentgenograms, and photomicrographs are reproduced. MILTONJ. EISEN 128 ABSTRACTS

Multiple Abdominal Tumors, G. W. LAUENSTEIN.Ueber einen Fall von eigenartigen multiplen Bauchtumoren, Zentralbl. f. allg. Path. u. path. Anat. 67: 305-308, 1937. A seventy-eight-year-old woman died ten days after laparotomy and construction of an artificial anus for the relief of intestinal obstruction secondary to an adenocarcinoma in the left flexure of the colon. The tumor contained areas of mucinous degeneration. There were metastases on the serosa of the large bowel chiefly localized in the appendices epiploicae, on the parietal peritoneum, and in the liver. Two photomicrographs are included. MILTONJ. EISEN Symptomatic Steatorrhea Associated with Diffuse Carcinomatosis and with the Puer- perium, E. LUNDSTEEN.Symptomatisk steatorrhoea ved carcinosis diffusa og puerperium, Hospitalstid. 80: 698-706, 1937. Two cases are reported of idiopathic steatorrhea or non-tropical sprue. In one a carcinoma of the small intestine was found at autopsy, with widespread metastases along the intestinal lymphatics. The question is raised whether the absorption of fat was interfered with by the plugging of the intestinal lymph channels with tumor tissue. In the case occurring during the puerperium no tumor was present. EDWARDHERBERT, JR.

Sacrococcygeal Tumour Obstructing the Birth-canal, A. NAYLOR. Lancet 2: 1059, 1938. A cyst 3 cm. in diameter lying between the sacrum and rectum was removed from a woman aged twenty-five. It was discovered during pregnancy and necessitated cesarean section. Histologic examination showed a lining of epidermis and much intramural hemorrhage and chronic inflammation. Id. FOULDS

DIAGNOSIS AND TREATMENT Similarity of Specific Serological Properties in Urine and Blood from Patients with Cancer, Tuberculosis, and Syphilis, M. ARON. Similitude de I’existence de pro- priCtCs sphcifiques de I’urine et du sang, demonstrables par la meme methode sCro- logique, chez les canchreux, les tuberculeux et les syphilitiques, Compt. rend. Soc. de biol. 129: 229-230, 1938. In numerous publications (e.g. Compt. rend. SOC.de biol. 124: 370,373, 1937. Abst. in Am. J. Cancer 31: 511, 1937) the author has described a flocculation reaction which occurs when an extract of urine from cancer patients is mixed with serum of cancer patients. A similar reaction was carried out using extracts of urine obtained from tuberculous patients; positive reactions were obtained with 73 out of 84 tuberculous sera and in 3 out of 84 sera from patients with diseases other than tuberculosis. Comparable results were obtained with sera and urinary extracts from syphilitic patients. L. FOULDS

Fuchs Carcinoma Reaction, B. SNELLMANAND B. EBENIUS. Resultate mit der Fuchs- schen Carcinomreaktion, Klin. Wchnschr. 16: 464-465, 1937. Despite unfavorable reports of numerous investigators who have attempted to utilize the Fuchs reaction in the diagnosis of cancer, Snellman and Ebenius find the test to be of value. In 68 cases of malignant disease, it was positive in 62 and negative in 6, while of 17 non-cancer patients 16 reacted negatively and only 1 positively. MILTONJ. EISEN

The Three-phase Modified Bendien Reaction, C. H. G. PRICE. Brit. M. J. 1: 551-554, 1939. Cronin Lowe’s “ three‘phase ” modification of the Bendien reaction (see Absts. in Am. J. Cancer 18: 419, 1933; 19: 879, 1933; 23: 612, 1935; 24: 425, 1935) was applied to blood from 427 patients about three-quarters of whom had malignant disease. Almost all the tests were carried out without knowledge of the clinical diagnosis. The serological diagnosis agreed with the clinical diagnosis in 55.5 per cent. The most favor- DIAGNOSIS AND TREATMENT 129 able results were obtained in 66 cases of carcinoma of the breast, of which 60 per cent gave a positive reaction. By comparison, among 99 cases of non-malignant disease there were positive reactions in 42 per cent. Analysis of the results suggested that the numbers of positive and negative results approach equality as the total number of tests increases; that is, the association of a positive reaction with malignant disease is a matter of chance. A number of cases were followed for six months after the last blood test. The author concludes that “ the test is of no value whatever either in the diagnosis of malignant disease or in the control of treatment or prognosis in that condition. The test in my hands has shown itself to be entirely unreliable.” Some experiments on the mechanism of the reaction are described. The basic processes of the three-phase test do not serve as an index of any particular property of blood serum or serve to measure any specific constituent; the test is entirely empirical. L. FOULDS

Ninhydrin Serum Reaction for Cancer, 0. WEISS. Erfahrungen mit Ninhydrin zum Krebsnachweis im Serum, Wien. klin. Wchnschr. 50: 1416-1417, 1937. The Lehmann-Facius ninhydrin serum reaction was positive in 148 (83 per cent) of 178 cases of malignant disease and negative in 208 (86.3 per cent) of 241 control subjects. [Tantini (Sperimentale, Arch. di biol. 90: 476, 1936) previously found the test completely valueless for the diagnosis of cancer.] MILTONJ. EISEN

Clinical Experiences with Freund’s Methods of Cancer Diagnosis and Dietetic Therapy, J. KRETZ. Ueber klinische Erfahrungen mit der Freundschen Krebsdiagnostik und Diattherapie, Wien. klin. Wchnschr. 50: 1102-1104, 1937. The various methods of cancer diagnosis devised by Freund and Kaminer were positive in 123 (91.1 per cent) of 135 cases of cancer and negative in 1103 (84.9 per cent) of 1299 subjects free from neoplastic disease. A general discussion is appended on the value of the dietetic measures suggested by Freund in the treatment of cancer, such as a high-protein and low-sugar diet, vegetable fats, abstinence from fermentative foods and animal fats, and intestinal disinfection, but no statistics of cures are furnished. MILTONJ. EISEN

Results with the Freud-Kaminer Cancer Reaction, M. PLONSKIERAND R. CYTERMAN- KON. Unsere Erfahrungen mit der Freund-Kaminerschen Krebsreaktion, Wien. klin. Wchnschr. 50: 1526-1528, 1937. The Freund-Kaminer test for the presence of a protective substance for cancer cells in the feces in cases of malignant disease was positive in 139 (86.4 per cent) of 161 patients with carcinoma and in 25 (58.2 per cent) of 43 patients with sarcoma. It was negative in 30 (88.3 per cent) of 34 patients with benign tumors and in 214 (86.7 per cent) of 247 subjects free from neoplasia. MILTONJ. EISEN

General Treatment of Cancer, E. FREUND.Die Stoffwechseltherapie des Karzinoms, Wien. klin. Wchnschr. 50: 541-542, 1937. This paper is a reiteration of Freund’s doctrines on the diagnosis of cancer by means of the cytolytic reaction, and on the importance of specific dietetic measures in treatment. MILTONJ. EISEN

Criteria of General Treatment of Cancer, M. REISS. uber einige bei der Ausarbeitung interner Krebsbehandlungsmethoden in Betracht zu ziehende Kriterien, Klin. Wchnschr. 16: 231-233, 1937. A general discussion on the importance of hormonal balance and changes in oxygen metabolism in the treatment of neoplastic disease. MILTONJ. EISEN 130 ABSTRACTS

Cause of Cancer and the Possibility of Therapeutic Action of Oxygen Acceptors, A. M~LLER.Ueber die Ursachen der Krebskrankheit und die eventuelle Maglichkeit der Krebsbektimpfung mit Sauerstoff-Akzeptoren, Wien. klin. Wchnschr. SO: 1614- 1617, 1937. On the assumption that carcinogenic agents are formed in the body by a process of dehydrogenation of sterols, the author suggests the possibility of utilizing chemical compounds acting as oxygen acceptors and hydrogen donators (specifically the ally1 sulphide group) in the therapy of cancer. These compounds, theoretically, would prevent the formation of carcinogens by reacting with the unknown substances involved in the dehydrogenation of the sterols. A bibliography is included. MILTONJ. EISEN

The Trend in Radiotherapy of Cancer, F. C. WOOD. Radiology 30: 52-56, 1938. Among the more important trends in the roentgen therapy of cancer pointed out in this paper are the use of the protracted fractional method developed by Coutard under the direction of Regaud and the use of higher voltages, which reduce back-scatter from the tissues to the skin. With these higher voltages-800 to 1000 kv.-the clinical results are apparently equivalent to those of radium, with the additional advantage that, owing to the approximately parallel beam obtained by the use of a long skin-focus distance of from 100 to 150 cm., such as is possible with the higher voltages of x-rays, the depth dose at 10 cm. with moderate portals may be 50 or 60 per cent of the impinging radiation, whereas with the radium pack it is not more than 25 per cent of the impinging dose measured in air. Electrical engineering improvements in x-ray apparatus have in late years made available these higher voltages at a fairly moderate cost, so that they are to some extent replacing radium, but this may be offset as a result of recent development in experimental physics which point to the possibility of the production of vast quantities of radio-active material by the relatively simple procedure of breaking up the atom of various substances by impacts with heavy hydrogen atoms. Already Prof. Ernest 0. Lawrence of the University of California is working with energies equivalent to about 6,000,000volts and has produced approximately one kilo of radio-active sodium. If energies equivalent to 20,000,000volts can be produced there is no theoretical reason why the long-life radio-active substances cannot be made. LIT' are, in other words, within striking distance of the production of radium by the radiation of uranium. References are appended.

Dosage, Length of Treatment, and Reactions with Protracted Fractional Roentgen Therapy, J. JUUL. Dosis, behandlingstid og reaktioner ved protraheret, fraktioneret R$ntgenbehandling. Hospitalstid. 80: Dansk radiol. selsk. forh. 2633, 1937. This paper is based on 121 cases of carcinoma of the hypopharynx, nasopharynx, tonsils, base of the tongue, and larynx treated by roentgen therapy at the Radium Center in Copenhagen between 1931 and 1934. Thirty-one per cent of the patients became symptom-free after treatment, but late results are not given. By plotting the cases with successful results on a graph with total dosage in roentgens as ordinate and length of treatment in days as qbscissa, it was found that 88 per cent fell within two parallel oblique lines. A computation of the average showed that the total dose was increased by 90 Y for each day that the treatment was prolonged. When tlic unsuccessful cases were similarly plotted, only 42 per cent were within the same oblique lines, and 54 per cent fell below the lower line. A curve of the cases plotted with the average daily dose as ordinate and length of treatment as abscissa, showed a rapid drop at first, but became more and more horizontal approaching the level of 90 Y, but never going below it. It has been found empirically that the skin damage caused by radiation tends to regress at a rate of from 6 to 7 per cent per day, and that the similar regeneration of c:ucinoma tissue averages 4 per cent per day. Thus it would seem, logically, that the more prolonged the treatment, provided that it still falls in the area of effective destruction uf the tumor, the less severe would be the ultimate damage to the skin. DIAGNOSIS AND TREATMENT 131

Juul believes that the severe skin reaction to radiotherapy is not due primarily to a direct action on the epithelium, but that the epithelial changes are a result of an exuda- tive reaction of the underlying blood vessels and connective tissue causing epithelial exfoliation. Four graphs and a table are included. EDWARDHERBERT, JR.

Method in Rabiotherapy, A. U. DESJARDINS.Radiology 30: 57-61, 1938. In the present stage of radiotherapy the emphasis is too frequently placed on dosage and on the penetrating power of the rays, with neglect of the method or scheme of irradiation which is equally and sometimes even more important. By method or scheme of irradiation is meant the arrangement of the treatment from the standpoint of the lesion or lesions toward which it is being directed-in other words, the number of fields of irradiation or beams of rays, and the direction of the several beams with refer- ence to the anatomic situation and extent of the pathologic process. Illustrative examples are given.

Basic Principles for Successful Roentgen Therapy of Carcinoma, H. IVINTZ. Radiology 30: 35-42, 1938. This paper is a discussion of the principles of roentgen therapy, especially those governing'dosage. The cancer dose the author has found to be from 90 to 125 per cent of the skin unit. In the case of tumors in the depth of the body this dose can be attained only through the use of multiple ports. The author does not favor fractionated dosage, claiming more favorable results with his own single-dose technic, though no statistics are quoted here. Failure of roentgen therapy is often attributable to one of the following mistakes: (1) application of dosage insufficient for destruction of cancer cells because of ignorance of the biologic recuperative capacity of these cells; (2) such cumulation of radiation that not only the neoplasm is destroyed, but severe injury is also inflicted upon surrounding healthy tissue, the biologic radiosensitivity of which has been increased simultaneously so that the destruction produced can no longer be repaired. Wintz believes that there are no wholly radioresistant cancers, though differences in radiosensitivity exist. Concomitant inflammation exerts an unfavorable influence and inadequate after-care may reduce the number of permanent cures. No references are given.

Indications for Surgery or Irradiation Based upon the Results of Modern Radiotherapy, H. HOLFELDER.Grenzen der Anzeigestellung zur Operation oder Bestrahlung eines Karzinoms auf Grund der Ergebnisse der modernen Strahlentherapie, Wien. klin. Wchnschr. 50: 1051-1054, 1937. The results of irradiation therapy of malignant tumors are tabulated. Skin cancer: While small growths were cured in 100 per cent of the cases, 20 per cent of the larger or inoperable tumors recurred. Breast cancer: Of 51 patients with advanced inoperable tumors in whom an estimate of results after three years was possible, 21 were without evidence of disease. After five years 9 of 40 patients were cured. Inoperable recurrences were irradiated in 57 patients; 23 were tumor-free after three years, and 15 of 42 were cured after a period of five years. The condition of a number of patients with generalized skeletal involvement remained considerably ameliorated two years after radiotherapy. Postoperative irradiation was administered in 236 patients and 161 were symptom-free three years later. After five years 94 of 175 patients remained cured. Bronchial cancer: Of 92 patients, 9 remained tumor-free for three years. Three patients were well four years and nine months, six years, and seven years respectively after irradiation. Thymus carcinoma: One case was treated, and the patient had no evidence of disease after four and one half years. Cancer of the stomach: Inoperable cancers were treated in 182 patients. Improve- ment was observed in 76, and a three-year cure resulted in 10 patients. In one instance 132 ABSTRACTS the patient was symptom-free eight years after irradiation of a tumor which laparotomy showed to have metastasized in the abdominal lymph nodes. [This patient obviously never had carcinoma of the stomach.-ED.] liodgkin's disease: Of 179 treated patients, 129 died, 50 survived, and 10 were symptom-free after five years. Hypoplyseal tumors: Radiotherapy cured 25 of 50 patients. With the exception of 6 patients cured five to ten years after treatment, no mention is made of the length of observation, nor is the type of tumor stated. Eye tumors: Enucleation was necessary in 7 of 28 cases. Thirteen patients were cured. The interval after irradiation, however, is not given. One patient with a retro-orbital sarcoma was tumor-free fifteen years after treatment. Melanoma: Radiotherapy is advocated especially for small growths. A cure is recorded in one patient thirteen and one half years after irradiation. Lymphosarcoma: Inguinal lymphosarcoma remained cured for ten years in one patient; metastases then appeared in the gluteal and retroperitoneal regions. These disappeared following irradiation and the patient is now symptom-free seven years later. Bone sarcoma: Irradiation therapy alone was followed by a five-year cure in 7 of 35 patients, and combined surgical intervention and irradiation cured 7 of 24 patients. Five-year cures were obtained by irradiation in 2 of 4 patients. with Ewing's sarcoma; combined excision and irradiation cured 1 of 2 patients. Angiosarcorna of the intestine: Despite a pulmonary metastasis radiotherapy resulted in a cure and the patient was symptom-free nine years following treatment. MILTONJ. EISEN

Clinical Observations in the Treatment of Cancer by Supervoltage X-rays, S. G. MUDD,C. K. EMERY,AND L. M. LEVI. Radiology 30: 489-492, 1938. The authors record their preliminary results with supervoltage therapy, though they state that it is too early to draw final conclusions as to this mode of treatment. There have been treated 746 patients wth inoperable malignant lesions. The present treatment factors are: 900 kv., 3 ma., 6 mm. steel plus 1 mm. lead filter, 58 cm. target-skin distance, intensity 15 r per minute as measured by a standard air chamber. This quality of radiation is characterized by a half value layer of 6.5 cm. of water or 8.1 mm. of copper. For carcinoma of the cervix the authors give preferably a single cycle of treatment through six to eight portals measuring 10 x 15 cm., usually at a daily treatment rate of 300 I over one field, with a total dose between 10,000 and 20,000 r. Many cases were treated by roentgen rays alone but in general a combination of roentgen and radium therapy is now preferred. Of 42 Group 111 patients thus treated, 19 were alive without evidence of the disease after one to four years, while of 86 Group IV patients 18 were living and well. One hundred and four patients with proved carcinoma of the prostate have been treated, and 31 of these have remained free of symptoms for one to four years. Results in carcinoma of the bladder and rectum have not been favorable. In small groups of renal tumors and testicular growths the results have been good. Some palliation has been obtained in carcinomas of the esophagus, but there have been no two-year survivals. In the mid- and late stages of carcinoma of the breast and in carcinoma of the pharynx and larynx 900 kv. radiation appears to offer little or no advantage over 200 kv.

Three-Year Results in the Treatment of Malignant Neoplasms with Supervoltage Roentgen Therapy, T. LEUCUTIA. Radiology 30: 356-360, 1938. A series of 312 cases of malignant neoplasm treated in 1933-34 by roentgen therapy, chiefly 500 kv., form the basis for the author's conclusions. In 93 cases in which prior treatment at 200 kv. had resulted in failure, subsequent supervoltage therapy produced no material improvement. Only 7 patients in this group were alive after three years. The remainder of the cases were treated primarily with 500 kv. roentgen rays and of these 87 were uninfluenced and 132 were improved. DIAGNOSIS AND TREATMENT 133

No change in the law of radiosensitivity was observed as compared to 200 kv. radiation. It appeared in this respect that there is no direct quality dependence or selective reaction. The groups of malignant tumors which proved unfavorable to 200 kv. irradiation continued to remain unfavorable to 500 kv. Better results can be expected with the higher voltages under two circumstances: if the radiation has been rendered more efficacious and if the lesion remains localized. The author believes that with increasing voltages there is a better differential action. From a practical standpoint this means that a larger total dose may be administered to a neoplasm when using higher voltages than is possible with 200 kv. radiation and that at the same time there is less injury to the skin. In other words, the irradiation becomes more homogeneous and efficacious. [This is not the explanation. The reason why there is less injury to the skin is that the back-scatter with the higher voltages is much less that at 200 kv.] If all malignant neoplasms are divided into five clinical stages, it is found that 500 kv. therapy has led to definite improvement of the three-year results in Stages 111 and IV, in those groups which were favorable also to 200 kv. radiation. The best example is carcinoma of the uterine cervix, in which the percentage of three-year survival was increased from 30 to nearly 60. A similar improvement was obtained in certain bulky skin cancers, in carcinoma of the rectum, in the earlier cases of carcinoma of the prostate, in some types of sarcoma, in carcinoma of the thyroid, and to a lesser extent in metastatic carcinoma of the lymph nodes of the neck.

Cardiovascular Disturbances during Continuous Fractional Irradiation of Malignant Tumors of the Upper Respiratory and Gastro-intestinal Tracts, H. BARTSCHAND G. WACHNER. Herzgefassschadigungen bei protrahiert-fraktioniert bestrahlten malignen Tumoren der oberen Luft- und Speisewege, Klin. Wchnschr. 16: 743-746, 1937. Prophylactic Treatment of Cardiovascular Disturbances Occurring during Continuous Fractional Irradiation of Malignant Tumors of the Upper Respiratory and Gastro- Intestinal Tracts, H. BARTSCHAND G. WACHNER.Herzgefassschiidigungen und ihre Prophylaxe bei protrahiert-fraktioniert bestrahlten Tumoren der oberen Luft- und Speisewege, Strahlentherapie 62 : 339-342, 1938. The following cardiovascular disturbances were observed as a complication of local administration of continuous fractional roentgen therapy in 47 patients with malignant tumors of the larynx and pharynx. The manifestations generally occurred after the completion of irradiation and were in a large measure of self-limited duration. (I) Changes in heart rate: Tachycardia, with an increase in frequency of 18 to 50 beats per minute, occurred in 33 patients, and bradycardia, with an average heart rate of 45, in 3 patients. (2) Changes in blood pressure: A decrease, averaging 65 systolic and 45 diastolic, was observed in 37 patients. (3) Auscultation of heart: Two patients had extra-systoles. (4) Electrocardiographic changes: Tracings showed indications of myocardial damage in 33 patients; the common findings were excursion of the descending limb of the QRS complex below the isoelectric level and a decrease in the amplitude of the T-wave. (5) Clinical changes: Anginal attacks developed in 2 patients. These manifestations are probably a result of absorption of products of the tumor proteins, which exert a toxic effect on the cardiovascular system. Microscopic evidence of myocardial degeneration is described in rabbits following irradiation of the entire body with and without protection of the heart, or of the femoral region. In an additional series of 20 patients, phenomena indicating cardiovascular abnormalities were largely obviated by digitalization and the administration of adrenalin (Sympathol) and caffeine prior to irradiation. Electrocardiographic tracings and a photomicrograph illustrating the effect of roentgen therapy on the myocardium of the rabbit are reproduced. MILTOMJ. EISEN 131 ABSTRACTS

Relation of Roentgen Therapy to the Treatment of Fibrosarcoma, H. P. DOUB. Radi- ology 30: 122-131, 1938. Fibrosarcomas are commonly found in the skin and subcutaneous tissues. In the series of 12 cases recorded here the point of origin was more commonly in the muscle sheaths or septa. These tumors present a therapeutic problem. The prognosis is poor: the tumors are usually radioresistant and are situated in areas where preservation of the surrounding and underlying tissues is important. These are likely to be irreparably damaged by the large doses of radiation required for destruction of the tumor. In all of the cases recorded here the tumor was excised and postoperative roentgen therapy was given. Seven of the 12 patients are alive and 5 have died, one of the latter having lived eleven years after radiotherapy for a recurrent tumor. Of the 7 patients still alive, 4 had tumors primary in the abdominal wall; all these are alive for periods of five to eleven years. In one case the tumor arose in the chest wall and this patient is without recurrence a year after excision. Two cases originated in the extremity. One was primary in the head with metastases in the inguinal nodes. Both the primary growth andsthe nodes were excised, with subsequent irradiation, and the patient was well a year later. The remaining case was a recent one. Histories of 2 cases are given, illustrated by roentgenograms. One of these is of the patient who lived eleven years after a recurrence in the scapula. Roentgen therapy caused extensive muscular atrophy and telangiectasia. Death occurred after amputation of the arm because of thrombosis of the brachial artery. The other patient, a boy first seen at the age of eight, had a recurrence in the region'of the knee treated by roentgen therapy. Death occurred five years later from pulmonary metastases. In this case interference in bone growth and bone dissolution occurred in the region of the epiphysis, a frequent result of irradiation in growing patients with unclosed epiphyseal lines. References are appended.

Case of Fibrosarcoma in a Mastoidectomy Wound, Apparently Cured, A. JORGENSEN. Et tilfaelde af fibrosarcom i retroauriculaer saarcavitet tilsyneladende helbredt, Hospitalstid. 80: Dansk oto-laryng. selsk. forh. 19-21, 1937. A six-months-old girl had otitis media followed by mastoiditis. A simple right mastoidectomy was performed, but the wound failed to heal and a month later microscopic examination of some of the supposed granulation tissue showed fibrosarcoma. A radical mastoidectomy was then done and the bone scraped in all directions but the tumor promptly recurred. For want of other treatment, but without hope of success, roentgen therapy was given, the total dosage being only 1800 r. The tumor disappeared completely, the wound healed normally, and six months later there was no clinical or radiographic evidence of recurrence. No similar case was found in the literature. The author stresses the fact that the diagnosis was certain and that the tumor was a highly malignant one according to the unanimous opinion of numerous pathologists. There are no illustrations. EDWARDHERBERT, JR.

The Radium Safe of the Portuguese Institute of Oncology, F. B~NARD-GUEDES.Der Radiumsicherheitsschrank des Portugiesischen Instituts fur Geschwulstlehre, Strahlentherapie 57: 181-186, 1936. The Radium Building of the Portuguese Institute of Oncology at Lisbon, consisting of three floors and a terrace, contains in its basement an iron safe,for storing radium which is described in all its details and illustrated by two pictures. F. BURGHEIM Biological Action of Roentgen Rays and Radium on Normal Tissues and on Neoplasms. ANNAGOLDFEDER. Action biologique des rayons Roentgen et du radium sur les tissus normaux et les nboplasmes, Compt. rend. SOC.de biol. 130: 571-572, 1939. The author studied the effects of x-rays and radium on fragments of normal tissues of a human fetus and of new-born rats and mice and fragments of a human myxosarcoma and Crockr mouse sarcoma 180. Larger doses of radiation were needed to change the metabolism, as determined by the Warburg method, than to prevent growth in vitro. I,. FOULDS THE SKIN 135

THE SKIN Skin Cancer in Bali, H. H. NOOSTEN. Huidcarcinoom op Bali, Geneesk. tijdschr. v. Neder1.-Indie, 78: 3254-3264, 1938. It has been said, on the basis of large groups of cases in Java, that skin cancer of the lower extremities is ten times as frequent there as in Europe, while epitheliomas of the face are only one-tenth as frequent. Noosten spent a fortnight’s vacation in Bali and during that time saw 20 cases of unmistakable cancer of the face. These were observed in ordinary travel about the island and not in hospitals. A photograph of each was taken, and when possible a biopsy was obtained. Noosten’s impression is that facial epitheliomas are much more frequent there than in Java. Further statistical and scientific studies should be made and if the apparent difference proves to be real all factors with a possible causal relationship should be compared. It is known that the Balinese and Javanese differ greatly in dress, diet, and exposure to sunlight. Twelve photographs and several references are included. EDWARDHERBERT, JR. Skin Carcinoma and Sarcoma Following Exposure to Sunlight and the Action of Photo- sensitizing Substances, %’. BUNGELER. Uber die Entstehung von Hautcarcinomen und Hautsarkomen nach Sonnenbestrahlung und Photosensibilisierung, Klin. Wchnschr. 16: 1012-1013, 1937. A more extensive exposition of material appearing in Ztschr. f. Krebforsch. 46: 130, 1937 (Abst. in Am. J. Cancer 34: 277, 1938). MILTONJ. EISEN

Treatment of Skin Cancer with Low-voltage Roentgen Rays, E. EBBEH~~J.Fors$g paa behandling af Hudcancere med bl$de Rplntgenstraaler, Hospitalstid. 80: Dansk. radiol. selsk. forh. 13, 1937. In cases of skin cancer where the depth of the tumor does not exceed 5.0 mm. a cure can be obtained with 4 single dose of5600 r given in a period of eleven minutes with low-voltage roentgen rays. This treatment causes a marked radiodermatitis which clears up in four to six weeks, leaving a minimal scar. This method of therapy is an acceptable substitute for radium therapy, especially since the latter is so expensive and can be obtained only in the larger centers. [For reports of good results with a similar technic, see Coste: Arch. derm. syph. 4: 195, 1932. Abst. in Am. J. Cancer 19: 892, 1933.1 EDWARDHERBERT, JR. Rare Forms of Nevi in Childhood, R. STEINDLER.Seltene Formen von Navi im Kinrle- salter, Arch. fiir Kinderh. 107: 237-243, 1936. Four cases are reported: a bathing-trunk nevus in a girl of twelve, with lesser lesions on the back, left arm, and chest; a “ naevus anaemicus Voerner ” on the chest of an infant eleven months old, with a telangiectatic nevus on the forehead and a pigmented nevus on the axillary fold; mongolian spots in infants of eighteen and twenty months.

Case of Malignant Angiomatosis in an Infant, SOEWADJIPRAWIROHARDJO AND SOER- TARTO. Een geval van maligne angiomatose bij een zuigeling, Geneesk. v. Neder1.- Indig, 78: 3240-3243, 1938. A male Javanese infant developed jaundice the day after birth and nine days later a crop of red nodular tumors appeared all over the body, including the palms, soles, and mucous membranes. The child was seen by a physician at the age of four weeks. Biopsy of one of the tumors showed a vascular structure with proliferation of what appeared to be the endothelial cells, and with many mitotic figures. The microscopic picture did not fit in with any well known group and the diagnosis was malignant angiomatosis. The child lost weight, became more cachectic, and died in the seventh week. Permission for autopsy could not be obtained. All that can be said is that the child had multiple malignant angiomatous tumors of the skin. Whether they represented a local skin tumor of multicentric origin or metastases from a tumar situated internally, possibly a hemangio-endothelioma of the liver, cannot be stated. Two photomicrographs and three photographs are included. EDWARDHERBERT, JR. 136 ABSTRACTS

Multiple Cylindromas (Endotheliomas) of the Face, A. REYN. Multiple cylindromer (endoteliomer) i Ansigtet, Hospitalstid. 80: Dansk derm. selsk. forh. 12, 1937. A woman thirty-four years of age had numerous subcutaneous nodular tumors of the face, especially at the hair line, near the ears, on the sides of the nose, and on the chin. They had appeared many years previously and had been steadily increasing in number and in size. Biopsy showed circumscribed nodules of cylindrical and spindle-shaped cells with dark oval nuclei, arranged in palisade formation around cavities containing mucoid or hyaline material. These tumors, previously called endotheliomas, are benign cylindromas. The only treatment is surgical excision of the larger nodules. There are no illustrations. EDWARDHERBERT, JR. THE BREAST A Clinico-pathological Classification of Cancer of the Breast, R. W. RAVEN. Brit. M. J. 1: 611-613, 1939. A uniform system of classification of cancer of the breast is needed in order to assess the value of treatment and the factors which influence prognosis. The author proposes a classification which correlates the condition in the breast with the condition of the axilla and other parts of the body. Four stages of disease in the breast are distinguished. I. Strictly confined to the breast. 11. Infiltrating skin or pectoralis fascia. 111. Infiltrating pectoralis muscle or ulcerating through the skin. IV. Infiltrating ribs, costal cartilage or sternum; or infiltrating whole breast with peau d’orange and/or infiltration of underlying pectoralis fascia and muscle. Five stages of disease in the regional lymph nodes are distinguished: (a) Involving nodes under lower border of pectoralis major. (b) Involving nodes under tendon of pectoralis major. (c) Involving nodes under tendon of pectoralis minor. (d) Involving supraclavicular nodes. (e) Involving mediastinal nodes. The stage is recorded a’, b’ etc., if the perinodal connective tissue is invaded. If the disease has spread to other parts of the body, the first two letters of the organ are added. Thus a case with infiltration of whole breast, peau d’orange, infiltration of pectoralis major, invasion of nodes under lower border of pectoralis major and under tendon of pectoralis minor and metastases in lungs is classified IV (whole breast), a, c, lu. I,. FOULDS

Prognosis in Carcinoma of the Breast, R. W. SCARFFAND R. S. HANDLEY.Lancet 2: 582-583, 1938. The authors followed up 172 cases of carcinoma of the breast first operated upon during 1925-35. Radical mastectomy was carried out in every case but one and prophylactic irradiation in about a third of the cases. The tumors were graded histologically, according to the criteria of Patey and Scarff (Lancet 1 : 801, 1928) into three grades, namely Grade I, low malignancy; Grade 111, high malignancy: Grade 11, intermediate. There were 62 patients with Grade I tumors, of whom 45 per cent survived five years and 31 per cent ten years. Of 66 patients with Grade I1 tumors 29 per cent survived five years and 11 per cent ten years, and of 44 patients with Grade 111 tumors 23 per cent survived five years and 13 per cent ten years. Attention is drawn to the heavy mortality, from recurrence, between the fifth and tenth years. The length of life of the patients who died within ten years was surprisingly little affected by the grade of the tumor; the average survival times for Grades I, I1 and 111 were thirty-seven months, thirty-three months, and twenty-nine months respectively. The cases were also subdivided according to the presence or absence of involvement of the axillary nodes. There were 47 patients without microscopic involvement of axillary nodes and of these 72 per cent were alive after five years and 45 per cent after ten years. The five-year survivals for Grades I, I1 and 111 were 81 per cent, 59 per cent and 78 per cent respectively and the .ten-year survivals 57 per cent, 23 per cent and 56 per cent. Of the 125 patients in which the axillary nodes were involved only 18 per cent THE BREAST 137

were alive after five years and 9 per cent after ten years. In this group the five-year survivals for Grades I, I1 and I11 were 24 per cent, 18 per cent and 9 per cent respectively and the ten-year survivals 17 per cent, 6 per cent and 3 per cent. The difference between the five-year and ten-year results is again emphasized and it is pointed out that the word " cure " should be avoided in cases of carcinoma. Contrary to current teaching, age had little bearing on prognosis. The authors conclude that histologic grading is of real importance in the prognosis of carcinoma of the breast, but that it loses much of its value if considered apart from the clinical stage of the disease. The presence of tumor in the axillary nodes is the most important single factor in prognosis. A number of patients do not behave as expected, probably because paths of spread other than the axillary route are not accessible to investigation. L. FOULDS

The Sedimentation Rate in Various Types of Cancer :, Its Prognostic Value. I. Mam- mary Cancer, P. JACOBYAND J. SPOTOFT. Saenkningsreaktionen ved forskellige cancerformer, saerlig med henblik paa dens prognostiske vaerdi. I. Cancer mammae, Hospitalstid. 80: 811-813, 1937. The erythrocyte sedimentation rate is valueless in the diagnosis of carcinoma, since it is dependent on the destruction of tissue whether malignant or benign. In 59 cases of mammary carcinoma the sedimentation rate, considering the normal to be below 15, was increased in 24 cases and normal in 35. During radiotherapy of 31 cases with metastases the rate increased in 18 and fell in 13. Of 37 cases that became clinically symptom-free it rose in 21 and fell in 16. Thus the test appeared to be of no value as a prognostic aid during therapy. In the follow-up period, however, the symptom-free cases showed a percentage of normal sedimentation rates which constantly increased as time went on, being 58 per cent after one year and 100 per cent after five years. The test thus has a certain limited value in prognosis after treatment. A normal rate does not preclude the occurrence of metastases, but an increased rate without other explanation argues strongly for their presence though they may not yet be demonstrable clinically. EDWARDHERBERT, JR.

Histologic Diagnosis and Prognosis of Mammary Neoplasia, H. LIMBURG.Zur histologischen Diagnose und Prognose von Neubildungen in der Mamma, Ztschr. f. Geburtsh. u. Gynak. 114: 7-28, 1936. The benignity of chronic cystic mastitis, fibro-adenoma, adenoma, and diffuse fibrosis of the breast is illustrated by reexamination of living patients with the above affections five to ten years after conservative treatment. Of 135 patients, 6 died of intercurrent disease and only 1 of cancer; 128 were alive and symptom-free. Radical mastectomy was performed in 11 cases. Chronic cystic mastitis was present in 78 patients, in 15 of whom it was associated with fibro-adenoma. With the exception of radical amputation in 7 cases surgery was limited to biopsy. Cancer developed in 1 patient of the latter group after four years. Forty-two patients had fibro-adenoma without cystic mastitis; in 1 instance the tumor was a pure fibroma. Radical mastectomy was performed twice; in 40 patients the tumor was resected. Adenoma occurred in 3 patients, and was treated by excision. Diffuse fibrosis of the breast associated with atrophy of the glandular elements was observed in 12 patients. Radical amputation wad performed twice, although the reasons for this procedure are not recorded. Conservative treatment is hence considered satisfactory. Sixteen photomicrographs and a bibliography are included. MILTONJ. EISEN

Histologic Studies of Mammary Fibro-adenomatosis with Special Consideration of the Effect of Treatment with Estrin, F. S$RENSEN.Histqlogiske unders$gelser over nogle tilfaelde af fibroadenomatosis mammae med specielt henblik paa $strinbe- handlingens virkning paa disse, Hospitalstid. 80: 1333-1354, 1937. Nine cases of fibro-adenomatosis of the breast were treated with estrin, while 8 untreated cases served as controls. The untreated cases showed a much greater pro- 138 ABSTRACTS

liferation of the intralobular connective tissue than the treated group, in which this tissue displayed a striking resemblance to the normal physiological changes associated with menstruation. Cytologic studies of the glandular epithelium in both groups showed instances of pre-menstrual, menstrual and post-menstrual stages. There was an enlargement of the Golgi apparatus and a closer grouping of the mitochondria. In 4 of 7 cases in which the urine was tested there was a deficiency of the gonadotropic hormone, follicular hormone, or both. Nine photomicrographs and several references are included. EDWARDHERBERT, JR.

Skin Metastasis in Post-operative Irradiated Breast Cancer, F. W. O’BRIEN. Radiology 30: 437-438, 1938. Skin metastases occurred in 54 of 255 cases of cancer of the breast in spite of postoperative x-ray therapy. Statistically there was no evidence that the occurrence of these metastases was related to .the kind or amount of irradiation. They appeared rather to depend on the extent of the growth and the inadequacy of the operative procedure.

Erysipelatous Carcinoma in a Sixty-year-old Woman, A. KISSMEYER.Et tilfaelde af carcinoma erysipelatodes hos en kvinde paa 60 aar. Hospitalstid. 80: Dansk derm. selsk. forh. 1-2, 1937. A woman of sixty had an enlarged left breast with generalized induration and an erysipelas-like erythema extending to the axilla and involving the right breast to a lesser degree. Biopsy of the involved skin showed all the blood vessels dilated and filled with carcinoma cells. The case therefore falls in the group described as erysipelas carcinoma- tosum. A photograph and a photomicrograph are included. EDWARDHERBERT, JR.

Metastasis in Gasserian Ganglion Following Carcinoma of Breast, D. C. L. FITZ- WILLIAMS ANP J. N. FELL. Brit. M. J. 1: 387-388, 1939. A woman aged thirty-seven had a lump in the left axilla. Mastitis and induration were present in the breast, but no lump was defined. A complete operation was carried out and radium needles were inserted. Histologic examination showed scirrhous carcinoma of the breast and metastases in the axillary nodes. Violent headaches occurred eighteen months later, associated with nausea, retching, and vomiting, and the patient died. No growth was found in the region of the old scar, but there were metastases in the nodes on the left side of the neck, in the nodes of the pancreas, in the thymus gland, in the pericardium, and in the second and fourth ribs on the left side. Basal meningitis was present, due probably to secondary carcinoma in the right gasserian ganglion. The metastases in the various organs must have been blood-borne and had probably left the primary growth before the operation. The lymphatic spread probably was held up in the lymph nodes. L. FOULDS

THE ORAL CAVITY AND UPPER RESPIRATORY TRACT

9 Classifhation of Buccal Neoplasms in Relation to Treatment and Prognosis, A. J. GARDHAM.Lancet 1: 677-681, 1939. Neoplasms of the mouth vary greitly in their response to treatment and the variation is not due, as often supposed, to the times at which patients seek advice. The author believes that the time is ripe for an evaluation of present methods of treatment and he attempts to provide reliable standards by correlating variations in malignancy with gross pathological characteristics, including site, mode of spread, and rate of development. The neoplasms of the mouth are divided into three classes: Class A comprises accessible tumors without characteristics of high malignancy. The results of operation and of irradiation are good, irradiation usually being the method of choice. The author does not advise prophylactic treatment of lymph nodes but relies on periodic examinations and reserves operation for secondary nodes which appear comparatively late and develop slowly. Nodes which become inoperable within three THE ORAL CAVITY AND UPPER RESPIRATORY TRACT- 139 months are unsuitable for operation from the beginning, and even the dissection of those not palpably enlarged may be disastrous. An undetermined fraction of carcinomas of the anterior two-thirds of the tongue belong to this group; the slight effect of variations in the scope of treatment on the end-results suggests that cure is determined mainly by the nature of the tumor, the ” curable ” growths being the same whether surgery or irradiation is used. Class B comprises inaccessible but not highly malignant tumors. As a rule, the risks of damage to normal tissues by irradiation are unjustifiably great; the risks include late necrosis and possibly, the author thinks, predisposition of the damaged tissues to the development of independent primary neoplasms. Extensive operations are justi- fiable for those growths in Classes A and B which are widespread as a result of delayed treatment but not for those of rapid growth. Group C comprises tumors of high malignancy. Extensive and mutilating operations are rarely justified. The chance of cure being negligible, treatment should be palliative. Long-term palliation may be achieved by irradiation, but recurrence within five years is the rule. Extremely radiosensitive tumors are almost always unsuitable for operation, but irradiation produces the best ultimate results with tumors of a lower degree of radiosensitivity. Surgical treatment should not be used for fast-growing carcinoma on account of the risk of diffuse recurrence. The appearance of secondary tumors while the primary lesion is still small, or disproportionately rapid growth of secondary tumors, is of bad prognosis. Small early growths which persist after irradiation or recur early are usually resistant to all forms of treatment. L. FOULDS

Morphology and Nature of Mucous Gland Tumors of the Gum and the Mouth and Their Relation to Mixed Tumors of the Salivary Glands, W. HOEPFEL. Bau und Wesen der Schleimdriisengeschwulste am Gaumen und im Mundhiihlenbereich, insbe- sondere in ihren Beziehungen zu den sag. Speicheldriisenrnischgeschwulsten, Ztschr. f. Hals-, Nasen- u. Ohrenh. 41: 52-87, 1936. This paper contains a discussion on the histology and pathogenesis of mixed tumors of the mouth, based on a study of 5 localized growths removed from the hard palate. One tumor had the characteristic morphology of a cylindroma. Correlated observations are made on mixed tumors of the parotid and cylindroma of the nose, orbit, and subcutaneous tissue. No essential differences between the first and second groups of tumors were observed. They are classified as special forms of epithelioma. Cylindroma is considered an atypical mixed tumor. The growths probably originate in the undifferentiated epithelium of the excretory ducts of the mucous glands of the mouth or of the salivary glands. The much in the tumors is believed to be primarily a secretory product of the epithelial cells which, on accumulation, causes separation of groups of tumor cells or isolation of the individual elements. The secretion penetrates the stroma and is amalgamated with it. Swelling of the connective-tissue fibrils and degenerative changes follow, giving rise to cartilage-like masses or, rarely, to the formation of a tissue resembling bone. Chemically and morphologically the cartilaginous masses are not wholly comparable with normal cartilage or that of chondromatous tumors. Ten photomicrographs and a review of the literature with a bibliography are included. MILTONJ. EISEN

Radium Therapy of Cancers of the Buccal Cavity, R. B. ENGELSTAD.Curiethkrapie des cancers de la cavitk buccale, J. de radio!. et d’blectrol. 21 : 53-56, 1937. During 1932, 1933, and 1934, there were treated with radium at the Radium Hospital in Norway, 56 patients with cancer of the tongue, gums, and buccal mucosa. Of these, 29 were symptom-free after two and a half to four years, and 3 were symptom-free after a second course of radium therapy for recurrences following the first treatment. Four patients were alive but not cured, and 20 were dead. The author states that these tumors may be considered as one of the most important groups, if not the most important, for telecurietherapy. There are no illustrations. EDWARDHERBERT, JR. 140 ABSTRACTS

Case of Rhabdomyoma Granulocellulare of the Tongue (Myoblastoma), F. BANG. Et tilfaelde af rhabdomyoma granulocellulare (myoblastmyom) i tungen, Hospital- stid. 80: Dansk oto-laryng. selsk. forh. 55, 1937. .4 tumor which had been present for two years was removed from the tongue of a woman sixty-three years of age. Microscopically it was a benign rhabdomyoma granulocellulare or myoblastoma. There was no recurrence five years later. Whether these tumors arise from congenital rests or from mature striated muscle is a matter of dispute. Often they are accompanied by a proliferation of the overlying epithelial tissues, in which case they may be confused with epitheliomas. There are no illustrations. EDWARDHERBERT, JR.

Evaluation and Diagnosis of Adamantinomatous Tumors of the Jaw, K. HAUENSTEIN. Zur Wertung und Diagnostik der adamantinomartigen Kiefer-tumoren, Deutsche Zahn-, Mund- u. Kieferh. 4: 387-406, 1937. The difficulties in the differential roentgen diagnosis of multilocular dentigerous cysts and cystic adamantinoma are described. In 3 cases adamantinoma was diagnosed preoperatively as dental cyst and in 2 cases a cyst was found, whereas roentgen evidence indicated adamantinoma. Three cases each of adamantinoma and dental cyst were, however, diagnosed correctly by means of roentgenograms. Diagnosis in 2 additional cases of cystic disease and 1 of adamantinoma was ascertained by biopsy or operation. Clinically and radiographically no characteristic changes were present. An adamantinoma of the soft tissues of the lower jaw in 1 patient produced no roentgen signs of disease. The possibility of recurrence of benign adamantinoma is illustrated by 2 cases. In a third the recurrence proved to be a sarcoma. In 1 case a squamous-cell cancer developed on the site of an extirpated dental cyst. Roentgenograms and photomicrographs are reproduced. MILTONJ. EISEN

Technic of Radical Surgery for Advanced Carcinoma of the Lower Jaw, W. MENNINGER. Zur Technik der Radikaloperation beim vorgeschrittenen Unterkieferkarzinorn, Deutsche Zahn-, Mund- u. Kieferh. 4: 196-200, 1937. A radical operation for advanced oral cancer involving the gum and cheek is described. It consists in complete resection of the malignant process with the underlying portion of the mandible, extirpation of the regional lymph nodes, and construction of a cervical skin flap for approximation of the mouth incision. Four patients treated by this method were tumor-free two, two and a half, three, and six years after operation. Photographs of the patients are reproduced. MILTONJ. EISEN

Cystic Adamantinoma of Twenty-six Years’ Duration, M. REINM~LLER.Ein 26 Jahre lang bestehendes zystisches Adamantinom, Deutsche Zahn-, Mund- u. Kieferh. 4: 407-41 1, 1937. A case is described of a large adamantinoma of the lower jaw of twenty-six years’ duration in a woman aged forty-six. As the condition had not been cured by several partial resections, radical extirpation was resorted to and the patient was tumor-free two years later. Photographs of the patient and the tumor and photomicrographs are reproduced. MILTONJ. EISEN

Several Unusual Tumors of the Jaw, A. FOSSENAND SOETOMOTJOKRONEGORO. Eenige bijzondere kaakgezwellen, Geneesk. tijdschr. v. Neder1.-Indie 78: 3249-3253, 1938. Four unusual cases are reported. (1) A ten-year-old Javanese girl had a tremendous fibrous tumor of the upper jaw, which deformed the mandible as well as the left eye. It was successfully removed. Whether it was a fibrous epulis or a central fibroma could not be determined, since the exact site of origin was uncertain. (2) A twenty-one-year-old Indo-Chinese man had a large tumor removed from his right lower jaw. It proved to be a spongy osteoma. After a bone graft he was well. THE ORAL CAVITY AND UPPER RESPIRATORY TRACT 141

(3) A Chinese man, thirty years of age, had a very large tumor of the left mandible. It was removed and was found to contain areas of squamous-cell epithelioma and adamantinoma. No follow-up is given. (4) A Javanese man of forty years had an extensive ulcerated tumor of the left mandible. It was removed successfully and was found to be an adamantinoma in . conjunction with a fibrosarcoma. Six photographs and 4 photomicrographs are included. EDWARDHERBERT, JR.

Case of Osteofibroma of the Left Superior Maxilla, H. LINDENOV. Et tilfaelde af osteofibroma ossis maxillae sup. sin, Hospitalstid. 80: Dansk oto-laryng. selsk. forh. 1-3, 1937. A man twenty-three years of age had nasal symptoms which led to the discovery of a tumor in the left antrum. It was removed surgically and was found to be an osteofibroma without signs of malignancy. The patient remained symptom-free thereafter. Only nine similar cases were found in the literature. There are no illustrations. EDWARDHERBERT, JR. Two Cases of Malignant Tumors of the Maxillary Sinus, (Carcinoma, Chondroma), P. M~RCH.To tilfaelde af maligne kaebehuletumorer (Carcinom, chondrom), Hospitalstid. 80: Dansk oto-laryng. selsk. forh. 61-66, 1937. A man forty-six years of age had had a fetid nasal discharge for three years. For six months it had been bloody at times. When the condition failed to improve with ordinary irrigations the patient was sent for operation, at which time he had an enlarged lymph node at the angle of the jaw. An extensive tumor was found and a radical resection was carried out, including the cervical node. Microscopically the tumor was a solid carcinoma. A Coutard series of roentgen therapy was given and the patient was symptom- free ten months later. The second patient, a man of fifty years, gave a six-year history of chronic infection of the antrum. At the end of that time a swelling appeared below his left eye. A large tumor was removed from the left antrum, which was reported as a benign chondroma. Radiotherapy was given but the tumor recurred, as it did again following a second operation which was more radical than the first one. A third operation was performed followed by more radiotherapy, but the tumor continued to grow. Later microscopic examinations led to a diagnosis of polymorphocellular sarcoma, but without any evidence of derivation from cartilaginous tissue. If apparently benign chondromata recur as malignant tumors it is more common for them to take this form than that of a chondrosarcoma. There are no illustrations. EDWARDHERBERT, JR.

Fibroma of the Maxillary Sinus, F. MANCI. Fibroma del sen0 mascellare, Ann. d. laring., otol. 37: 1-14, 1937. A woman of thirty-seven years had a slowly growing, radioresistant mass on the left side of the face, of ten years' duration. On removal it proved to be a fibroma arising in the antrum. Photographs of the patient and of the extirpated mass and photomicrographs are included. MILTON J. EISEN

Lymphosarcoma of the Mucosa of the Sphenoidal Sinus Clinically Evident as Rhino- genic Meningitis, F. HANDKE. Lymphosarkom der Keilbeinhohlenschleimhaut unter dem Bilde einer rhinogenen Meningitis, Ztschr. f. Hals-, Nasen- u. Ohrenh. 41: 44-51, 1936. A man of forty-three years with chronic sinusitis of many years' duration died of a relatively mild form of acute meningitis several days after operative intervention for evacuation of the infected sinuses. Tumor was not suspected. Post-mortem examination, however, disclosed a lymphosarcoma in the right sphenoidal sinus with extension about the hypophysis, infiltration of the right pyramid, and metastases in the kidneys. Three roentgenograms of the skull and 2 photomicrographs are included. MILTONJ. EISEN 142 ABSTRACTS

Radiotherapy of Malignant Tumors of the Nasopharynx, H. R. SCHINZAND A. ZUP- PINGER. Ziircher Erfahrungen der Radiotherapie bei bljsartigen Epipharynx- tumoren, Ztschr. f. Hals-, Nasen- u. Ohrenh. 41: 173-177, 1936. Continuous fractional roentgen therapy was administered in 26 cases of malignant . tumor of the nasopharynx. There were 21 male and 5 female patients, and the condition in the majority was advanced. Histologically 16 of the tumors were carcinomata, of which 11 were lympho-epitheliomata, 3 transitional-cell cancers, and 2 undifferentiated carcinomata. There were 9 sarcomata of various types, and in the remaining case the morphology was undetermined. Therapy was completed in 17 patients and in 15 was followed by total regression of the growth. Subsequently 8 of this group died: 7 survived without evidence of disease two to four years after irradiation. MILTONJ, EISEN

Radiotherapy of .Carcinoma of the Larynx, K. VOGEL. Die Strahlenbehandlung des Kehlkopfcarcinoms, Ztschr. f. Hals-, Nasen- u. Ohrenh. 40: 172-191, 1936. The results of radiotherapy of cancer of the larynx and hypopharynx are recorded. Localized internal laryngeal tumors in 71 patients were treated for eight days with 6.8 mg. radium element (filtration 1 mm. gold) inserted in a capsule through a window constructed in the thyroid cartilage. Twenty-seven patients were tumor-free three to seven years later and 24 for periods varying from six months to three years. Radium needles were inserted through the cartilage in 4 patients and 2 were symptom-free after nineteen and twenty-two months. Continuous fractional roentgen therapy was administered when the growths were more extensive or when metastases in the neck were present, and in cases of cancer of the hypopharynx. The total dosage is not indicated, but in cases treated more recently an attempt was made to avoid untoward local and general effects of irradiation by de- creasing the daily dose and increasing the total number of treatments. Of 42 patients in the first group, 4 were without evidence of disease three to five years after treatment and 13 for periods less than three years. One patient of the second group of 13 was cured of malignant disease but died of a complicating pulmonary tuberculosis. Cancer of the hypopharynx without metastases was treated in 21 patients. Four patients in this group were cured; in 1 the interval after treatment was longer than three years and in 3 it was less than three years. Of 32 patients with cancer of the hypopharynx and regional metastases, 1 was tumor-free three years after treatment, and 2, in whom the involved nodes were resected, were symptom-free one to two years later. Drawings and roentgenograms illustrate the methods of treatment employed. MILTONJ. EISEN

Technic of Radiotherapy of Carcinoma of the Larynx, A. ADAM. Technik und Methodik der Strahlenbehandlung des Larynx-Carcinoms, Ztschr. f. Hals-, Nasen- u. Ohrenh. 40: 192-200, 1936. The methods of treatment in the cases recorded here are similar to those employed by Vogel (see preceding abstract). Of 23 patients with laryngeal cancer treated with radium, 21 were tumor-free one to two and a half years later. In the series of 28 patients receiving roentgen therapy and followed for periods up to twenty-seven months, 17 were symptom-free. Of 18 patients with cancer of the hypopharynx 1 remained alive without evidence of tumor after one year. MILTONJ. EISEN

Four Cases of Associated Cancer and Tuberculosis of the Larynx, A. DBNOYEB. Con- siderazioni cliniche su quattro casi di associazione cancro-tuberculosi in laringe, Ann. d. laring., otol. 37: 60-71, 1937. Four cases of associated tuberculosis and carcinoma of the larynx verified by biopsy or necropsy are described. Chronic pulmonary tuberculosis was present in each instance. (1) A man of fifty-three years died of hemorrhage from the lung eight months after roentgen therapy had been administered for the laryngeal condition. (2) Papillomata of the larynx were removed surgically on two previous occasions in a woman aged forty-five. One year following the second intervention extensive THE DIGESTIVE TRACT ’ 143 tuberculous and carcinomatous lesions were discovered in the larynx, producing dysphagia and inanition. Death occurred one month later, following a hemorrhage. (3) Roentgen irradiation was ineffective in a man of forty-four, who died seven months after a diagnosis of cancer and tuberculosis was established. (4) A man of seventy-two died in a cachectic state, of laryngeal and pulmonary tuberculosis. The presence of a cancer in the larynx was ascertained at necropsy. There is a bibliography. MILTONJ. EISEN THE THYROID GLAND Reticulum-cell Sarcoma of the Thyroid, H. AMBO. Ein Retothelsarkom der Schild- driise, Zentralbl. f. allg. Path. u. path. Anat. 67: 225-227, 1937. A reticulum-cell sarcoma of the thyroid was removed surgically from a woman aged seventy years. Three photomicrographs are reproduced. MILTONJ. EISEN INTRATHORACIC TUMORS

Erosion of the Bodies of the Vertebrae by Pressure from a Tumor. JEANDINAND TRIAL. Usure des corps vertkbraux par compression tumorale, J. de radio]. et d’blectrol. 21: 308-310, 1937. A man fifty-four years of age showed radiographically a mediastinal tumor with erosion of the 3rd to the 6th dorsal vertebrae. The type of tumor apparently was not ascertained. Two roentgenograms are included. EDWARDHERBERT, JR. An Unusual Form of Pulmonary Carcinoma, C. BONNE. Over een bijzondere vorm van longcarcinoom, Geneesk. tijdschr. v. Neder1.-Indie 78: 3204-3210, 1938. A presentation of material and illustrations included in a more extensive paper by the same author in Am. J. Cancer 35: 491-501, 1939. EDWARDHERBERT, JR.

THE DIGESTIVE TRACT Cancer of the Alimentary Tract: Its Pathogenesis and Its Prophylaxis, A. HURST. Lancet 1 : 553-558, 621-626, 1939. Hurst restates his views on the pathogenesis of carcinoma of the stomach, which he believes is usually secondary to chronic gastric ulcer or to chronic gastritis. The possible reasons for the higher incidence in the poor compared with the well-to-do, and in the English compared with the Dutch, are discussed. The relatively low incidence in women is apparently due to deaths from cancer of the breast or uterus on an average of fifteen to twenty years before gastric cancer commonly develops. Now that most patients with pernicious anemia can be kept free from symptoms indefinitely by liver therapy, it is probable that an increasing number will develop gastric cancer. Pro- phylaxis of gastric carcinoma consists in preventing, or at least curing as early as possible, gastric ulcer and chronic gastritis. The importance of attention to the teeth is emphasized. Hurst believes that recurrence after operation is more often due to development of a new tumor than to failure to remove the whole of the tissue already invaded by cancer; residual gastritis after operation therefore demands careful attention. Carcinoma in the post-cricoid part of the esophagus occurs almost exclusively in women, probably because it is the result of malignant degeneration of the atrophic mucous membrane present in the Plummer-Vinson syndrome, which is almost unknown in men. This syndrome is curable by large doses of iron and cancer never develops in cases which are adequately treated. Cancer of the middle and lower portions of the esophagus are rare in women, in whom the extrinsic causes must be inoperative. For prophylaxis, the avoidance of excessive consumption of strong alcoholic drinks and of excessive smoking of strong tobacco is commended. Carcinoma of the colon is apparently due to intrinsic causes and is usually the result of malignant degeneration of simple adenomata. Prophylaxis consists mainly in the diagnosis and removal of polyps. Chronic irritation of the colon is probably a factor in the development of a carcinoma from a polyp. Commonly used purgatives cause more irritation than constipation, which usually can be cured without their aid. L. FOULDS 144 ABSTRACTS

Integration of Clinical and Roentgenologic Findings in the Diagnosis of Carcinoma of the Esophagus; Study of 100 Cases, J. T. FARRELL,JR. Radiology 30: 412-416, 1938. An analysis is made of 100 cases of esophageal cancer in an attempt to determine whether correlation of the clinical and roentgen findings might reveal some sign by which an early diagnosis could be made, but little success was attained. A number of facts, however, emerged. The lower and middle thirds of the esophagus are involved three times as often as the upper third. Male patients predominate 12 to 1. Ninety-one per cent of the patients gave no family history of malignancy, and cancer of the esophagus was not recorded in a single instance. The influence of syphilis is of no apparent import, for in cases in which the blood was studied the ratio of the negative to positive reactions was as 13 to 1. In the series recorded symptoms were of comparatively brief duration-less than six months in 58 per cent and less than a year in 87 per cent-though in most instances the disease was in an advanced stage. As would be expected, mechanical interference with swallowing leads to dysphagia, the most frequently encountered initial symptom and the one with the highest incidence. The rapidity of its development and the pain which commonly accompanies it distinguish it from dysphagia in other conditions. In 95 per cent of the patients the diagnosis was suspected before roentgen studies were made. The paper has no illustrations and no bibliography.

Presence and Significance of Kopratoporphyrin (“ Deuteroporphyrin ”) in Cancer of the Stomach, F. BECKERMANNAND H. SCHULKE.uber Vorkommen und Bedeutung des Kopratoporphyrins (“ Deuteroporphyrin ”) unter besonderer Berucksichtigung des Magencarcinoms, Klin. Wchnschr. 16: 1311-1313, 1937. Kopratoporphyrin is formed in the intestinal canal of normal individuals by bacterial action on the hemoglobin or hematin ingested in a meat diet or is liberated following bleeding from a lesion in the gastro-intestinal tract. Its presence in feces or in meat undergoing putrefaction is ascertained spectroscopically. Analysis of the feces for this compound in cases of peptic ulcer or gastric cancer, however, was of no accurate aid in differential diagnosis. Kopratoporphyrin was isolated in the feces of 21 of 27 cancer patients and 11 of 31 ulcer patients on a vegetarian diet, and in 22 of 150 persons on a normal diet and with no evidence of cancer or gastro-intestinal disease. A bibliography is included. MILTONJ. EISEN Case of Macrocytic Anemia with Carcinoma of the Pylorus and Laennec’s Cirrhosis, H. BENTZEN. Et tilfaelde af macrocytaer anaemi ved cancer pylori og cirrhosis hepatis Laennec. Hospitalstid. 80: 157-165, 1937. A woman forty-three years of age developed a macrocytic anemia with atrophic tongue and gastric achylia. With liver treatment her hemoglobin rose from 48 to 76 per cent, with an increase in reticulocytes up to 32 per cent, but she lost weight and developed gastric symptoms. Further examination demonstrated a carcinoma of the pylorus. Death occurred soon afterwards and autopsy showed carcinoma without metastases, a hyperplastic bone marrow, and a typical Laennec’s cirrhosis with ascites. Histologic examination of the stomach showed that many of the pyloric glands, supposed source of the intrinsic factor, were intact, and for this reasoll it was believed that the anemia was probably secondary to the liver cirrhosis. A photograph and several references are included. EDWARDHERBERT, JR.

Sarcoma of the Stomach, U. BRACCI. I1 sarcoma gastrico, Ann. ital di chir. 16: 1-40, 1937. This is a report, with necropsy record, of a polymorphous-cell sarcoma of the lesser curvature of the stomach with metastases in the omentum, mesentery, kidneys, retroperitoneal tissue, and right axilla. The clinical course and roentgen evidence of gastric disease were indistinguishable from the findings in carcinoma. A roentgenogram, photographs of the gross lesions, and photomicrographs are reproduced. There is a review of the literature. MILTONJ. EISEN THE DIGESTIVE TRACT 145

Case of VenMculo-duodenal Carcinoma, B. HEIBERG. Et tilfaelde af carcinoma ventri- culo-duodenale, Hospitalstid. 80: 881-883, 1937. A woman thirty-five years of age had symptoms of gastric carcinoma. At operation tumor tissue was found in the prepyloric region but extended into the duodenum, being present in the submucosa, the muscularis, and along the lymphatic vessels. There were metastases to the regional lymph nodes and to the under side of the diaphragm. No follow-up is given. There are no illustrations. Several references are appended. EDWARDHERBERT, JR.

Isolated Hodgkin’s Disease of the Small Intestine, J. LINCKE. Ueber isolierte Lympho- granulomatose des Diinndarmes, Zentralbl. f. allg. Path. u. path. Anat. 68: 85- 87, 1937. Hodgkin’s disease in a man of eighty-two years was limited to ulcerative lesions in the small intestine and moderate infiltration of the mesenteric and aortic lymph nodes. Autopsy disclosed acute peritonitis secondary to perforation of two foci of the disease in the ileum. MILTONJ. EISEN Argentafihe Tumors. Report of Eighty-four Cases; Three with Metastases, J. E. PORTERAND C. S. WHELAN. Am. J. Cancer 36: 343-358, 1939. A series of 84 argentaffine tumors or carcinoids is recorded, of which 12 were extra- appendiceal. Three‘ of the latter group were malignant, bringing the total number of malignant argentaffine tumors in the literature to 67. Details of 18 of these in addition to the authors’ cases are presented here. The others have been previously tabulated (Wyatt: Ann. Surg. 107: 260, 1938. Abst. in Am. J. Cancer 36: 327, 1939). The authors suggest that argentaffinornas found in obliterated appendices may be the result of proliferation of the argentaffine cells following chronic inflammation, while the tumors of extra-appendiceal origin are true neoplasms. Photomicrographs and photographs of gross specimens are included. A bibliography is appended.

Tumors of the Appendix, M. NIELSEN. Tuniores i appendix, Hospitalstid. 80: Foren. for Gyn. og Obs. forh. 34-39, 1937. Four cases are reported. Three of these are of carcinoid tumors found incidentally, twice in conjunction with an acute appendicitis, once in an otherwise normal appendix removed routinely during a hysterectomy. The fourth patient was a man thirty-three years of age in whom generalized lymph node enlargement followed a cervical abscess. Biopsy showed. a benign lymphoma. Radiotherapy was given and the enlarged nodes regressed. Twelve years later, at the age of forty-five, the patient suffered from severe colicky abdominal pain and at operation a tumor was found in the appendix, infiltrating the adjacent wall of the cecum. Microscopically it was a lymphosarcoma. There was no indication of involvement of any other part of the body and the growth was considered to be primary in the appendix. Postoperative radiotherapy was given and the patient was well nine months later. One photograph is included. . EDWARDHERBERT, JR. Lipoma of the Large Intestine. Observations on Roentgen Diagnosis, H. FETZER. Das Dickdarmlipom. Betrachtungen zur Rontgendiagnose, Klin. Wchnschr. 16: 205-208, 1937. The right flexure of thk colon, containing a submucous lipoma, was resected in a man of sixty-five years. The growth had given rise to paroxysmal abdominal pain of seven years’ duration. Roentgen examination after a barium enema revealed an irregular filling defect in the involved area, but a study of the relief patterns following compression of the tumor disclosed the mass as non-infiltrating, with regular margins, sharply defined from the surrounding mucosa. A circumscribed clear zone, reputed to be characteristic of lipoma of the large bowel, was not observed in a preliminary roentgenogram prior to the administration of the contrast medium. The roentgenograms and a photograph of the extirpated tumor are reproduced. MILTONJ. EISEN 146 ABSTRACTS

Intussusception in an Adult Due to a Lipoma, H. G. N. COOPER. Brit. M J. 1: 328, 1939. A man aged thirty-three was admitted to the hospital on account of colicky abdominal pain of two weeks’ duration. The abdomen was explored and an intussusception of the ascending colon into the transverse colon was found. Resection was carried out and the operation completed by Mikulicz’s method, which seems to be the ideal procedure for dealing with adult intussusception. The intussusception was caused by a submucous lipoma, some 4 X 5 cm., growing from the posterolateral wall of the upper end of the cecum. L. FOULDS Clinical Aspects and Therapy of Carcinoma of the Colon, H. FINSTERER.Zur Klinik und Therapie des Colonkarzinoms, Wien. klin. Wchnschr. 50: 236-238, 1019-1025, .1059-1063, 1937. Radical resection was performed in 179 of 226 patients in whom operative intervention was resorted to for cancer of the large intestine. An estimate of the results after five years was possible in 96 instances: 23 patients died postoperatively, 7 died of intercurrent disease and 20 of metastases, and 42 patients were without evidence .of tumor. The record was not available in 4 cases. The paper contains a profusion of details on methods of diagnosis and surgical technic. MILTONJ. EISEN Improvements in the Operative Treatment of Carcinoma of the Large Bowel, W. W. BABCOCK. Am. J. Obst. & Gynec. 35: 386394, 1938. Babcock again calls attention to the advantages of a single-stage abdomino-perineal proctosigmoidectomy with the immediate formation of a perineal colostomy or perineal anus in cancer of the large bowel (see Surg., Gynec. & Obst. 55: 627, 1932. Abst. in Am. J, Cancer 20: 484, 1934). In the excision of the cecum, ascending colon, hepatic and splenic flexures and the descending colon he has found oblique muscle-splitting incisions of advantage. Other measures which have contributed to a reduction of mortality and morbidity following the Mikulicz type of resection are (a) suturing the antimesenteric sides of the arms of the loop to avoid inclusion of mesenteric blood vessels, a cause of fatal necrosis of the bowel; (b) closing the wound about the exterior- ized loop of bowel, applying dressings and immediately cutting away the diseased bowel; (c) tying bulbous glass tubes in the protruding ends of the bowel external to the skin level, to avoid obstructive symptoms and pressure perforation into the peritoneal cavity from indwelling glass or rubber tubes: (d) division of the spur by incision with immediate follow-up suture of the margins with interrupted 35-gauge alloy steel wire sutures, eight to fourteen days after the first operation, which requires no anesthetic or special preparation and saves the patient the days of discomfort occasioned by the crushing clamp: (e) the inversion and suture of the bowel edges also with fine wire sutures at the time of, or six to ten days after, the division of the spur. A modification of the Mikulicz operation may be used for high rectosigmoid growths with the advantage of preserving the normal sphincteric control. There are no illustrations and no references.

Rectal Carcinoma with Radical Operation in the Odense County and Town Hospital, 1922-1936, S. MULLER. Radikalopererede tilfaelde af cancer recti paa Odense amts og Bys Sygehus 1922-1936, Hospitalstid. 80: 768-771, 1937. This is a report of 162 cases of rectal carcinoma, of which 59 received radical operation. In the latter group, 19 patients were females and 40 males. There were 16 postoperative deaths. The 43 persons surviving operation had received the following treatment: 18 rectal amputation, 39 abdomino-perineal resection, and 2 local resection. Later 17 died. Of those still living, 10 had been treated by rectal amputation, with survival from one to ten years: 14 by abdominoperineal operation, with survival from one to fourteen years: 2 by local excision. There are no illustrations. EDWARDHERBERT, JR. THE PANCREAS 147

Sacral Resection of Carcinoma of the Rectum in Two Stages, T. EIKEN. Om exstirpatio sacralis recti cancrosi i 2 seancer, Hospitalstid. 80: 538-548, 1937. Sixty-one cases of rectal carcinoma are reported. Twenty-nine of these were seen before radical operations were done and received only palliative treatment. The other 32 were seen after this period. Of these, 13 were too advanced for radical surgery, 3 patients refused operation, 1 had a local excision, while the other 15 were operated on radically in two stages. A colostomy was performed, followed after several weeks by a sacral resection, the technic of which is described in detail. Only 1 of the 15 patients died as a result of the operation, while 6 died from one to two and a half years later, 4 with local recurrences, and 2 with distant metastases. The remaining 8 patients were living and symptom-free at the time of the report: 2 over five years, 1 over four years, 2 over three years, 2 over two years, and 1 over one year, A short rhmk of each case is given. There are no illustrations. EDWARDHERBERT, JR.

Three Cases of Carcinoma of the Rectum with Abdominoperineal Resection in One Stage, J. HENRICHSEN.3 tilfaelde af C. recti med extirpatio recti abdomino-sacral i 1 sbance, Hospitalstid. 80: 1224-1228, 1937. Three clinically typical cases of rectal carcinoma were operated on by the one-stage abdominoperineal method. Two patients were women, thirty-nine and fifty-nine years of age; one was a man of thirty-three years. Two patients were alive and symptom-free after four years and one year respectively. One of the women after ten months showed signs of recurrence in the region of the cervix. There are no illustrations. EDWARDHERBERT, JR.

Multiple Cancers and Polyposis of the Large Intestine, H. SCHNAACK,Ueber multiple Karzinome und Polypen im Dickdarm, Zentralbl. f. allg. Path u. path. Anat. 68: 83-85, 1937. A report of a necropsy in a man, aged fifty-seven years, with polyposis of the colon, a large ulcerating adenocarcinoma in the rectosigmoid region, and three smaller independent cancers of the large bowel as a result of malignant alteration in adenomatous polyps in the ascending, transverse, and descending colon respectively. There was a hypernephroma in one kidney. MILTONJ. EISEN

THE PANCREAS Roentgen Diagnosis of Pancreas Tumors, J. BORAK. Die Rontgendiagnostik bei Pankreastumoren, Wien. klin. Wchnschr. 50: 1428-1429, 1937. This is a general discussion of the diagnosis of pancreatic tumors by roentgen rays. An early radiographic sign of value, in the absence of pulmonary disease, is the presence of linear shadows in the basal portions of the right or left lung, depending upon the site of the pancreatic growth. The shadows represent circumscribed zones of atelectasis resulting mechanically from diminished respiratory excursions. In organs adjacent to the pancreas, changes may also be detected, i.e., in the stomach, duodenum, and gallbladder. In the stomach malignant tumors occasionally give rise to irregular deformities or filling defects; benign growths or cysts produce regular, sharply defined abnormalities. The possibility of gastric disease must be eliminated. An increase in the distance from the vertebral column to the stomach, produced by an expanding pancreatic tumor, may be demonstrated when examination is conducted in the course of inflation of the stomach by gas formed after the ingestion of a mixture of baking soda and tartaric acid. Retraction by a growth in the head of the pancreas results in diminution in size of the duodenal curve. Cholecystographic studies, in the presence of stenosis of the common duct, reveal an enlarged gallbladder, a persistent shadow of the organ, and absence of contrast medium in the intestinal canal. No illustrative cases or roentgenograms are included. MILTONJ. EISEN 148 ABSTRACTS

Two Cases of Islet Adenoma of the Pancreas, G. REITER. uber zwei Falle von In- selzelladenoin des Pankreas, Klin. Wchnschr. 16: 844-849, 1937. Two cases of islet tumor of the pancreas, manifested clinically by phenomena of hyperinsulinism, are described. The first patient, a man of forty-three, died of pneumonia, and post-mortem examination corroborated the diagnosis of islet adenoma, which was suspected during life. Excision of a growth, 2.5 cm. in diameter, in the second patient, a man of thirty-four years, resulted in a complete cure. Photographs of the gross specimens and a photomicrograph are included. MILTONJ. EISEN

THE FEMALE GENITAL TRACT

An Evaluation of Common Cervical Lesions, N. F. MILLERAND R. L. MALCOLM.Am. J. Obst. CSZ Gynec. 35: 990-995, 1938. The authors believe that the time is ripe for a revaluation of the commoner cervical lesions, especially in their relation to subsequent carcinoma. A cause-and-effect relationship or even a predisposing kinship between commonly recognized cervical disorders and cancer is by no means consistent nor proved, leukoplakia excepted. References are appended. Early Diagnosis of Cancer of the Body of the Uterus, J. P. PRATT.Am. J. Obst. B: Cy- nec. 35: 395-405, 1938. The author emphasizes the importance of irregular bleeding in the early diagnosis of cancer of the body of the uterus and records three illustrative cases. In one there was irregularity in menstruation, in a second postmenopausal microscopic bleeding, and in a third a continuous flow occurring twelve years after the menopause. In the first two cases the diagnosis was made by curettage. In the third case hysterectomy showed associated adenocarcinonia and hyperplasia. Photomicrographs are included.

Skeletal Changes Secondary to Cervical Cancer, K. W. SCHULTZE.Knochenverander- ungen bei Kollumkarzinom, Ztschr. f. Geburtsh. u. Gynak. 113: 315-324, 1936. Roentgen evidence of skeletal involvement in 7 cases of cancer of the cervix is described. True bone metastases are uncommon and were encountered in only 2 patients. One had metastases in the right femur and nasal bones, and a second in the right humerus. In 5 patients the pelvic bones were involved as a result of direct extension of the malignant process. Two patients in this group also had foci of disease in the lumbar vertebrae which were probably secondary to metastases in the aortic lymph nodes. The bone lesions are of the osteoclastic type. Fractional roentgen therapy was administered in one patient with involvement of the pelvic bones, in whotn no recurrence of the primary growth was detected. The result is not indicated. Ex- tensive disease in the remaining patients precluded therapy. Necropsies are not recorded. Three roentgenograms are reproduced. MILTONJ. EISEN

Three Cases of Carcinoma of the Cervix with Procidentia, E. PERCIVAL.Am. J. Obst. 81 Gynec. 35: 710-711, 1938. In ten years there were observed in two large Montreal hospitals 3 examples of cervical carcinoma in a prolapsed uterus. Two of the patients were old women with a long history of procidentia. The other was young, with a recent prolapse. Both the older women were treated by hysterectomy. One was well after eight years; the other had been operated on only recently. In the third case the uterus was replaced in the vagina and radium therapy was given, 5444 mg. hours in three treatments. At the time of the report, between three and four years later, there had been no recurrence.

Carcinoma in an Adenomyoma of the Uterus, D. M. GRAYZEL.Am. J. Obst. & Gynec. 35: 690-693, 1938. A case report, illustrated by photomicrographs. The diagnosis of carcinoma extending into a leiomyoma was not altogether excluded but was held by the author to be less probable than carcinoma arising in a uterine adenomyoma. THE FEMALE GENITAL TRACT 149

Use of Interstitial Radiation in the Treatment of Primary and Recurrent Carcinoma of the Uterine Cervix, A. N. ARNESON. Radiology 30: 167-179, 1938. The author first used interstitial irradiation in cases of cervical cancer recurrent in the cervix itself. Later the method was extended to patients with more extensive recurrences, and still later to certain cases of primary disease. An intra-uterine tandem alone is inadequate for most patients with cervical cancer, due to the large dose falling upon the primary lesion and the relatively small amount reaching the parametrial regions. The parametrial dose can be increased without administering excessive amounts from any particular source of radium if a greater number of sources are dis- tributed throughout the tumor-bearing region. The author plans the distribution of the needles on the basis of Quimby’s data for amounts required for delivering threshold doses to specified volumes (Am. J. Roentgenol. 33: 306, 1935). Four illustrative cases are recorded with roentgenograms showing the distribution of needles under different circumstances. As an aid in calculating tissue doses, isodose charts were prepared for interstitial sources, which can be used for radium in the same manner in which depth dose charts prepared by others have been used for x-rays. These indicate the distribution of various threshold doses along a line perpendicular to the middle of the source. The preparation of these charts is described and examples are reproduced. A bibliography is appended.

Clinical Observations on the Treatment of Primary Carcinomata of the Cervix with 800 k.v. Roentgen Rays, H. SCHMITZ,H. E. SCHMITZ,AND J. F. SHEEHAN.Am. J. Obst. & Gynec. 35: 405-417, 1938. Thirty-four cases of primary carcinoma of the uterine cervix treated by 800 kv. roentgen rays in 1933 and 1934 form the basis of this report. Treatment was given through two fields, in 10 equally spaced fractions to each field within twenty-eight days, the total for each field being 4225 r. Since the absorption at a depth of 11 cm. is about 50 per cent, this means a total midpelvic dose of 4225 to 5000 7, depending on the pelvic dimensions. The rate of irradiation is not stated. The cases are of too recent date for evaluation of end-results but a number of observations of interest have been made. Systemic reactions were negligible and the changes in the blood count and hemoglobin percentage were mild and transitory. The reactions in the skin and mucous membranes lying within the radiation beams are maf-ked during the last week of the four-week treatment period, but they usually subside rapidly and completely within four to eight weeks. The skin recovers completely within three to six months. Of the 34 patients, 17 or 50 per cent showed arrest of the growth subjectively and anatomically after three or four years. Of 4 patients in clinical Groups I and 11, all were well; 9 of 13 Group I11 patients and 4 of 17 Group IV patients were symptom-free. Photomicrographs are included, showing the radiation changes.

Adenoma of Giirtner’s Duct, REEB. AdCnome du canal de Gartner, GynCc. et obst. 36: 401-407, 1937. Also in Strasbourg mkd. 97: 375-378, 1937. A hysterectomy was performed in a woman of thirty-seven on biopsy evidence of an adenoma of the cervix, probably arising in Gartner’s duct. The growth extended bilaterally from the superolateral to the inferomedial margin of the cervix, thus cor- ,responding to the normal site of the vestigial Gartner’s duct. Microscopically it consisted of narrow, regular, non-mucus-secreting glandular formations lined by a single layer of cuboidal or flat epithelial cells with large nuclei. Two photomicrographs are included. MILTONJ. EISEN

Red Degeneration in Uterine Fibroids, P. H. J. JAKOBSSON. Om “ rgde ” fibromyomer i uterus, Hospitalstid. 80: 861-871, 1937. Red degeneration in uterine fibroids has been reported rarely in the Scandinavian literature. A case is here described in a woman forty-two years of age in whom supravaginal hysterectomy was carried out, and a general discussion of the subject is given. The classical symptoms are pain, hemorrhage, increased temperature, and the presence of 150 ABSTRACTS a tumor. Two explanations of these tumors have been given, first that they are rapidly growing myomas composed of young muscle tissue; second, that they are fibro- myomas which are degenerating. The preponderance of evidence is in favor of the latter interpretation. The treatment is surgical, either myomectomy or supravaginal hysterectomy. There are no illustrations. Several references are included. EDWARDHERBERT, JR.

Uterine Fibromyomata during Pregnancy, E. ESMANN. Fibromyoma uteri in gravi- ditate, Hospitalstid. 80: Foren. for Gyn. og Obs. forh. 29-31, 1937. From the literature it was found that the incidence of uterine fibroids as a serious complication in pregnancy was only 0.68 per cent in 25,000 births. Ten cases are reported here in women ranging in age from twenty-eight to thirty-nine years. Four patients went through labor normally,’but in one of them a hysterectomy had to be performed afterwards due to an intestinal obstruction caused by adhesions between a fibroid in the fundus and the transverse colon. In 3 cases an enucleation of the tumor was performed, with subsequent normal birth in 2 cases. The other patient aborted, but later had a normal pregnancy. In 2 cases hysterectomy was performed during pregnancy, due to the large size of the tumors. The tenth patient had a large fibroid near the cervix as well as others in the fundus, and was allowed to go to term, when a cesarean section and hysterectomy were performed. The variety of the clinical picture and the course of the fibroids as a complication is so great that no uniform treatment can be advocated. Therapy must be modified according to the characteristics of the individual case. There are no illustrations. EDWARDHERBERT JR. Large Calcified Fibroid Discovered during Roentgen Examination for Fracture of the Hip, H. BOCLBRE. Enorme fibrome calcifiC dbcouvert a I’occasion d’un examen radiographique pour fracture de la hanche, J. de radiol. et d’klectrol. 21 : 324, 1937. A woman ninety-five years of age fell and injured her hip. Radiographic examination revealed not only a fracture of the neck of the right femur but the presence of a large calcified uterine fibroid which had given no symptoms. EDWARDHERBERT, JR.

Multiple Myoblastic Myoma in a Gravid Uterus, VOSSKUHLER. Multiple Myoblasten- myome in einem graviden Uterus, Zentrabl. f. allg. Path. u. path. Anat. 68: 116-119, 1937. Hysterectomy was performed post-partum in a thirty-eight-year-old woman because of bleeding.. The uterus contained multiple nodular growths, with the histologic characteristics of myoblastic myoma. The tumor consisted of large round or polygonal non-striated cells with a homogeneous cytoplasm, containing one or rarely two nuclei. Two photomicrographs are included. MILTON J. EISEN

Radium Treatment of Uterine Fibromyoma, R. GAUDUCHEAU.Traitement curie- thbrapique des fibromyomes utCrins, J. de radiol. et d’klectrol. 21 : 1-4, 1937. Twenty-nine cases of uterine fibroids were treated with radium with only one death, and this occurred in a patient who disobeyed all instructions. Radium should be used for fibroids of small or moderate size, for cases with hemorrhagic metritis, and for all those with profuse hemorrhage. The duration of treatment is from five to seven days, which is much less than with roentgen therapy. Dosage varies from 24 to 30 milli- curies destroyed, which should produce a menopause. In case of serious hemorrhage, where the patient cannot be moved, radium is invaluable. There are no illustrations. EDWARDHERBERT, JR.

Results of Radium Therapy of Bleeding Fibromyomata, 0. BITTMANN.Unsere Er- fahrungen mit der Radiumtherapie bei blutenden Myomen, Wien. klin. Wchnschr. 50: 1552-1559, 1937. The results of intra-uterine radium therapy in 64 cases of bleeding fibromyoma of THE FEMALE GENITAL TRACT 151 the uterus are recorded. In contradistinction to roentgen irradiation, which produces regression of fibroniyoma by destroying ovarian function, radium acts directly on the myoma and the uterus, producing atrophy of the endometrium. Destruction of ovarian activity occurs less rapidly and is less complete. Radium therapy in the form of emanations (2800 mc. hr.) was successful in 2 of 5 patients with large uterine growths. In 2 patients there was no symptomatic improvement. In a third, receiving 1800 mc. hr., hysterectomy was necessary eleven months after treatment because of a supervening pregnancy and maceration of the fetus. Of 59 patients with growths of moderate or small size, treatment was successful in 56 instances. Intramural tumors are more amenable to radium than those of the submucous or pedunculated type, which readily become necrotic. In favorable cases a rapid cessation of uterine bleeding follows and the myoma either diminishes in size or remains stationary. In 11 patients sporadic bleeding was observed during short intervals after treatment, and in 2 patients pregnancy and spontaneous abortion occurred. In 3 cases the results were distinctly unfavorable: in 2 the growths enlarged progres- sively, and in 1 a uterine sarcoma developed after one year. A panhysterectomy was performed in the latter case, but the patient died seven months later of a recurrence. The paper concludes with general remarks on surgery and radiotherapy. When possible, the author is inclined to prefer excision of a fibromyoma. Roentgen therapy is more uniform than radium and simpler to control. It may be administered in the presence of complicating inflammatory disease and for any type of fibromyoma. On the other hand, when radium is employed hemorrhage is controlled more rapidly, and the effect is more localized. MILTONJ. EISEN

Value of Hormonal Findings in Hydatidiform Mole and Chorionepithelioma, S. A. COSGROVE.Am. J. Obst. & Gynec. 35: 581-589, 1938. Among 20,450 full-term deliveries there were encountered 15 cases of hydatid mole, which is 1 in 1333. Three of the 15 patients, or 20 per cent, had chorionepithelioma. In each of these cases symptoms persisted following removal or extrusion of the mole and the Friedman test was positive. In 2 patients hysterectomy was done on the basis of the hormone test and in the other following a diagnostic curettage. All three patients were well at the time of the report, eleven, twenty-three, and twenty-six months after treatment. Since metastasis is usually rapid in chorionepithelioma, it is hoped that at least the two latter cases represent permanent cures. In the patients without chorionepithelioma the Friedman test was usually reported negative at varying intervals after passage of the mole. Photographs of gross specimens and a photomicrograph are included.

A Working Classification of Adnexd Cysts and Neoplasms, V. S. COUNSELLERAND A. C. BRODERS. Am. J. Obst. & Gynec. 35: 642-648, 1938. A simple classification of cysts and neoplasms of the ovaries, parovarium, and fallopian tubes. Pathological and Clinical Aspects of Ten Cases of Primary Carcinoma of the Uterine Tube, K. SCHMIDT.Pathologie und Klinik von 10 Fallen von primarem Tuben- karzinom, Ztschr. f. Geburtsh u. Gynak. 112: 339-361, 1936. A det'ailed description of 10 cases of primary carcinoma of the fallopian tube is given. A correct diagnosis is generally made only at operation. Preoperatively the condition is considered as inflammatory adnexal disease or ovarian neoplasm. Malig- nant epithelial tumors of the tube are almost exelusively papillary alveolar carcinomata. In this series the process was too advanced in 1 patient to permit surgical intervention. Of 9 patients in whom a radical operation was carried out, 3 were tumor-free after two, three, and seven and one half years. Five patients died of progressive tumor growth. A sixth, with a second primary cervical cancer, had a recurrence of the latter tumor three months after panhysterectomy. Photographs of the gross specimens and photomicrographs are reproduced. MILTONJ. EISEN 152 ABSTRACTS

Chorionepithelioma of the Fallopian Tube, T. J. WILLIAMS. Am. J. Obst. & Gynec. 35: 863-868, 1938. A report of a chorionepithelioma in a woman of 23, believed to have arisen primarily in the fallopian tube following a tuba1 pregnancy. After removal of the right tube and ovary the Friedman test remained positive and a total hysterectomy and left salpingo- oophorectomy were done. Postoperative irradiation was given but except for one examination the Friedman test continued positive. Death twenty-three months after the first operation was apparently due to brain metastases. Autopsy was not obtained. Photomicrographs and a bibliography are included.

Chorionepithelioma of the Uterine Tube, R. L. PEARSEAND C. K. FRASER.Am. J. Obst. & Gynec. 35: 1046-1052, 1938. A case of chorionepithelioma of the fallopian tube is recorded, bringing the number of cases in the literature to 35. In the present instance, as in most of the other cases, the diagnosis at operation was ectopic pregnancy. Vaginal hysterectomy was done with removal of the adnexa but a month later the patient re-entered the hospital with pain in the chest and dyspnea. Roentgen examination showed tumor nodules in both lungs and in spite of irradiation death occurred. Autopsy was not obtained. The authors state that 4 instances of remarkable regression and recovery following chorionepithelioma of the tube have been reported. One patient was well four months after operation for a recurrence (Phillips: J. Obst. & Gynaec. Brit. Emp. 20: 299, 1911) and another two years after a salpingo-oophorectomy (Hartz: Surg., Gynec. & Obst. 23: 602, 1916). The interval in the other cases (cited by Fleurent et al.: Bull. SOC.d’obst. et de gynCc. 22: 452, 1933) is not given here. Photomicrographs are included. References are appended.

Diagnostic Difllcultiesin Operating on Ovarian Tumors, G. W. A. PRUIS. Diagnostische moeilijkheden tijdens operaties van ovariaaltumoren, Geneesk. tijdschr. v. Neder1.- Indi&78: 3235-3239, 1938. Several cases are briefly reported that showed clinical findings indicative of malignancy, while histologically they were benign. Several others showed the reverse condition. The best chance for successful diagnosis, which is so necessary to carry out proper therapy, is close collaboration between the surgeon and the pathologist. There are no illustrations. EDWARDHERBERT, JR.

Observations on the Histogenesis of Brenner Tumor of the Ovary, H. 0. KLEINE. Zur Kliirung der Histogenese der Brennerschen Eierstocksgeschwillste, Ztschr. f. Ge- burtsh. u. Gynak. 114: 125-140, 1937. Five cases of Brenner tumor found incidentally in operative specimens are described. In 3 cases the tumor was associated with a pseudomucinous cyst, in 1 with a serous cyst, and in 1 with a cyst of the epoophoron situated in the mesosalpinx. The Brenner tumor is benign and possesses no endocrine function. The histologic characteristics of the tumors in the author’s series were typical-small circumscribed groups of undifferentiated epithelial cells, rich in glycogen, embedded in a dense stroma. Differentiation to squamous epithelium and serous or mucus-secreting cells may be observed in isolated areas of the growths. Microcysts are common. A discussion on histogenesis is appended. Three possibilities of origin are considered. The tumors may arise in the superficial epithelium of the ovary, in the celomic epithelium, thus being related to the Werth nodules of epithelial cells occasionally observed in the serosa of the uterine tube, or in remnants of the wolffian body. Photomicrographs are included. MILTONJ. EISEN Disgenninoma of the Ovary. Clinical and Pathologic Study of Seventeen Cases, E. NOVAKAND L. A. GRAY. Am. J. Obst. & Gynec. 35: 925-937, 1938. This paper deals with 17 disgerminomas observed by the authors. The patients ranged in age from six to thirty-eight years. In 10 cases the capsule of the tumor was intact with no extension beyond the ovary. Except for one patient who died of post- THE FEMALE GENITAL TRACT 153 operative intestinal obstruction all of this group have remained free from recurrence, though in some only a few months have elapsed since operation. In 6 patients there was evidence at operation of local infiltration, at times extensive, or of metastases to other organs. Three of these 6 patients are dead, 1 of postoperative shock, 1 three months, and 1 six months after operation. One patient, treated by incomplete operation followed by radiotherapy, is living and in good general health four years after operation, though a small pelvic nodule is still palpable on rectal examination. The remaining 2 patients have not been traced. In 1 instance information as to the presence or absence of metastases was unavailable. Three patients showed under-development of the external or internal genital organs. Three had borne children before the occurrence of the tumor and 2 became pregnant after operation. The authors believe that conservative unilateral operations should be limited to unilateral growths in which the capsule of the tumor is intact, and in which there is no evidence of infiltration or metastasis. In all other cases removal of both ovaries and uterus would seem to be the preferable procedure. [Postoperative irradiation is a valuable adjunct, as this type of neoplasm is presumably radiosensitive, cures having been obtained after incomplete excision among the 72 published examples of this tumor.] Photomicrographs and 2 gross illustrations are included and there is a bibliography.

Disgerminoma Ovarii, S. BRODY. Am. J. Obst. & Gynec. 35: 708-710, 1938. The author is in agreement with the majority of writers that ovarian disgerminomas are only mildly malignant. He records the case of a young woman whose right ovary was removed on a diagnosis of medullary carcinoma. Three and a quarter years later she complained of lower abdominal pain and the remaining ovary was found to be slightly enlarged. Because of the former diagnosis of carcinoma a panhysterectomy was performed. A chronic salpingo-oophoritis was found, without evidence of malignant growth. A restudy of the specimen from the earlier operation led to revision of the diagnosis to disgerminoma. Photomicrographs are included.

Disgerminoma Ovarii, R. B. GREENBLATTAND E. R. PUND. Am. J. Obst. & Gynec. 35: 667-675, 1938. Five examples of ovarian disgerminoma are recorded. Two were bilateral and 3 unilateral when first seen, but all proved to be malignant. The patients were from twelve to thirty-five years of age and the symptoms seem in no instance to have exceeded a year in duration. The disgerminoma arises from germinal cells misplaced at the time of asexual em- bryonal growth of the gonad when the mesenchyme is undifferentiated, undetermined and neutral. It exerts no masculinizing effect but is frequently accompanied by breast hypoplasia, an infantile uterus, and under-development of the external genitals. Photomicrographs and references are included.

Theca Cell Tumor of the Ovary, H. S. FISCHER.Am. J. Obst. Sr Gynec. 35: 1070-1072, 1938. A case of ruptured theca-cell tumor of the left ovary in a woman of thirty-four is recorded. The chief symptoms were amenorrhea of eleven months’ duration and a sudden attack of pain in the left leg, thigh, and hip radiating to the lower abdomen, the day before admission. Removal of the ovary was followed by complete regression of symptoms. A photomicrograph and 3 bibliographic references are included.

Psammocarcinoma of the Ovary, E. WERNER. Ein Beitrag zur Frage des Psammo- karzinoms des Ovariums, Ztschr. f. Geburtsh. u. Gynak. 114: 140-146, 1937. Two cases of papillary carcinoma of the ovary containing laminated deposits of calcium are described in patients aged fifty-seven and sixty-one years. Histologically the tumors were of low-grade malignancy but peritoneal implantations made radical resection impossible. There is no mention of any attempt at irradiation. The psam- momatous areas were present chiefly in the papillary projections of the growths. Photo- micrographs are included. MILTONJ. EISEN 154 ABSTRACTS

Masculinizing Elements in the Ovary, R. A. REIS AND 0. SAPHIR. Am. J. Obst. Sr Cynec. 35: 954-959, 1938. Three instances of apparent foreign cell structures in the ovary are reported. In the first, the ovary of a still-born infant revealed misplaced suprarenal cortical structures situated below the surface, opposite the hilus. In the second instance,*sucha structure was found in the wall of a cyst in an adult ovary. In the third, a tumor of the ovary consisting of similar structures was found definitely linked with the symptoms of interrenalism. The question of differential diagnosis between lutein-cell tumor and hypernephroma of the ovary is discussed, and it is suggested that whereas on morphologic grounds a differential diagnosis is next to impossible, interrenalism is more likely to point toward the suprarenal cortical origin of the tumor cells. Photomicrographs and references are included.

Hormone Assays in a Patient with a Masculinizing Ovarian Tumor, E. GLASERAND 0. HAEMPEL. nber Hormonbefunde bei einer virilisierenden Ovarialgeschwulst, Klin. Wchnschr. 16: 858-861, 1937. Moderate masculinization developed in a twenty-seven-year-old woman during the fourth month of pregnancy. Three and a half months after the birth at term of a still- born infant, a solid tumor of the left ovary was removed, which histologically proved to be a fibroma with areas of mucoid degeneration. Masculinization was incomplete, as shown by the recurrence of menstruation eight weeks after childbirth. Urine and blood examined prior to operation contained excessive amounts of androgenic substance, but after operation the abnormal urinary androgen disappeared. Androgen was also demonstrable in the ovarian tumor and in the fluid of a right ovarian cyst. Blood estrogen was normal preoperatively. Assays of urinary estrogen before operation and of the hormone levels in the blood after removal of the tumor were not made. The masculinizing syndrome disappeared. There are no illustrations, A bibliography is included. MILTONJ. EISEN Bilateral Ovarian Dermoid Cysts with One Dermoid Containing an Appendix and a Portion of Ileum, L. E. SCHOTTENPELDAND E. V. LITTAUER.Am. J. Obst. & Gynec. 35: 889-892, 1938. Bilateral ovarian dermoid cysts were removed from a woman of thirty-nine years. The smaller contained hair and osseous and adipose tissue. In the other there was a segment of intestine and an appendix with the muscular coat and serosa well formed; the mucosa was intact, and the submucosa contained several immature lymph follicles and one which was mature. Photographs of the larger cyst are included.

Pregnancy Complicated by Bilateral Dermoid Ovarian Cysts, B. NOTES, Am. J. Obst. & Gynec. 35: 1069-1070, 1938. The author records the successful removal of bilateral ovarian cysts from a patient three and one-half months pregnant. The pregnancy continued normally except for transient edema and elevation of blood pressure in the ninth month, when labor was induced and no further complications ensued. This adds to the evidence already at hand that, in the human being, the corpus luteum verum is not absolutely necessary for the preservation and sustenance of pregnancy. References are included.

Dermoid Cyst of Ovary in a Child Five Years Old, with Comments on Value of X-ray in the Diagnosis, V. P. MAZZOLAAND L. M. RYAN. Am. J. Obst. & Gynec. 35: 696-698, 1938. A five-year-old girl had lower abdominal pain unassociated with nausea or vomiting. Examination revealed a palpable mass in the abdomen and roentgen examination showed a tumor containing what appeared to be a rudimentary mandible with teeth. A diagnosis was made of dermoid cyst of the ovary and this was confirmed at operation. Recovery was uneventful. Roentgenograms and references are included. THE FEMALE GENITAL TRACT 155

Late Metastases Following Removal of Bilateral Malignant Ovarian Cysts, C. FLEISCH- MA”. Spatmetastase nach Exstirpation beiderseitiger karzinomatoser Eierstock- zysten, Wien. klin. Wchnschr. 50: 1396-1397, 1937. A case is reported of papillary carcinoma of the ovary in a patient of twenty-one years with late widespread metastases and a fatal termination fourteen and one-half years after the first manifestations of the disease. Roentgen therapy was employed following .extirpation of the primary growth, which involved both ovaries. Seven years later a metastasis in the left supraclavicular region appeared. In spite of repeated radical removal and radiotherapy, the supraclavicular mass recurred on two occasions. One year before death metastases developed successively in the mediastinum, ileocecal region, and subcutaneous tissues of the extremities. Several courses of irradiation therapy were of palliative effect. Post-mortem examination is not recorded and there are no illustrations. MILTONJ. EISEN

Bilateral Ovariectomy in Cases of Unilateral Ovarian Tumor, H. KAHR. Wann ist bei einseitiger Ovarialgeschwulst die Entfernung beider Ovarien angezeigt? Wien. klin. Wchnschr. 50: 1083-1088, 1937. The probable necessity of bilateral ovariectomy in cases of neoplasia of the ovary may be deduced from the following table indicating the frequency of bilateral ovarian involvement by various types of tumor. I. Connective-Tissue Tumors (3 per cent of total) Fibroma ...... , 14 per cent Sarcoma...... 35 percent 11. Epithelial Tumors (80 per cent o Pseudomucinous cystadenoma (benign or with malignant change). 6 per cent

... 40-50 per cent ...... st always unilateral Granulosa-cell tumo . . , , . . 7 per cent Arrhenoblastonia. .. st always unilateral Hypernephroma...... st always unilateral 111. Teratoid Tumors (17 per cent of total) ...... 13 per cent Teratoma ...... Almost always unilateral Rare forms, as fibro-adenoma cysticum, Brenner’s tumor, and struma ovarii are usually unilateral. Metastatic cancer is generally bilateral. No data are included illustrating the final results of various operative procedures as employed by the author in cases of each type of ovarian neoplasm. MILTONJ. EISEN

Radium Therapy of Cancer of the Vulva, J. NUYTTENAND R. GARRAUD.Valeur de la curiethkrapie dans le traitement du cancer de la vulve, GynCc. et obst. 36: 508-521, 1937. The author records 17 cases of cancer of the vulva treated with radium. The series includes a basal-cell cancer and 16 squamous-cell carcinomata. Four patients were alive and without evidence of disease two to five years after treatment; 4 became tumor- free but had recurrences after eight months, two, five, and six years. In 9 instances radium had no appreciable effect on the neoplasm. MILTONJ. EISEN

Cystic Adenofibroma Developing from Breast Tissue Remnants in the Left Labium Majus, V. ROTH. Zystisches Adenofibrom auf der Basis einer persistierenden Brustdriisenanlage in der linken grossen Schamlippe, Ztschr. f. Geburtsh. u. Gynak. 112: 245-255, 1936. A single case is recorded of a large cystic adenofibroma in the left labium majus, identical with the type encountered in the breast. The mass was removed surgically. An origin in heterotopic mammary tissue is surmised. Photographs of the patient and of the tumor and photomicrographs are included. MILTONJ. EISEN 156 ABSTRACTS

Dysmenorrhea in a Girl of Fifteen Associated with an Inguinal Adenoflbroma, REEB. A propos d’un cas particulier de ‘‘ dysmCnorrhCe ” chez une jeune fille de 1.5 ans: adhofibrome de la r6gion inguinale, GynCc. et obst. 35: 161-168, 1937. Pain in the lower back recurred in a girl, aged fifteen, with each menstrual period. At the age of five months an operative reduction of a strangulated inguinal hernia, containing the uterus and left adnexa, had been performed. A bilobed mass, measuring 5 x 3 x 3 cm.,’was now present in the region of the inguinal cicatrix. This enlarged and became tender at the time of menstruation. It was excised and a complete cure resulted. Microscopically the growth was an endometrioma formed of uterine glands and a fibromuscular stroma. A photomicrograph is included. MILTON J. EISEN

Papillary Cystadenocarcinoma in the Canal of Nuck, J. K. MILLER. Am. J. Obst. Sr Gynec. 35: 1065-1067, 1938. A woman of fifty-four gave a history of a slowly growing mass in the left labial region first observed three years previously. At operation it proved to be a papillary cystadenocarcinoma in the canal of Nuck. Whether it arose from a wolffian body or an ovary could not be determined with certainty. A photomicrograph of the tunior is included. References are appended.

Case of Primary Epithelioma of the Clitoris, A. LAPFONT,J. MONTPELLIER,AND P. JACQUEMIN. Sur un cas d’CpithCrlioma primitif du clitoris, GynCc. et obst. 35: 81-94, 1937. Also in LiCge mCd. 30: 443-460, 1937. A woman of sixty years had a squamous-cell cancer of the clitoris which attained dimensions of 2 X 3 cm. in the course of three and one half years. The mass was treated with radium, applied intravaginally for six days and externally for eight days. The total dose was 269 mg., the filtration 0.5 mm. platinum and 1.5 mm. gold. Seventy days later the mass was greatly reduced in size. Three photographs of the patient are included. MILTON J. EISEN

THE GENITO-URINARY TRACT

Carcinoma in Kidney Fistula of Thirty Years’ Duration, H. KUNSTMANN.Karzinom- entwicklung in einer 30jahrigen Nierenfistel, Zentralbl. f. allg. Path. u. path. Anat. 68: 49-51, 1937. A thirty-seven-year-old man gave a history of rupture of the right kidney at the age of seven years following a fall. An operative repair had been performed, leaving two fistulae continuously secreting urine and concrement. Pain in the diseased area, excretion of purulent material and loss of weight of two months’ duration prompted surgical intervention. A squamous-cell cancer and kidney remnant were extirpated. The growth probably arose in the wall of one of the fistulous tracts lined by cornified epithelium. Within a short time it was necessary to remove a local recurrence and a metastasis on the right side of the thorax. MILTON J. EISEN

Glomeruloma of the Kidney with Report of a Case and Review of the Literature, C. I. OWEN. Am. J. Clin. Path. 8: 302-314, 1938. A woman of fifty-two years who gave a history of lumbar pain and frequency of urination was found to have a solitary tumor in the lower pole of the right kidney, 2.5 cm. in diameter. The periphery of the tumor showed well demarcated glomerular structures without any vascular tufts and having a limiting membrane lined by a single layer of cuboidal cells which exhibited some piling up and some anaplasia. The glomerular structures themselves consisted of masses of cells similar to the lining of the peripheral membrane and were attached to the peripheral cells at one or more points. The cytoplasm of the cells was non-granular; the nuclei were round, some of them were hyperchromatic, and an occasional mitotic figure was present. Because of the architecture of the tumor the author calls it a glomeruloma, though it could also be termed a metanephroma since it has its source in metanephric tissue. He believes that it arose in an embryonic remnant. Microscopically it is malignant THE NERVOUS SYSTEM 157 because of its invasive properties and because of the anaplasia of the cells. Clinically, however, it has behaved as a benign tumor, since it has pot recurred after an interval of five and one-half years following removal. The patient had previously been operated on for a breast carcinoma but this is believed to bear no relation to the renal neoplasm. In a review of the literature 8 cases were found which the author believes may be designated glomeruloma. These are briefly described. Only one (Hildebrand : Arch. f. klin. Chir. 48: 343, 1894) bore a close resemblance to the case recorded here. Four photomicrographs are reproduced and a bibliography is appended.

Tumors of the Renal Capsule, E. WACHS. Reitrag zu den Nierenkapselgeschwulsten, Beitr. z. klin. Chir. 166: 1-11, 1937. This is a case report of a fibrosarcoma originating in the capsule of the posterior surface of the left kidney in a man of thirty years. The growth and the infiltrated kidney were removed surgically. The mass measured 30 X 22 cm. and weighed 7.5 kg. An inoperable recurrence developed after three and one half months. Irradiation therapy was without effect and the patient died several months later. Two photographs of the tumor and photomicrographs are reproduced. MILTONJ. EISEN

Calcified Bilharziasis, Ureteral Dilatation, and a Tumor Originating in the Bladder. Radiologic Diagnosis, P. C. SMYRNIOTIS.Vessie bilharzienne calcifiCe, dilatation des urethres et tumeur greffCe sur la vessie. Diagnostic radiologique, J. de radiol. et d’klectrol. 21 : 489-493, 1937. Bilharziasis or schistosomiasis of the bladder which is so common in northern Africa can lead to a tremendous thickening of the bladder wall with calcification. Of 11 cases of carcinoma arising in bilharzial bladders, 10 showed marked calcification. From this series and a review of the literature it is concluded that cancer in these cases is dependent on the calcification rather than on the bilharziasis per se. Two roentgenograms and 17 references are included. EDWARDHERBERT, JR.

Significance of Mucus in Carcinoma of the Prostate Gland, F. PILCHER,JR. Am. J. Clin. Path. 8: 366-370, 1938. In a study of 71 cases of adenocarcinoma, 4 cases of squamous-cell carcinoma, and 13 cases of ordinary benign hyperplasia of the prostate gland, it was found that the amount of mucus present is inversely proportional to the degree of malignancy, the lower the degree of malignancy the greater being the production of mucus. Even the high-grade carcinomas contained mucus only in their somewhat slower-growing areas, the extremely rapidly growing areas containing no mucus whatever. The occurrence of mucus in carcinoma of the prostate gland may be due to the less differentiated and less specialized carcinoma cell reverting to a more primitive function of mucus formation which is rarely exhibited in the fully differentiated adult cell of the prostate. In the more rapidly growing high-grade carcinomas the cells are too undifferentiated to function as producers of mucus. References are appended.

Squamous-cell Carcinoma of the Penis, A. REYN. Carcinoma spinocellulare penis, Hospitalstid. 80: Dansk derm. selsk. forh. 41, 1937. A man thirty-eight years of age with syphilis had large condylomata of the penis which were treated by diathermy and radiotherapy without improvement. Several biopsies showed no evidence of malignancy. The patient refused operation but returned nine months later with an advanced ulcerated squamous-cell epithelioma. No follow-up is given and there are no illustrations. EDWARDHERBERT, JR.

THE NERVOUS SYSTEM

Brain Tumors during the First Decade of Life. H. DI GASPERO. Hirntumoren im ersten Lebensjahrzehnt, Arch. f. Kinderh. 108: 149-171, 1936. Three cases of intracranial tumors in children, proved by necropsy, are recorded : ;L glioblastoma multiforme of the cerebellopontinc angle in a child of four and astro- 158 ABSTRACTS cytomas of the cerebellopontine angle in children of five and nine. [The location is rather unusual in children.] . EDWINM. DEERY Cerebellar Tumors with Essentially Normal Spinal Fluid Findings in Children, P. v. KISS AND I. FBNYES.Uber Kleinhirntumoren mit fast normalem Liquorbefund beim Kinde, Arch. f. Kinderh. 108: 71-78, 1936. Three short case reports are given: two of ependymomas and one of a sarcoma, occurring in the midline of the cerebellum in children. In none of the cases was the spinal fluid remarkable. EDWINM. DEERY

Injection of Air into Cystic Brain Tumors in Children, P. v. KISS AND I. F~NYES. LuftfUllung von zystischen Gehirntumoren beim Kinde, Arch. f. Kinderh. 107: 129-132, 1936. The writers give two rather incomplete case reports to illustrate the replacement of cystic fluid in brain tumors by air. The rationale of injecting air is to '' restore intracranial pressure and prevent hemorrhage.'' [Patients with intracranial tumors need no restoration of intracranial pressure. They need relief from increased intracranial pressure and an attempt at surgical removal of the tumor. Air injected into the brain is absorbed anyway within about forty-eight hours.] EDWIN M. DEERY

Hereditary Brain Tumors, J. HALLERVORDEN.Erbliche Hirntumoren, Nervenarzt 9: 1-8, 1936.

A review of the literature on " hereditary " brain tumors is given, covering the years 1896 to 1932, followed by abstracts of some recent cases and a report of a case seen by the author. The patient, whose sister had died from a brain tumor, had convulsive seizures and at necropsy showed " a diffuse extension of glial cells that had undergone blastomatous change." EDWINM. DEERY

Differential Diagnosis of Progressive Paralysis, Brain Syphilis, and Brain Tumor, F. UTZ. Beitrag zur Differentialdiagnose zwischen progressiver Paralyse, Hirnsyphilis und Hirntumor, Deutsche Ztschr. f. Nervenh. 143: 39-60, 1937. Two cases of brain tumor with positive serologic evidence of syphilis are described. The first patient, a man aged thirty, had visual disturbances of six weeks' duration. The right eye was blind. Light perception was present in the left eye. The Wasser- mann reaction of the blood and spinal fluid was positive and the colloidal gold curve was of the paretic type. A diagnosis of paresis was made despite bilateral papilledema. Antisyphilitic treatment was administered without avail and an induced malaria termi- nated following the development of facial erysipelas. The patient died two months later in a demented state. Necropsy disclosed syphilitic changes in the aorta and meninges and a meningioma in the right temporal lobe. No cerebral evidence of paresis was observed. The second patient was a woman of sixty-three years who complained of headache, vertigo, and nausea. Dementia succeeded an early moderate decrease of mental power. A roentgenogram of the skull revealed an indistinct contour of the sella turcica and absence of bone markings in the surrounding region. The changes suggested a diagnosis of hypophyseal tumor, but the colloidal gold curve of the spinal fluid indicated cerebral syphilis. The blood and spinal Wassermann reactions were, however, negative. No benefit was derived from irradiation of the pituitary or mercury inunctions. Ten months later blindness, bilateral choked discs, and enlarged cervical lymph nodes developed. The case is considered one of tumor, but the ultimate course is not stated. A bibliography is included. MILTONJ. EISEN

Roentgen Diagnosis of Meningiomata of the Sphenoid Wing, S. ERIKSON.Die Kont- gendiagnostik der Meningeome des Keilbeinfltigels, Nervenarzt 9: 161-170, 1936. A good study of 12 cases of meningiomata of the sphenoid wing from the roentgenographic point of view. X-ray studies were carried out in all cases and a correct pre- THE NERVOUS SYSTEM 159

operative diagnosis was made in 8. All 12 cases were verified at operation. The typical roentgen findings are described and there are 18 illustrations. A bibliography is appended. EDWINM. DEERY

D)Muse Melanotic Tumors of the Leptomeninges, A. UENEDEK. Zur Kenntnis der diffusen melanotischen Geschwiilste der weichen Hirnhaut, Deutsche Ztschr. f. Nervenh. 142: 153-161, 1937. A woman of twenty years had signs of meningeal irritation, epileptiform seizures, tremor, vomiting, optic nerve atrophy, disturbances in the function of the eye muscles and in audition, difficulty of speech and deglutition, muscular hypotonus, and absence of reflexes in the lower extremities. Her condition was diagnosed as syphilitic meningo- encephalitis, although the Wassermann reaction in the blood and spinal fluid was negative. She died six months after the onset of the illness. Necropsy showed a diffuse gray to black pigmentation of the thickened leptomeninges of the brain, with small isolated nodular growths. The spinal meninges were infiltrated but not pigmented. Microscopically the constituent tumor cells were either round or elongated. They showed little tendency to polymorphism. Mitoses were uncommon. Many cells contained melanin. In some areas there was infiltration of the cerebral cortex by way of the blood vessels. The process represents a diffuse melanoma of the meninges. An isolated harmless nevus on the right arm was probably without significance. Photo- micrographs are included. MILTONJ. EISEN

Case of Intracranial Tumor, E. S~RENSEN.Tilfaelde af intrakraniel tumor, Hospital- stid. 80: Dansk neur. selsk. forh. 51-52, 1937. A man forty-four years of age with a clinical history dating back twenty-one years was believed to have a frontal lobe tumor. At operation a large olfactory meningioma was found. No follow-up is given and there are no illustrations. EDWARDHERBERT, JR.

Case of Intracranial Tumor with Sinusitis as the Presenting Symptom, 0. BRINCH. Tilfaelde af intracraniel tumor med sinuitis som hovedsymptom, Hospitalstid. 80: Dansk oto-laryng. selsk. forh. 26-28, 1937. A man fifty-two years of age had symptoms of a frontal sinusitis. Roentgenograms showed a cloudiness of all the sinuses on the right side but no bony changes. Drainage was instituted but the symptoms persisted and the patient became irrational. Other- wise neurological examination was negative. A few weeks later a right hemiparesis developed and death occurred the next day. At autopsy a large tumor was found, apparently arising from the meninges. It had infiltrated through the sphenoid and ethmoid bones, but showed no infiltration into the brain tissue. Microscopically it was not typical of a meningioma but was composed of cells more like epithelial cells, closely packed with scanty stroma. In some areas these tended to form small alveoli, in others their arrangement was more irregular. They grew invasively along the vessels of the pia and into the sulci, but not into the brain substance. Brinch is inclined to believe that the tumor was a type of endothelial sarcoma, possibly meningeal. There are no illustrations. EDWARDHERBERT, JR.

Case of BilaterJ Parasagittal Meningioma, K. G. BENTSEN. Tilfaelde af dobbeltsidipt parasagitalt Meningeom, Hospitalstid. 80: Dansk neur. selsk. forh. 33-34, 1937. This is a report of a parasagittal meningioma in a woman of forty-three, demonstrated radiographically and successfully removed at operation. No follow-up is given and there are no illustrations. EDWARDHERBERT, JR.

Two Cases of Meningioma of the Sylvian Fissure, E. S~RENSEN.To tilfaelde af fissura Sulvii meningeom, Hospitalstid. 80: Dansk neur. selsk. forh. 34-36, 1937. The cases of a forty-five-year-old woman and a thirty-seven-year-old man are recorded. Clinically they were identical, with right exophthalmos, diminution of vision on the right side, and diplopia. In both cases roentgen examination revealed a menin- 160 ABSTRACTS

gioma of the fissure of Sylvius. The diagnosis was verified at autopsy in the first case. The second patient refused operation. Two photographs are included. EDWARDHERBERT, JR.

Clinical and Pathologic Aspects of Glioma Metastases in the Subarachnoid Spaces, G. BODECHTELAND K. SCHULER. Zur Klinik und Pathologie der Liquormetastasen bei Gliomen. Deutsche Ztschr. f. Nervenh. 142: 85-119, 1937. Eight cases of cerebrospinal dissemination of brain tumor are described. With the exception of a single example of meningoblastoma, all the tumors were gliomata. While glioma does not give rise to metastatic foci outside the central nervous system, dissemination in the brain and spinal cord subsequent to rupture of a tumor into the ventricles or subarachnoid space occurs not infrequently. Diagnostic and therapeutic procedures or trauma appear to operate as factors predisposing to this complication. In some cases an associated clinical syndrome is observed-signs of meningeal irritation and unexplainable symptoms referable to the cranial nerves at the base of the brain and to the spinal nerves. Rarely the identification of neoplastic cells in the cerebrospinal fluid is possible. Hemorrhagic gastric erosions and hematemesis may develop as a result of a disturbance of the hypothalamic region. Frequently there are no clinical manifestations. (1) A man of twenty years with a medulloblastoma of the cerebellum died postoperatively. Clinically the case was purely one of cerebellar neoplasm. Necropsy disclosed in addition diffuse tumor growth in the ventricular system, but the subarachnoid space was free. (2) The primary site in this case of medulloblastoma in a child of six years was undetermined. Clinically the condition was manifested by vertigo, ataxia, vomiting, papilledema, disturbances in the function of the bladder and rectum, paraparesis of the lower extremities, and inanition. The child died postoperatively. Diffuse involvement of the subarachnoid space of the brain and spinal cord was found at autopsy. (3) A man of thirty-one years with clinical evidence of a tumor in the posterior fossa and prominent associated cerebellar symptoms died nine months after decompres- sion. Three foii of medulloblastoma were identified-one, probably primary, in the wall of the fourth ventricle, with rupture into the cerebellopontine region; a second in the cerebellum, and a third in the third ventricle. There were diffuse deposits of tumor in the subarachnoid space of the base of the brain and cerebellum. (4)A woman of forty years had clinical manifestations of an expanding lesion in the posterior fossa, accompanied by convulsive seizures. The primary tumor was not definitely identified. The growth was a meningeal sarcoma or meningioblastoma of Oberling, with diffuse involvement of the meninges, especially at the base of the brain, and secondary invasion of the brain tissue along the blood vessels. The tumor invaded the optic and oculomotor nerves, metastasized to the ependyma of the infundibulum, and infiltrated the spinal meninges and spinal nerve roots. (5) A man aged thirty-five had epileptiform seizures over a period of fifteen years, and hematemesis shortly before death. No gastric lesion was discovered, but a medulloblastoma was found in the right temporal lobe. The tumor infiltrated the adjacent meninges, involved the basal ganglia internally, and ruptured into the inferior horn of the lateral vertricle, thus giving rise to numerous metastatic foci in the lateral and fourth ventricles. I (6) The condition of a woman aged thirty years, with a medulloblastoma or atypical ependymoma in the right parietal lobe, was temporarily ameliorated following a de- compression. Gastric hemorrhage without a local lesion developed prior to death. The tumor was disseminated in the entire ventricular system secondary to rupture in the inferior horn of the lateral ventricle. (7) A man of twenty-four years had signs of meningeal irritation and marasmus, and at autopsy a medulloblastoma was found originating in the region of the corpora quad- rigemina. It infiltrated the cerebellum and the basilar meninges and metastasized to the walls of the third and fourth ventricles. (8) A forty-five-year-old man died three weeks after operation for tumor in the left THE NERVOUS SYSTEM 161

temporal lobe. The growth was an undifferentiated glioma which infiltrated the basal ganglia and ruptured into the cisterna basalis possibly as a consequence of operative trauma. There were terminal hemorrhagic erosions in the stomach. The paper is accompanied by a photograph of the brain in the fifth case and photomicrographs. MILTONJ. EISEN

Cases of Glioblastoma Multiforme, T. DALSGAARD-NIELSEN.Tilfaelde af glioblastome multiforme, Hospitalstid. 80: Dansk neur. selsk. forh. 37-41, 1937. Three cases of glioblastoma multiforme are reported, all confirmed by autopsy. In the first patient, a woman of fifty-seven years, the tumor was superficially located in the right parietal and occipital lobes. In the second, a woman of forty-seven years, it arose in the corpus callosum and extended laterally into both hemispheres. In the third patient also, a man of thirty-seven, the tumor was in the corpus callosum. In all cases the clinical picture was typical of a rapidly growing tumor of the particular part of the brain involved. Two photographs are included. EDWARDHERBERT, JR.

Colloid Tumor of the Third Ventricle, W. SCHMIDT.Kolloidtumor des dritten Ventri- kels, Zentralbl. f. allg. Path. u. path. Anat. 67: 1-3, 1937. A woman of thirty-seven suffered from headache and short intervals of loss of con- sciousness one week prior to sudden death. Necropsy revealed a cyst, 2.1 cm. in diameter, probably ependymal in origin, attached to the choroid plexus in the anterior portion of the third ventricle. The mass consisted of colloid material in which prac- tically no cellular structure was visible. A photograph of a cross-section of the brain is reproduced. MILTON J. EISEN

Carcinoma of the Choroid Plexus with Unusual Clinical Manifestations, N. ZDRAHAL. Ein Fall von Karzinom des Plexus chorioideus mit ungewohnlichen klinischen Erscheinungen, Arch. f. Kinderh. 109: 24-29, 1936. A clinical case report, relating the appearance of diabetes insipidus and progressive signs of increased intracranial pressure in a child of ten years. Necropsy revealed a papillary carcinoma of the third ventricle. There is a brief review of the literature and three illustrations are included. EDWINM. DEERY

The Electro-encephalogram in a Case of Pathological Sleep Due to Hypothalamic Tumor, W. G. WALTER,G. M. GRIFFITHS,AND S. NEVIN. Brit. M. J. 1: 107-109, 1939. Electro-encephalograms were taken from a woman aged sixty-two who was admitted to hospital in a state of pathological sleep. She died five days later and autopsy revealed a tumor, described as a perithelial sarcoma, involving the thalamus, hypothala- mus, and basal ganglia on the left side. The encephalograms resembled those obtained in deep natural sleep and were characterized by very large, slow irregular waves imperfectly synchronized in the two hemispheres. These slow waves indicate that the cortex responsible for them is in a state of profound, sometimes pathological, inactivity; their distribution in the present case suggests that no part of the cortex was functional. In cases of coma due to raised intracranial pressure or hydrocephalus a very regular rhythm of small amplitude may be found in all areas; it seems, therefore, that the electro-encephalogram may be useful in differentiating between the stupor of hydrocephalus and that of hypersomnia associated with a local lesion in the hypothalamic region. L. FOULDS

Case of Intracranial Angioma, C. JOHANSEN. Et tilfaelde af intracranielt angiom, Hospitalstid. 80: 671-677, 1937. A man twenty years of age developed signs of intracranial hemorrhage and died. Autopsy showed a racemose angioma involving the right temporal lobe. A photograph, a photomicrograph, and several references are included. EDWARDHERBERT, JR. 162 ABSTRACTS

Psychotic Symptoms Following Irradiation Therapy of Cerebral Tumors, L. BENEDEK. Psychotische Symptome nach Rontgenbestrahlungen hei zerebralen Tirmoren, Wien. klin. Wchnschr. SO: 278-280, 1937. A psychopathic syndrome characterized by pronounced euphoria and mental hyperactivity was observed in 2 patients with cerebral tumors following roentgen therapy. MILTONJ. EISEN

Cushing’s Disease and Basophilic Adenoma, E. J. KRAUS. Morbus Cushing und basophiles Adenom, Klin. Wchnschr. 16: 533-536, 1937. Hypophyseal basophilic adenoma is considered a secondary phenomenon in Cush- ing’s disease, developing as a result of a compensatory mechanism, rather than of etiologic significance. Typical cases have been described without changes in the pituitary gland, and basophilism without clinical Cushing’s syndrome may occur, as in obesity and in older individuals, who tend to have in addition arteriosclerosis, diabetes, and osteoporosis. A central cerebral disturbance and interrenalism have been suggested as primary factors. Lipoid hyperplasia of the adrenal cortex is a common finding in the disease. Abnormalities in the sex functions are characteristic of Cushing’s disease, despite the increase in basophilic cells which are said to secrete the gonadotropic hormone. Im- plantation in infantile female mice of fragments of basophilic adenoma of a patient without endocrine disturbance was followed by the identical ovarian changes and vaginal proliferation produced by normal anterior pituitary gland tissue or secretion, in contrast to an absence of reaction after a similar experiment with adenomatous tissue of a patient with Cushing’s disease. A case considered clinicall) as Cushing’s syndrome in a man aged twenty-seven years is described, with the following manifestations: polydipsia, polyuria, glycosuria and hyperglycemia, hypercholesterinemia, hypertonia, striae on the abdomen and thighs, adiposity, decrease in the quantity of facial hair, and osteoporosis. There was a terminal sepsis. Necropsy failed to reveal pituitary basophilism. The hypophysis showed instead a decrease in basophiles, colloid degeneration of the individual cells, and a chromophobe adenoma, 1 mm. in diameter, to which no significance is attached. The lipoid in the suprarenal cortex was increased. MILTONJ. EISEN

Chromophobe Adenoma of the Pituitary, L. LAURSEN. Chromofobt hypophyseadenom, Hospitalstid. 80: Dansk neur. selsk. forh. 48-49, 1937. This is a report of a case in a man forty-three years of age in which the diagnosis of pituitary adenoma was apparently based on the clinical and roentgep findings, No operation or autopsy is mentioned. There are no illustrations. EDWARDHERBERT, JR.

Bony Changes Accompanying Tumors of the Spinal Cord, L. LINDGREN. U‘ber Skelet- veriinderungen bei Riickenmarkstumoren, Nervenarzt 10: 240-248, 1937. A carefully presented report dealing with the roentgenographic recognition of spinal cord tumors. Since the object of such recognition is primarily to find the level of the lesion for the clinician, myelography must be resorted to if no characteristic bony changes can be found. The study is based on 79 intraspinal tumors of various locations, levels, and histo- pathological types. The two types of skeletal change sought for by the writer were (1) an increase above normal of the interpediculate spaces and (2) an enlargement of an intervertebral foramen. He also mentions the destructive changes in bone produced by malignant tumors. Of 8 cervical meningiomas, 2 showed skeletal changes, whereas no one of 15 thoracic meningiomas showed bony changes. Of 7 neurinomas in the cervical region, 5 showed bony changes. Of 8 similar tumors in the thoracic region, 3 showed bony changes. Of 9 neurinomas of the lumbar canal, 4 showed bony changes. EDWIN M. DEERY THE NERVOUS SYSTEM 163

Roentgen Diagnosis of Localized Enlargement of the Vertebral Canal, A. SCHULLER. Ueber die Rdntgendiagnose lokaler Erweiterungen des Wirbelkanals, Wien. klin. Wchnschr. 50: 317-319, 1937. The author discusses the diagnosis of spinal cord tumors on the basis of roentgen evidence of widening of the spinal canal and deformities of the vertebrae. An adequate review of comparable material appeared in a paper by Busch and Scheuermann (Fortschr. a. d. Geb. d. Rontgenstrahlen 53: 107, 1936. Abst. in Am. J. Cancer 35: 481, 1939). MILTONJ. EISEN Primary Optic Atrophy in von Recklinghausen’s Disease, A. FUCHS. Ueber einfache Opticusatrophie bei Recklinghausenscher Erkrankung, Wien. klin. Wchnschr. 50: 291-292, 1937. Ophthalmoscopic examination in a thirty-seven-year-old man who complained of diminished visual acuity of four years’ duration disclosed a bilateral primary optic atrophy. A diagnosis of neurofibromatosis with localization in the optic nerves, was made when firm subcutaneous nodules were discovered in the right arm and left thigh. The patient was not seen again until twelve years later, at which time the visual symptoms and signs appeared unchanged. There was, however, a great increase in the number of subcutaneous tumor nodules. MILTONJ. EISEN

Multiple Fibromatosis of von Recklinghausen, G. COZZANI. Fibromatosi multipla e morbo di Recklinghausen, Arch. ital. di dermat., sif. 13: 466-472, 1937. A description of 2 cases of generalized neurofibromatosis with no unusual features, accompanied by a photograph and photomicrographs. MILTONJ. EISEN

Peripheral Nerve Turnours in a Case of Phenylketonuria, L. S. PENROSE.Lancet 1: 572-573, 1939. Phenylpyruvic acid was identified in the urine of a male idiot, aged five, who died about four years later with symptoms of pulmonary inflammation. The vagi, sciatic and other nerves were irregularly hypertrophied. Sections of nerves showed appear- ances indistinguishable from those found in some cases of neurofibromatosis; localized swellings which were evident macroscopically seemed mainly due to the presence of fluid. L. FOULDS Neuroblastoma: a Childhood Type of Malignant Tumor of the Sympathetic Nervous System, I. S. STARTZAND J. AQRAMS. Radiology 30: 232-241, 1938. Two cases of neuroblastoma are reported in children of three and three and a half years. In one the primary tumor was in the upper sympathetic ganglion. This patient had no orbital symptoms, such as ecchymosis or unilateral exophthalmos, which are usual in the Hutchinson syndrome, and diagnosis of neuroblastoma was made on the basis of roentgen studies of the bones and biopsy of a lymph node. It was confirmed at autopsy. The second patient also had extensive bone lesions but as these dated back to early infancy-three years before the discovery of a suprarenal tumor-the authors are inclined to regard them as independent of the latter. Unfortunately no biopsy was obtained of these lesions. The suprarenal growth was removed with a fatal result. Neither patient responded to radiotherapy. Roentgenograms and photomicrographs illustrate both cases. References are appended.

A Case of Neuroblastoma of the Sciatic Nerve, 0. MARNER. Et tilfaelde af neuro- blastom i n. ischiadicus, Hospitalstid. 80: 392-394, 1937. A man forty-one years of age had symptoms of a right sciatica and a tumor of the right sciatic nerve was found and excised. It was a neuroblastoma. Two weeks later a recurrence, similar histologically to the original tumor, was excised. One photograph is included. EDWARDHERBERT, JR. 164 ABSTRACTS

Histology of Neurinomas, H. LINDENOV. Om neurinomernes histologie, Hospitalstid. 80: 102-107, 1937. Following a lengthy historical account of the histology of neurinomas a single case is reported of one of these tumors arising in the gastrolienal ligament of a man forty-five years of age, who died of pneumonia. The tumor was an incidental finding at autopsy. Apart from the unusual location, there were no striking features. Two photomicrographs and several references are included. EDWARDHERBERT, JR.

THE BONES

Tumors Involving the Skeleton, H. A. JARRE. Radiology 30: 94-109, 1938. Ten instances of bone tumor are recorded with roentgenograms and photornicro- graphs of the lesions. Unfortunately the latter have been so reduced in size that the details are not altogether clear. The cases include: a metastatic thyroid adenoma; 3 multiple myelomas; a case of chloroma of lymphoblastic type; an osteogenic sarcoma of the femur in a girl of fifteen and a tumor of the sternum (unclassified) in her father; an osteochondrosarcoma of the cranium; 2 examples of Ewing’s tumor involving the pubic bones.

Osteogenic Sarcoma. A Report of Two Unusual Cases, G. A. CARLUCCI. Arch. Surg. 36: 838-844, 1938. In both cases of osteogenic sarcoma recorded here there was a history of trauma followed by pain and swelling. One patient was a girl of thirteen, whose parents at first refused to consent to amputation. A local excision was therefore done and a series of injections of Coley’s toxin was given. The pain and disability increased, however, and there was prompt local recurrence of the tumor. Amputation was eventually done three months after the patient was first seen and five years later there was no evidence of recurrence or metastasis. The second patient, a young boy, had an osteogenic sarcoma of the upper third of the femur. A radical disarticulation of the hip was done and at the time of the report, two years later, there had been no recurrence. Roentgenograms, photographs of gross specimens, and a photomicrograph are reproduced.

Large Cranial Exostosis with Radiographic Signs of Osteosarcomatous Change, CASTAY. Volumineuse exostose cranienne avec signes radiologiques de dCgCnCrescence ostko- sarcomateuse, J. de radiol. et d’klectrol. 21: 160-161, 1937. A man developed an exostosis of the skull during the war, presumably as a result of trauma. Eighteen years later, when the patient was fifty-five, the turnor began to grow rapidly. The roentgen picture was that of osteosarcoma, but no biopsy was performed. Two roentgenograms are included. EDWARDHERBERT, JR. Immediate and End-Results of Radiation Therapy in Certain Benign Bone Tumors, H. P. DOUB, F. W. HARTMAN,AND C. L. MITCHELL. Radiology 30: 420-436, 1938. ‘This paper deals for the most part with giant-cell tumors of bone. The author reviews the literature, quoting the results of radiotherapy as recorded by various writers and analyzing 22 cases from the Bone Tumor Registry. Among this latter group there were 9 cases treated by radiation alone in which the patient remained well; 4 patients were well after curettement and irradiation, 5 after irradiation followed by resection or amputation, and 1, with a malignant giant-cell tumor, four years after amputation. In the remaining 3 cases irradiation, in 1 case alone and in 2 with curettage, was followed by malignant change. The authors record 4 of their own cases followed for three years or longer. In one patient in whom biopsy showed a benign giant-cell tumor of the lower tibia with no evidence of malignancy, fibrosarcoma developed during the course of irradiation, with metastatic involvement of the inguinal nodes. Amputation was performed, the in- THE BONES 165 volved nodes were dissected, with postoperative irradiation of the groin, and the patient was without signs of recurrence sixteen months later. In a second patient the tumor when first seen showed evidence of malignancy. The diagnosis was osteogenic sarcoma with tumor giant cells and foreign-body giant cells, probably arising as a variant of giant-cell tumor. Roentgen therapy was given and x-ray films showed some decrease in the size of the tumor, but the patient died. In both the other cases there was a satisfactory response to radiotherapy, though in one there occurred a telescoping of the lower end of the femur, due probably to over- irradiation. It has been the authors’ practice to use 185 to 200 kv. with 0.5 mni. copper plus 1 nim. aluminum filtration at 50 cm. target-skin distance. Their dosage varies from 400 to 500 r units applied through each of two or more portals of entry. A full dose over each port is usually applied at one sitting. The progress is watched by means of period- ical roentgenograms and clinical observations. Succeeding treatments are given at intervals of from two to three months, depending upon the clinical findings. The authors suggest, however, that it might be advisable to give fewer and larger doses with a lengthening of the interval between treatments, since small frequently repeated doses may have a stimulative effect on the tumor cells. Two other cases are recorded-a benign bone cyst which showed excellent recalci- fication after roentgen therapy but later underwent sarcomatous ‘change, and a benign chondroma in which curettement was required after irradiation. Roentgenograms and photomicrographs are reproduced. References are appended.

Tumors of the Spine with a Consideration of Ewing’s Sarcoma, R. R. RIX AND C. F. GESCHICKTER.Arch. Surg. 36: 899-948, 1938. In this study of 291 spinal tumors, metastatic carcinoma was by far the most frequently encountered neoplasm, accounting for 172 cases. .Eighty-six cases were of prostatic origin and 60 arose in the breast. Metastatic lesions of the spine are usually multiple and must be differentiated from other generalized neoplastic diseases, especially multiple myeloma. Primary tumors of the spinal column numbered 58, of which 37 were benign and 21 malignant. The benign tumors included 15 giant-cell tumors, 10 osteochondromas, 7 bone cysts, 3 chondromas, and 2 hemangionias. Sixteen osteogenic sarcomas and 5 chordomas constituted the malignant group. No examples of Ewing’s sarcoma were found but there were 12 cases oj sympathico- blastoma, which in its microscopic structure closely simulates the Ewing tumor. Both these tumors are radiosensitive and both have a tendency to metastasize to one or more bones, to the lungs, or to the lymph nodes. The sympathicoblastomas, however, are of paravertebral origin, whereas Ewing’s sarcoma usually arises in the bone. Other tumors in the series were neurinomas, meningeal tumors, neurofibromas, glial tumors, and teratoid and teratologic growths. The pathologic and roentgenologic features of the various tumors are described and roentgenograms and photomicrographs are reproduced. Case histories are included and references are appended.

Giant-cell Tumors of the Spine, G. E. RICHARDSAND A. C. SINGLETON.Radiology 30: 43-51, 1938. Three cases of giant-cell tumor of the spine are recorded: two benign and one malignant with extensive metastases. All were of the osteolytic type. A general discussion of the difficulties of diagnosis and of the indications for treatment is included. References are appended and roentgenograms and photomicrographs are reproduced.

Generalized Osteitis Fibrosa Cystica of von Recklinghausen. A Case Report, K. STRASSLER.Ostitis fibrosa cystica generalisata (Recklinghausen). Bericht iiber einen Fall, Klin. Wchnschr. 16: 1393-1395, 1937. A report of a case of typical von Recklinghausen’s disease in a fiftv-six-vear-old 1 66 ABSTRACTS woman. Pronounced improvement occurred following extirpation of a parathyroid adenoma. A photograph of the gross specimen and a photomicrograph are included. MILTONJ. EISEN

Differential Diagnosis of Ostitis Fibrosa Generalisata and Bone Sarcoma, A. UIHLEIN. Zur Differentialdiagnose des Ostitis fibrosa generalisata und des Knochensarkoms, Beitr. z. klin. Chir. 166: 522-534, 1937. A forty-eight-year-old man complained of pain and swelling in the left tibia at the site of an injury sustained one year previously. Roentgen examination two years after the appearance of the mass suggested a diagnosis of bone sarcoma. Biopsy was not available. The mass progressed in size and reexamination the following year showed progressive tumor growth, spontaneous fracture of the involved tibia and fibula, foci of disease in the left femur, pubis, and ischium diagnosed as metastases, cystic lesions in the ribs, and thickening of skull and mandible. Histologic examination of biopsy material removed from the leg mass revealed osteitis fibrosa. The blood calcium and phosphorus were 21.4 and 15.2 mg. per cent; the urinary calcium was 45 mg. per cent. Urinary function was normal. A sugar-tolerance curve showed a delayed fall in glucose values. No cervical mass was palpable, but dissection of the neck disclosed 2 small parathyroid adenomata, which were extirpated. Rapid symptomatic improvement followed. Blood calcium now varied from 7.1 to 10.5 mg. per cent, blood phosphorus from 11.4 to 12.5 mg. per cent. The urine calcium was 11.4 per cent. Blood-sugar curves re- verted to ngrmal. The spontaneous fractures healed four weeks postoperatively and there was a reduction in size of the bone growth. A photograph of the patient, roentgenograms, and photomicrographs of the lesions in the bone and parathyroid gland are reproduced. MILTONJ. EISEN

Case of Recurring von Reeklinghausen’s Osteitis Fibrosa Cystica with Adenoma of the Parathyroid and Diffuse Hyperplasia of the Basophilic Cells of the Anterior Lobe of the Hypophysis, S. FRANCICAND N. HJERRILD. Et tilfaelde af recidiverende generaliseret ostitis fibrosa Recklinghausen med parathyreoideaadenom og diff us hyperplasi af de basofile elementer i hypofyseforlappen, Hospitalstid. 80: 1117-1 130, 1.937. A woman fifty-five years of age with a history of skeletal pain and two spontaneous fractures of the femora was found to have osteitis fibrosa cystica. Following removal of an adenoma of the right parathyroid gland she was symptom-free and her blood calcium and phosphorus returned to normal. Four years later she developed psychotic symptoms and pains referable to the bones, but the blood calcium and phosphorus remained at the postoperative level. The patient died shortly afterwards and autopsy revealed an adenoma of the left parathyroid gland. There was also a marked hyperplasia of the basophilic cells of the anterior lobe of the hypophysis, the gland weighing 1.0 gm. instead of the normal 0.63 gm. Evidence of osteitis fibrosa cystica was found in the bones. On the basis of this case and from other cases in the literature it is concluded that the basophilic cells of the pituitary gland have a definite hormonal relationship to the parathyroid glands and that they in some manner regulate the activity of these glands. Six photomicrographs and several references are included. EDWARDHERBERT, JR.

THE LEUKEMIAS, HODGKIN’S DISEASE, RETICULUM-CELL SARCOMA

Diagnosis of the Acute Leukemias, F. MASAND MAGRO. Le diagnostic des leuct5mies aiguss, Sang 11: 420-427, 1937. A general discussion without new material. It is illustrated by six brief case reports, none of which is unusual. There are no pictures. EDWARDHERBERT, JR. THE LEUKEMIAS, HODGKIN’S DISEASE, RETICULUM-CELL SARCOMA 167

Bone Marrow Smears in the Diagnosis of Unusual Forms of Myeloid Leukemia, R. KLIMA AND H. SEYFRIED. Ungewohnliche Krankheitsbilder bei myeloischer Leukamie und deren Erkennung durch die bioptische Knochenmarkuntersuchung, Klin. Wchnschr. 16: 422-427, 1937. Five unusual cases of myeloid leukemia are described, in four of which the diagnosis was ascertained by examination of bone marrow smears obtained by sternal puncture. (1) A man of thirty-nine years had indefinite chronic generalized symptoms and signs of compression of the spinal cord lasting nine months, but the blood showed no evidence of leukemia. Leukemic infiltrations were found post mortem in the liver, spleen, abdominal lymph nodes and bone marrow of the femur and vertebrae. (2) A man of fifty-one years had gastric hemorrhages and severe anemia. A leukemic condition was diagnosed on sternal puncture some time prior to terminal hematologic evidence of the disease and enlargement of the spleen and peripheral lymph nodes. The duration of the illness was eight months. (3) Acute myeloblastic leukemia with a course of two and a half months, in a man of twenty-seven years, gave rise to gastro-intestinal hemorrhages and severe anemia, but was not accompanied by specific manifestations in the blood. Characteristic leukemic changes with associated chloroma were present in the bone marrow. (4) A woman of twenty-eight years had a chronic indefinite illness of three months’ duration, the characteristic hematologic findings of chronic myeloid leukemia, but no enlargement of the spleen or lymph nodes. Sternal bone marrow was not available. Improvement occurred following roentgen therapy of the spleen. (5) The first evidence of disease in a man of thirty-four years was generalized adenopathy. The changes in the blood and sternal marrow were characteristic of chronic myeloid leukemia. Necropsy six months later substantiated the diagnosis. A sixth case is recorded, of an unexplainable self-limited illness lasting several months, in a man of twenty-five years, characterized by fever, malaise, and enlargement of the spleen. Sternal bone marrow revealed hyperplasia of normal myeloid elements, but abnormal cells, as observed in leukemia, were absent. A bibliography is included. MILTONJ. EISEN

Clinical Signi6icance in Leukemia of Cytologic Examination of the Tonsils, H. BRUNNER AND J. SCHNIERER.Die zytologische Untersuchung der Gaumentonsillen und ihre klinische Bedeutung bei Leukamie, Wien. klin. Wchnschr. 50: 1772-1774, 1937. Myeloblasts were observed in smears of material expressed from tonsillar crypts in 2 of 3 cases of myeloblastic leukemia. A smear of tissue obtained by puncture of the tonsil in a case of myeloid leukemia contained myelocytes and promyelocytes. A predominant number of lymphocytes was present in the contents of the crypts in 2 cases of lymphatic leukemia. Examination of tonsillar material is therefore suggested as an aid in the diagnosis of leukemia. MILTONJ. EISEN

Histologic Differentiation of Myeloid and Lymphatic Leukemia in the Liver, C. CORO- NINI. Erklarung der histologischen Unterscheidungsmerkmale myeloischer und lymphatischer Leukamien in der Leber, Zentralbl. f. allg. Path. u. path. Anat. 67: 81-85, 1937. A theoretical discussion is given on the variations in the histologic aspects of myeloid and lymphatic leukemia in the liver. Intracapillary infiltration within the hepatic acini occurs in the former, as a result of the proliferation of leukemic cells in centers of fetal hematopoiesis. Periportal focal lesions are found in the latter type consequent upon leukemic changes developing in the lymph vessels of this area. MILTONJ. EISEN

Involvement of the Stomach in Leukemic and Aleukemic Conditions, H. TEMLIN. Ueber Beteiligung des Magens bei leukamischen und aleukamischen Erkrankungen, Wien. klin. Wchnschr. 50: 1268-1270, 1937. Three cases of myeloid leukemia are described accompanied by leukemic infiltrations in the stomach, predominantly of a nodular type. MILTONJ. EISEN 168 ABSTRACTS

A Few Cases of Leukemia with Skeletal Changes Demonstrated Radiographically, K. [email protected] par tilfaelde af r$ntgenologisk paaviselige knogleforandringer ved leukaemi, Hospitalstid. 80: Dansk radio1 selsk. forh. 18-25, 1937. Five types of bony changes in leukemia are recognized, infiltration, rarefaction, proliferation, degeneration, and hemorrhage. Of these, only rarefaction and proliferation are demonstrable radiographically. The two cases reported were of typical chronic myeloid leukemia in a man twenty-five and a woman thirty-three years of age. In the first case there was skeletal pain in the lower extremities; in the second there were no symptoms referable to the bones. In both cases bony changes were demonstrable only three months before death, consisting of multiple small areas of rarefaction in the bones, in the first case in the femur, tibia, and fibula, and in the second case in the pelvis. Apparently no autopsies were performed. A third case is mentioned in a woman sixty-three years of age with a similar picture of rarefaction in the pelvic bones. The clinical and hematological pictures, however, were not typical of leukemia, although they resembled this more than any other well defined syndrome. Two roentgenograms and several references are included. EDWARDHERBERT, JR. Diagnosis of Myelogenous Leukemia with Polynuclears. Study of a New Case, 1’. ISCH-WALL.Le diagnostic de la leucemie myeloghe A polynuclkaires: Ctude d’un nouveau cas, Sang 11: 535-539, 1937. A man fifty-four years of age with epistaxis and gingival hemorrhages was found to have a white blood count of 35,000 with 88 per cent polymorphonuclear neutrophiles and 10 per cent myelocytes. Splenic puncture, however, showed the typical picture of a myeloid leukemia. No follow-up is given. It is believed that this case and other similar ones, with a preponderance of adult neutrophiles, actually represent only an early stage of a typical myeloid leukemia. There are no illustrations. EDWARDHERBERT, JR. Case of Myelogenous Leukemia with Polynuclears Followed for Six Years, P. ISCH-WALL AND E. STORTI. Un cas de IeucCmie myhlogbne A polynucleaires suivi pendant 6 ans, Sang 11: 539-548, 1937. A man twenty-seven years of age with an abdominal tumor was found to have hepato-splenomegaly and a white cell count of 40,000 with 85 per cent polymorphonuclear neutrophiles, 8 per cent metamyelocytes, and 1 per cent myelocytes, but without anemia. Splenic puncture showed a picture typical of myeloid leukemia. Radio- therapy reduced the white count, but brought about no change in the liver or spleen. The patient was followed for six years, until he died of cachexia, but throughout the course of the disease there was always a preponderance of neutrophiles in the blood picture. Apparently no autopsy was performed. This clinical type of leukemia, with a preponderance of neutrophiles in the blood stream, but with a picture suggestive of myeloid leukemia in the bone marrow and in splenic puncture material, seems to run n more benign course than cases with a typical blood picture. EDWARDHERBERT, JR. Case of Subchronic Splenomegalic Myeloid Leukemia with Generalized Lymphade- nopathy and Lymphatic Leukemic Changes in the Lymph Nodes. Mixed Leukemia? E. STORTI. Sur un cas de IeucCmie myClofde subchronique splknomkgalique avec tumkfaction systematisbe et transformation leuckmique Iymphatique des ganglions. Leucemie mixte? Sang 11 : 722-732, 1937. A woman forty-four years of age complained of weakness, anorexia, loss of weight, and generalized lymph node enlargement. Examination of the blood showed a secondary anemia, with 54,000 white cells and a differential count typical of myeloid leukemia. Splenic puncture as well as examination of the sternal bone marrow confirmed the diagnosis. Biopsy of the enlarged lymph nodes, however, showed absence of the follicles and a marked preponderance of immature lymphoid cells. Radiotherapy was given but the patient died nine months after the appearance of the first symptoms. Autopsy confirmed the findings on biopsy. It is considered that this is a case of mixed leukemia, representing not two independent diseases, but two types of response to a single, as yet unknown stimulus. A plate, six photomicrographs, and several references are included. EDWARDHERBERT, JR. THE LEUKEMIAS, HODGKIN’S DISEASE, RETICULUM-CELL SARCOMA 169

Pathogenesis of Herpes Zoster in Lymphatic Leukemia, I. SCHEINKER.Zur Patho- genese des Herpes Zoster bei lymphatischer Leukamie, Wien. klin. Wchnschr. 50: 1065-1067, 1937. A fifty-two-year-old woman succumbed to lymphatic leukemia three years after the first manifestations of disease. Several weeks prior to death gangrenous herpes zoster developed on the thorax in the region corresponding to the second to seventh dorsal segments. Autopsy verified the clinical diagnosis and disclosed leukemic infiltration bilaterally about the nerve roots and in the spinal ganglia of the upper eight dorsal nerves. Since the herpes lesions were unilateral, the leukemic changes are considered as a predisposing factor in the localization of the infectious agent of herpes and not as a direct cause of the skin manifestations. Two photomicrographs are included. MILTONJ. EISEN

Case of Cryptic Lymphatic Leukemia in a Radiologist, P. J~ILE-WEIL.Un cas de crypto-leuchie lymphatique chez un radiologiste, Sang 11 : 548-550, 1937. A doctor fifty-five years of age with a twenty years’ history of radiological practice developed generalized lymph node enlargement with fever and loss of weight. The white count and differential count were normal, but splenic puncture and puncture of one of the enlarged nodes showed findings typical of lymphatic leukemia. Death occurred one year later, but apparently no autopsy was performed. If this is a result of exposure to x-rays it is the first case to be reported of an aleukemic leukemia following professional radiotherapy. There are no illustrations. EDWARDHERBERT, JR.

Monocytic Leukemias, G. MARCHAL,J. PORGE,AND DENNEWALD.Sur les IeucCmies li monocytes, Sang 11 : 561-564, 1937. A general discussion without reports of new cases. The typical case of chronic monocytic leukemia shows up to 98 per cent of monocytes in the blood stream. Monoblasts occur in a proportion of from 1 to 5 per cent. Acute monocytic leukemia, which has comprised three quarters of the cases hitherto reported, is considered as a cellular variant of a single morbid process, acute leukemia. There are no illustrations. EDWARDHERBERT, JR.

Cutaneous Manifestations of Monocytic Leukemia, G. SANNICANDRO.Le manifesta- zioni cutanee della leucemia monocitica, Arch. ital. d. dermat., sif. 13 : 263-277, 1937. A case of monocytic leukemia is described in a man of thirty-seven years, manifested by enlargement of the spleen, peripheral adenopathy, macular and nodular infiltrations of the skin associated with hemorrhagic skin lesions. The total leukocyte count varied from 60,000 to 70,000, of which the monocytes constituted 48 to 66 per cent. Biopsy of the skin eruption and an enlarged inguinal lymph node revealed diffuse infiltration with monocytic cells. Transitory amelioration occurred following roentgen irradiation of the spleen. Photographs of the patient and photomicrographs are included. MILTONJ. EISEN

Diagnosis of Hodgkin’s Disease, G. WEITZMANN.Zur Diagnose des Lyniphogranu- loms, Klin. Wchnschr. 16: 607-609, 1937. Characteristic mononuclear and multinuclear giant cells, comparable to the giant cells observed in histologic sections, appeared in four- to ten-day-old explants of lymph nodes involved by Hodgkin’s disease. Similar forms were not observed in cultures of normal lymphatic tissue. Photomicrographs are included. MILTON J. EISEN

Contribution to the Pathology and Clinical Picture of Reticulum-Cell Sarcoma, L. EDLING. Radiology 30: 19-34, 1938. This paper is based on 18 cases of reticulum-cell sarcoma, of which one was associated with lymphatic leukemia. The diagnosis of these tumors rests primarily on the niicro- scopic features, which are shown here in a series of photomicrographs. In this connec- tion the author discusses at length the relation of the reticulum-cell sarcoma to the 170 ABSTRACTS so-called lympho-epithelioma of Schminke and Regaud. He has never seen an example of the latter tumor and believes that many of the cases in which a diagnosis of lympho- epithelioma has been made have actually been reticulum-cell sarcomas. Transitional- cell carcinomas of the nasal cavity, epipharynx, and fauces also bear a close resemblance to the reticulum-cell sarcoma but in the majority of the former an alveolar disposition of the cells is suggestive of their carcinomatous nature while the fibrillary differentiation of the reticulum-cell tumor is lacking. The series of reticulum-cell sarcoma reported here represents 11.5 per cent of 150 malignant tumors of the throat and lymphatic organs seen over a period of seven years. Ten of the patients were males, 8 females. The two youngest patients were between thirty-one and forty years of age; 3 were over seventy. The majority of the tumors were highly malignant as manifest metastases were present on admission to the hospital in 14. The longest interval between the appearance of symptoms and hospital admission was eleven months. Three patients who were seen within a month of the time when enlarged cervical nodes were discovered were found to have enormous glandular masses occupying the entire extent of the neck. Five of the cases were primary in the cervical lymph nodes. These tumors metastasize by way both of the blood vessels and the lymph channels. As has been noted by others, there is a strong tendency to generalization and not infrequently distant metastases appear after complete disappearance of the primary growth and regional metastatic lesions under treatment. Primary blood changes of any magnitude were present in but one of the patients. In this case there was a typical lymphatic leukemia of chronic character, with 428,000 white blood corpuscles, 97 per cent of which were lymphocytes. Since these tumors are radiosensitive, radiotherapy is the treatment of choice. The author uses the fractional method of roentgen irradiation with daily doses of 150-200 r, spreading the treatment over two and a half or three weeks. The total dose to each portal should not be less than 1500 Y but the number of portals is not stated. [Why not give the dose in the tumor in r? That is the vital fact in therapy and almost never furnished.] In some cases roentgen therapy was supplemented by radium. Four patients are reported as free of symptoms after six years, two and a half years, one and a half years, and six months; 13 are dead, and one is alive with metastases. The author also records briefly two cases of generalized reticulosis-one with a rapidly progressive course terminating in death, the other with a chronic course, characterized by infiltration of the skin. References are appended.

STATISTICS

Cancer in the Surgical Chicof the Medical School at Batavia, T.REDDINGIUS. Kanker in de heelkundige kliniek der geneeskundige hoogeschool te Batavia, Geneesk, tijdschr. v. Neder1.-Indi&78: 3244-3248, 1938. This is a report of 293 cases of carcinoma seen in the surgical clinic at Batavia, of which 37 occurred in Europeans, 190 in native Javanese, and 66 in other races, mainly Chinese. An analysis of the 190 cases in Javanese confirmed several striking differences which have been repeatedly observed in the incidence of certain types of tumors as compared with the European statistics. Seventy-six cases were of cutaneous cancer, which represented 40 per cent of all carcinomas as compared with from 5 per cent to 12 per cent in European series. There were 6 epitheliomas of the penis, of which 5 occurred in circumcised patients. There were 7 cases of primary carcinoma of the liver, which is a common type of tumor in Java, but no cases of gastric cancer, this being one of the rarest forms. Tumors of the entire gastro-intestinal tract constituted only 27 per cent of the total, as compared with from 50 to 60 per cent in Europe. Ten thyroid carcinomas were seen, 9 of which were in women; during this period only 50 goiters were seen, which gives a very high incidence of malignancy. In only 27 cases, or 9 per cent of the total, was there reason to be optimistic about the results of therapy. This poor showing is due to the fact that the natives usually come for treatment only in the advanced stages of the disease, STATISTICS 171

During this same period 105 cases of sarcoma were seen, of which 43 were primary reticulo-endotheliomas of the cervical lymph nodes. This type of tumor, a rarity elsewhere, is one of the most common in Java. EDWARDHERBERT, JR. Survey of the Malignant Tumors in the Juliana Hospital at Bandoeng from.1928 to 1937 Inclusive, W. J. Roos VAN DEN BERGAND R. S. TJOKROHADIDJOJO.Overzicht der gevallen van kwaadaardige gezwellen in het Juliana-Ziekenhuis te Bandoeng in de jaren 1928 tot en met 1937, Geneesk. Tijds. v. NederLIndie 78: 3265-3278, 1938. During a ten-year period 26,327 patients were seen in the Juliana Hospital, Bandoeng, of which 16.9 per cent were Europeans or Indo-Europeans, 74.7 per cent were native Javanese, 7.8 per cent were Chinese, and 0.6 per cent belonged to other races. Among all these patients there were 864 cases of malignant tumor, 9.6 per cent in Europeans, 79.2 per cent in Javanese, 10.9 per cent in Chinese, and 0.3 per cent in others. Of these tumors, 198 were sarcomas and 666 were carcinomas, giving a ratio of 1 : 3.4, which agrees with other Javanese statistics, but differs markedly from the European and American ratio of 1 : 10. Of the carcinomas, 48.7 per cent were in men and 51.3 per cent in women; of the sarcomas, 70.7 per cent were in men and 29.3 per cent in women. Carcinomas occurred with relatively the same frequency in Javanese and Europeans, but sarcomas were much more frequent among the Javanese. Tabulations are given of all the cases, indicating the type of tumor and site of origin, with subdivisions according to race and sex. These statistics confirm several important differences which have been noted previously in the frequency of certain tumors in Javanese and Europeans. Cancer of the tongue was relatively eight times as frequent in Europeans as in natives. Only one case of gastric carcinoma was seen among the natives, and there were only 2 in Europeans out of a total of 83 tumors. Of 12 primary cancers of the lung, 6 were in Europeans, all in men; 5 were in Javanese (2 men and 3 women), and 1 was in a Chinese man. Tumors of the tonsils, pharynx, and larynx occurred exclusively in men, being 25 in number. Of 118 uterine carcinomas, 8 were of the body and 110 of the cervix. Carcinomas of the cervix were relatively twice as frequent in the Chinese as in the other races. Breast cancer was four times as frequent in Europeans as in the others, there being 40 cases in all. There were 155 cutaneous epitheliomas, of which 8 were in Europeans, all on the head; 138 were in natives, 60 per cent being on the head and 33 per cent on the lower extremities. Of 23 melano- sarcomas, all in natives, 21 were on the feet and legs. Of 88 lymph node tumors, 75 occurred in the cervical nodes; 33 were lymphosarcomas and 55 were reticulo-endotheliomas or reticulum-cell sarcomas, sometimes called retothelsarcomas. These last mentioned tumors are rarities in Europe and America but very common in Java. Of the 55 cases one occurred in an Indo-European woman, 8 in Chinese (7 in men) and 46 in Javanese (40 in men). -411 55 cases were primary in. the cervical lymph nodes. EDWARDHERBERT, JR.

Racial Variations in the Incidence of Cancer, G. LENTHALCHEATLE AND M. CUTLER. Radiology 30: 485-488, 1938. The author discusses in a rather general fashion the racial incidence of various forms of cancer and concludes, as others have done, that there appears to be little difference in racial susceptibility to cancer generally, but a marked difference in the incidence of cancer of various organs. The evidence would seem to favor the view that these differences are to be explained largely by individual rather than by racial susceptibility. [See, however, the two preceding abstracts.] No references are given.

Skin Cancer Observed in the Dermatological Clinic of Bologna in 1896-1935. A Statistical Survey, N. BAGNOLIAND F. PANFILI. Gli epiteliomi cutanei osservati presso la Clinica Dermosifilopatica di Bologna nel trentennio 1896-1935 (Riassunto statistico), Arch. ital. d. dermat., sif. 13: 527-533, 1937. A tabulation is given of 999 cases of neoplastic disease of the skin observed between 1896 and 1935. There were 581 female and 418 male patients. Cancer of the skin 172 ABSTRACTS occurred in 865 patients (530 males, 335 females), Bowen’s disease in 15 (7 males, 8 females), Paget’s disease of the nipple in 7 females, and precancerous senile keratosis in 112 patients (44 males, 68 females). MILTONJ. EISEN

Increase in Cancer Mortality in Vienna, E. FURTH. Keine Abnahme, sondern Zunahme der Krebssterblichkeit in Wien, Wien. klin. Wchnschr. 50: 96-97, 1937. Analysis of the mortality statistics for cancer in Vienna shows a steady rise as Fiirth has maintained is true in German cities (Ztschr. f. Krebsforsch. 45: 47, 1936. Abst. in Am. J. Cancer 31: 356, 1937) and in all Austria (Ztschr. f. Krebsforsch. 47: 24, 1937. Abst. in Am. J. Cancer 35: 325, 1939). MILTONJ. E1 ISEN

The Cancer Problem, A. WINDISCHBAUER.Zum Krebsproblem, Wien. klin. Wchnschr. 50: 1676-1680, 1709-1714, 1937. This is a general discussion based on recent surveys indicating an increase in frequency of cancer. MILTONJ. EISEN