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The anatomic and histologic characteristics of theca cell tumors are described, together with their distinctive clinical and hormonal features. Descriptions are given of six cases illustrating variations from the more benign fibroma type to the highly cellular and malignant type. A correlation is made between the presence of hormonal changes and the presence of intracellular, doubly refractile fat containing cholesterol and cholesterol esters. It is suggested that some of the ovarian neoplasms previously diagnosed as fibromas or fibrosarcomas may on further investigation prove to be of theca cell origin.

X-ray irradiation of mice at puberty results in the production of two types of ovarian tumors: tubular adenomas derived from the surface epithelium and parenchymal lutein tumors. The parenchymal lutein tumors alone exhibit hormonal activity expressed in proliferative changes in the endometrium and vaginal mucosa. Histologically, these tumors are composed of granulosa and theca cells with varying degrees of luteinization. They are entirely comparable to the granulosa cell tumor and its excessively luteinized variant, the Lecene tumor, and the theca cell tumor of the human ovary. The luteinized ovarian tumors in mice are derived from the undifferentiated parenchyma. While the theca interna cells participate in the early proliferation and luteinization, the mature granulosa cells play no role in the genesis of these neoplasms. The histogenesis of the analogous human tumors may well be identical.

A case of puberty hypertrophy of the breasts in a girl of fourteen years is described, including endocrinologic studies. The pathologic anatomy indicates a marked hyperplasia of the glandular and connective tissue elements with preservation of the unripe lobular structure ordinarily encountered at puberty. The hormonal factors responsible for mammary growth are discussed and a correlation made with normal physiologic development of the breast. The weight of evidence indicates that the estrogenic hormone and possibly also the corpus luteum hormone is directly responsible for growth of the breast and is concerned in the etiology of puberty hypertrophy.

The syndrome of masculinization in the female, attributed to pituitary basophilism or adrenal cortical lesions, usually includes regressive changes in the ovaries. At times, however, as evidenced by the two cases described in this report, there may be bilateral ovarian enlargement, due to excessive perifollicular proliferation and luteinization of the theca cells and diffusely scattered luteinized cells within the ovarian parenchyma. The ovrian effects are suggestive of increased gonadotropic stimulation and are probably secondary. It does not appear that they are responsible for the production of the masculinization syndrome. In the clinical investigation of virilism the presence of an ovarian enlargement has been and should be regarded as suspicious evidence of a possible arrhenoblastoma or adrenal rest neoplasm of the ovary. In view of this report, a third possibility exists, namely, enlargement of the ovary due to diffuse luteinization. It may be possible to decide, at operation, by incision of the ovaries, whether or not tumor is present. If, in young patients, tumor can unequivocally be ruled out by this device, one or both ovaries may be left in situ.

1. 1. The accuracy and relative simplicity of chromosomal sex detection by means of skin biopsy is confirmed in a study of 28 male and 27 female patients who were sexually and hormonally normal. Sex differences in epidermal nuclear morphology depend upon the presence in females and virtual absence in males of a characteristic chromatin mass, the sex chromatin. 2. 2. Studies of nuclear morphology in the skin of a group of individuals with marked aberrations of sex hormonal status indicate the stability of the sex chromatin in this respect. These observations are consistent with the hypothesis that the characteristic chromatin body is derived from portions of the two X chromosomes of females and that it is not an index of sex hormonal function. 3. 3. The male type of epidermal nuclear structure was encountered in a patient with ovarian agenesis (Turner's syndrome), in one with male pseudohermaphroditism, and in another with either male pseudohermaphroditism or true hermaphroditism. Some pertinent genetic considerations in the pathogenesis of these congenital sexual abnormalities are discussed. 4. 4. The chromosomal sex corresponded to the apparent genital sex in a boy with unilateral uncomplicated cryptorchidism, in a man and a woman with Cushing's syndrome, and in a male and a female with Addison's disease. 5. 5. These studies support the view that the identification of chromosomal sex by the skin biopsy method is helpful in the differentiation between female and male pseudohermaphroditism.

An arteriovenous fistula within the uterus is a rare occurrence. Only three previous cases have been reported. A review of their distinctive features is presented. The etiology of this unusual uterine vascular abnormality is undetermined. The symptomatology and physical findings are sufficiently characteristic to suggest the diagnosis of this condition preoperatively. The usual presenting symptom is postmenopausal bleeding, sometimes of severe degree. The uterus is symmetrically enlarged and soft, simulating an intrauterine gravidity. A definite pulsation and thrill are palpable in the vaginal fornices. An audible murmur with systolic accentuation may be heard through the vagina. Systemic circulatory disturbances are minimal. The pathologic findings of uterine arteriovenous fistulas are discussed. At operation, numerous dilated, tortuous vessels fill the broad ligaments. The enlarged, distended, and vascular uterus may pulsate visibly. Surgical