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Manassa1described an interesting pathologic condition that occurs in tuberculous laryngitis and called it tuberculous thrombolymphangitis. In the submucous tissue irregular spaces were found which, because of the direction of the section, were sometimes sausage-like in form and at other times flask-shaped or pear-shaped. They varied considerably in size and were connected with one another by narrow prolongations. These spaces were limited by a distinct thin or thicker layer of tissue with smooth muscle fibers which usually showed endothelium on the inner surface. They contained clotted fibrin with accumulations of mononuclear cells, in which sometimes coal pigment and sometimes coagulated material was seen. The contents of the spaces often exerted enough pressure to rupture the walls, with the escape of the material into the surrounding connective tissue. The invaded area showed distinct inflammatory changes and was usually infiltrated with fibrin and round cells. Manassa expressed the belief that

Introduction Tumors of the vagus nerve are not common. Those of the cervical portions of the vagus nerve are extremely rare. A neuroblastoma of the cervical portion of the vagus nerve is practically unknown. This report presents the case of a proven neuroblastoma which, I believe, arose from the nodose ganglion of the left vagus nerve. The tumor apparently was present at birth, and removal was several months later. Development of the Concept of the Neuroblastoma An understanding of the developmental anatomy of neuroblastoma has been reviewed by Kincaid, Hodgson, and Dockerty in 1957, 1 who pointed out that Virchow, in 1864, was the first to indicate these round cell tumors were not sarcomata but tumors of nerve origin. He labeled them gliomas. The same authors indicate that Marchand in 1891 reported that the round cells of what we now term "neuroblastomata," arose from the embryonic nerve system. Wright, 2

THEONTOGENETICAPPROACH TO THEPATHOLOGY OFDEAFNESS.DR.LOUISK.GUGGENHEIM, St. Louis. Of the various approaches to the pathology of deafness, the embryologic has been the most neglected. The reason seems to be that few otologists understand the ontogenesis of the ear and embryologists are usually not interested in deafness. An adhesive process or fibrosis of the tympanum was formerly considered to be entirely of inflammatory origin. If it was a sequel of chronic suppuration, it resulted from organization of granulation tissue or from direct differentiation of round cells into fibroblasts and connective tissue. In cases in which there was no suppuration a mild but long-continued round cell infiltration caused the fibrosis. The histologic picture of otosclerosis, accurately described by Politzer over fifty years ago, was accepted as the sole phase of that mysterious malady. Then came a closer relationship between otolaryngology and general medicine and with it

Nephritis in children can be divided into two main classes: hemorrhagic, or glomerular, and parenchymatous, or tubular. This paper attempts to characterize the group termed "parenchymatous," to indicate the etiology and nature of the disorder, to present the differential diagnosis from hemorrhagic nephritis, and to outline the therapy. The chief clinical features of parenchymatous nephritis are: marked edema and albuminuria, and the absence of hematuria, hypertension and retention of nonprotein nitrogen. The microscopic changes in the kidney in early cases are confined to degeneration of the tubules; in later cases, one may also observe interstitial infiltration with round cells. The hemorrhagic lesions typical of glomerular nephritis are not found. These features serve to differentiate the disorder from glomerular nephritis, as well as from other types of tubular degeneration, such as the febrile, that due to intoxication with mercury or with diphtheria toxin, and in the case of adults the nephritis

With the passing of Drs Jaffe and Lichtenstein from the forefront of bone pathology, Dr Mirra, among others, attempts to continue their tradition of excellence with the publication of a book on the diagnosis and treatment of bone tumors. The book is well organized and has excellent illustrations. The organization is based on the pathological assessment of the main tumor component: osteoid, chondroid, fibrous tissue, giant cells, round cells, and epithelial cells. Unique to this book is a chapter using sophisticated differential diagnostic tables based on the main pathological component to aid pathologists in formulating a reasonable differential diagnosis. The author stresses difficult areas of differential diagnosis that could lead to confusion and misdiagnosis, sometimes to the detriment of other more "classic" or common entities. He also includes discussions of nonneoplastic conditions of bone that often mimic tumors. The author occasionally spends too much of the text on entities of

• A 35-year-old man had a primary neuroblastoma of the left orbit. Histopathologically, the tumor was composed of uniform small round cells containing argyrophilic granules arranged in nests and cords with pseudorosettes, Homer-Wright rosettes, and a fine fibrillary background matrix. Immunohistochemical staining for chromogranin was positive. Electron microscopy showed small (108- to 173-nm) dense core granules. Eight years after surgery and radiation therapy the patient was free of local recurrence and metastases. To our knowledge, primary orbital neuroblastoma has been reported only once previously. Neuroblastoma, which occurs most frequently in children and has an incidence in the United States of 500 cases annually, is a distinctly unusual tumor in adults.

Nevus-like structures were observed at the base of experimental choroidal tumors. These neoplasms were obtained by injecting Greene transmissible hamster melanoma cells into the choroid of Syrian hamsters and murine neuroblastoma cells into the choroid of A/J strain mice. Cells from both tumors, when injected intraocularly or systemically, give rise to lesions composed predominantly of epithelioid or round cells. The choroidal tumors in both species, however, generally showed a zone of flattened cells adjacent to the sclera, composed of relatively benign-appearing, smaller, and more delicate cells—and in the case of the melanoma, usually more densely pigmented cells—than the main portion of the tumor. The cells in this area appeared similar to the "nevus cells" that have long been described beneath and adjacent to primary malignant melanomas of the uvea.

According to Ewing, 1 the occurrence of true sarcoma of the thyroid gland still requires demonstration, and in a review of the literature it is quite evident that tumors of the thyroid have been classified as sarcoma merely because of the presence of spindle cells or round cells without the application of any more accurate criteria of diagnosis. Since the age of incidence, clinical course, gross anatomic appearance and mode of extension are quite similar in carcinoma and sarcoma of the thyroid, only the histologic distinctions between the two remain. Confusion in microscopic diagnosis frequently occurs owing to the fact that.it has not been fully appreciated that the cells of a carcinoma of rapidly proliferating type assume an undifferentiated form superficially resembling in morphology the cells of a fibrosarcoma or lymphosarcoma; unless the arrangement of the cells is carefully studied in various parts of the tumor and special staining methods

To one who has done cultural work on both theBlastomycesand theHyphomycetesit is easy to understand how isolated elements of the one may resemble those of the other. But when it comes to dermatologic examinations of scrapings, pus, etc.—tissue products in general—we have been in the habit of believing that theBlastomycesshould appear as round cells unassociated with mycelia, more or less, and vice versa for theHyphomycetes. This still holds good as a general rule, and may turn out to be an absolute one when we come to know more about the genuineness of the pathogenicity of these higher fungi. I have already cited an instance (illustrated) in which the scrapings from a case of ringworm of the nails showed bodies resemblingBlastomyces,1and in which the bodies were reproduced later byPenicillium brevicaulewhich was isolated in the cultures. Here aHyphomycetesproduced

This report includes several cases of myomata where sarcomatous changes have occurred. From the number of cases recorded it is evident that the disease is more frequent than heretofore suspected. The sarcoma usually develops in one of several myomata and may be situated in a subperitoneal interstitial or submucous nodule. Until recently it was supposed to be confined chiefly to submucous myomata. The gross changes are characteristic, the firm cross-grained myomatous tissue being replaced by a homogeneous yellowish white growth devoid of a fibrous arrangement and closely resembling raw pork. Degenerations in the sarcomatous tissue are frequent. Histologically these growths arc found to develop from two sources: 1. The connective tissue. 2. The uterine muscle. Those of connective tissue origin may consist: ( a Of spindle shaped cells. ( b ) Of round cells. In those derived from the muscle a direct transition from the muscle fibers into the sarcomatous ones can be

To the Editor.— I would like to describe an unusual eruption occurring after intense sun exposure. Report of a Case.— A 53-year-old blond woman presented with grouped, tiny, flat-topped, brown, papular lesions on the exposed surfaces of the lower arms, extending sparsely up the arm. The woman, who has keratosis pilaris and multiple seborrheic keratoses, vacationed in Portugal in September 1968. After using a sun screen (Fashion Tan), she stayed out in the hot sun longer than had been her usual habit. She developed a red, blotchy, coin-shaped rash on her arms but continued to sun bathe treating her eruption with rose water and glycerine. The lesions faded but four weeks later, when back in this country, she noted the present papular lesions (Figure). Biopsy of the eruption revealed mild follicular hyperkeratosis, occasional dyskeratosis in the malpighian layer, slight upper dermal perivascular infiltration of round cells, and solar elastosis. At

While studying the hearts of patients who died from tuberculosis, not infrequently we have found cellular infiltrations in the myocardium indistinguishable from Aschoff bodies. In the English literature such lesions apparently have not been described. They are not mentioned in Rich's comprehensive contribution1or in any of the texts of pathology. In the United States only Gouley, Bellet, and McMillan (1933)2have observed "submiliary foci of epithelioid cells around small blood vessels" and "large and small nodules of endothelial and round cells" which they interpreted as "tuberculous granular infiltration" in six cases of tuberculosis. As the occurrence of Aschoff bodies in tuberculosis seems to be of greatest importance, not only for the understanding of this disease but especially for that of rheumatic heart disease, we felt it desirable to report our observations and briefly discuss their significance. MATERIAL This is a study of the hearts of 63 patients

Ewing, 1 in 1911, after a special study of malignant tumors of the testicle, came to the conclusion that "with relatively few exceptions tumors of the testicle belong in the embryonal class and that the great majority or possibly all of these embryonal tumors are of teratomatous origin." He classified testicular teratomas as follows: (1) adult embryomas or teratomas; (2) embryoid, teratoid or mixed tumors; (3) embryonal malignant tumors, and (4) miscellaneous tumors. He stated that the most common malignant tumor of the testis is embryonal carcinoma, alveolar or diffuse, with polyhedral or round cells and often with lymphoid stroma, which is probably a one-sided development of teratoma. This view was contrary to the belief of Chevassu, 2 who in 1906 classified the testicular tumors in the 128 cases which he reported as follows: He stated that the majority of malignant testicular tumors were either degenerated embryomas or seminomas (a

The disease entity known as myasthenia gravis was first described by Willis 1 in the seventeenth century. Although this condition is relatively easy to recognize clinically, its cause has remained obscure. Pathologically in many cases there are variable degrees of nonspecific degenerative muscle atrophy. In more than 50 per cent of cases focal collections of small round cells have been observed in muscles and other organs. These small foci of cells have been termed "lymphorrhages" and when present are diagnostically significant. A relatively large number of cases have been reported in which thymic neoplasms existed. The conspicuous symptomatic features of myasthenia gravis are excessively rapid fatigability of muscles in action and quick restitution of function on relaxation. The muscular exhaustibility may be elicited in the form of a characteristic electrical reaction which has been termed the Jolly reaction. In this article no effort will be made to discuss in detail

Bowen's Disease of Penis; Late Latent Syphilis (Treated). Presented byDr. James StrauchandDr. S. Colimodio. R. M., a Negro aged 51, was previously presented before the Cleveland Dermatological Society from the department of dermatology, University Hospitals, as "A Case for Diagnosis (Chronic Balanoposthitis?)." The penile lesions have shown no real change in the past four years. The glans penis continues to exude and is painful. A second biopsy was made on Jan. 9, 1941. Sections showed hyperkeratosis and patchy parakeratosis. There was definite acanthosis. Rete pegs were elongated. There was variation in the appearance of cells of the malpighian layer. There were many vacuolated cells with eccentrically placed nuclei and others decidedly swollen. Some cells had circular, deeply chromatic, irregularly shaped nuclei that were surrounded by small clear spaces. The nuclei were hyperchromatic. There were many atypical mitotic figures. Numerous lymphocytes and large round cells infiltrated the

Kaposi1first grouped mycosis fungoides, lymphodermia perniciosa, sarcomatosis cutis and the real sarcomas of the skin in a class which he called sarcoid. Spiegler2and Max Joseph3did some early work on the subject. Fendt4classed as sarcoid, "tumors of benign prognosis, having only a limited growth, frequently healing with arsenic, composed of groups of round cells, which are circumscribed, divided by septa and encapsulated." Boeck5in 1899 reported as multiple benign sarcoid a new disease of characteristic clinical and histologic appearance. In later articles Boeck6reported a series of cases and added a new type of the disease, the diffuse infiltrating type. The work of Boeck caused many cases to be reported in the European literature but in America the only cases are those of Gottheil,7Pollitzer8and Sutton.9G. H. Fox and Wile10reported an atypical case and

This report of a case of generalized herpes simplex that was recurrent over a period of two years will undoubtedly show its infectious origin. This type of herpes is rare, and the observations made offer suggestions as to the etiology of the more common herpes simplex. Cases of herpes may be roughly divided into three groups. Though in all three groups the skin lesions show a necrosis and exudation of varying intensity, these and other pathologic findings are most pronounced in the herpes zoster group. Von Barensprung 1 and others described changes in the posterior root ganglion in herpes zoster; but it remained for Head and Campbell 2 to describe these changes in detail. They found, in the ganglion of the posterior root of a part corresponding to terminal skin lesions, changes of acute degeneration, that is, exudation of round cells and hemorrhages, and destruction of cells and fibers. They

We have recently had the opportunity to study two cases of cutaneous tumor formation. We found that these tumors consisted of small round cells which we considered to be of lymphoblastic derivation. These two cases were presented at the New York Academy of Medicine and there was a divergence of opinion as to whether the condition was leukemia, Hodgkin's disease, lymphosarcoma or mycosis fungoides. One of them was regarded clinically as a case of either Hodgkin's disease or lymphosarcoma; the other, as either mycosis fungoides d'emblee, leukemia or cutaneous sarcoma. Biopsies from these cases were presented to several authorities. In our first case, opinion as to diagnosis varied from Hodgkin's disease to leukemia to lymphosarcoma. In the second case, the opinion was that the condition was lymphosarcoma or a small cell sarcoma. In an attempt to classify our cases definitely we studied pertinent literature and found that there were two