Search

Renal cell carcinoma (RCC) is one human tumor to which the immune response may control the growth of tumor cells. These tumors are infiltrated by a large mononuclear infiltrate mainly composed of T lymphocytes. To characterize the lymphocytes infiltrating RCC, we analyzed the molecular structure of the T cell receptor (TCR) alpha and beta chains in tumor and paired peripheral blood lymphocytes from a series of 6 untreated patients. We first determined V alpha and V beta gene segment usage by PCR using a panel of V specific oligonucleotide primers (V alpha 1-w29 and V beta 1-w24). A highly diverse usage of TCR V alpha and V beta gene usage was observed in 5 of 6 tumors. In addition, the few tumor overexpressed V beta specificities detected by reverse transcription-PCR were shown to contain minor T cell expansions. Strikingly, 1 of the 6 tumor studied displayed a skewed TCR repertoire with V beta 4 transcript representing 25% of the TCR signals. Clonality of the tumor overexpressed V beta transcripts was analyzed by CDR3 size distribution analysis. In the particular tumor displaying a biased repertoire large expansions of T cell subpopulations were detected (particularly in V beta 4) specifically at the tumor site. Such T cells may be expanded locally in response to tumor antigens.

Approximately one-third of the patients receiving renal transplants have functioning allografts at 10 years. Chronic rejection continues to be the leading cause of kidney loss in late survivors. Atherosclerotic cardiovascular disease, liver failure, malignancy, and sepsis are the major causes of late death. Identification and control of the risk factors contributing to patient mortality should enhance the long-term success of renal transplantation.

A retrospective multifactorial analysis on 261 previously untreated patients with Ewing's sarcoma (Es) of bone has been carried out in order to ascertain the prognostic value of several histological variables on survival. Among those cases accepted as Es, 208 (80% of the patients) were considered to be "typical Es", while 40 (15%) displayed a large cell predominance, being subclassified as "atypical large cell Es". Furthermore, 13 patients (5%) possessed tumours of endothelial-like appearance. Eleven cases which displayed a mixed histological configuration were finally included within one of the three previous groups according to their predominant histological pattern. After adjustment for therapeutic regimens and initial location of the tumour, only two histological characteristics remain significant; i.e. the presence of necrosis (p = 0.002) and, to a lesser degree, the presence of filagree "en damier" pattern (p = 0.08), both of which are of poor prognostic value. From this study, it can be assumed that the morphological (and possibly histogenetical) heterogeneity of Es of bone has no prognostic influence on survival.

In a series of 94 human mammary carcinomas, the determination of total estrogen (ER) and progesterone (PR) receptors by a single saturating dose method (5 nM for ER, 10 nM for PR) using dextran-coated charcoal was compared to an immunohistochemical method utilizing ER monoclonal antibody (ER-ICA test). There was a good correlation expressed in positive terms between the ER-ICA test and the biochemical determination of ER (94% of concordance) with a statistical value of P less than 0.01 being found between the concentration of ER (biochemical) and the percentage of labeled cells (ER-ICA). The ER-ICA test complements the ER and PR (biochemical) and is particularly useful for ER determinations on small tumor specimens as no additional tissue other than that from the biopsy is required.

This paper reports an asymptomatic coagulation defect responsible for an abnormality at the contact phase of blood coagulation in vitro, distinct from Hageman factor and Fletcher factor deficiencies. Coagulation studies in a 50-yr-old French woman without bleeding tendency revealed the following results: whole-blood clotting time in glass tubes and activated partial thromboplastin time with kaolin and ellagic acid were greatly prolonged; one-stage prothrombin was normal; no circulating anticoagulant was detected, and the infusion of normal plasma corrected the coagulation defect with an estimated half-life of 6.5 days; the levels of factor VIII, IX, XI, and XII were normal; mutual correction was obtained with a Fletcher factor-deficient plasma; the level of whole complement was normal. Studies of the contact phase of blood coagulation and contact-induced fibrinolysis showed the same abnormalities as in Hageman factor- and Fletcher-deficient plasmas. These results indicate that the patient's plasma is deficient in a previously undescribed coagulation factor, which participates in the initial stage of the blood coagulation process in vitro. Family studies revealed consanguinity in the propositus' parents. The assay of this newly described factor in the propositus' children revealed a partial defect, compatible with a heterozygous state, in three of the four tested children. This indicates a recessive inheritance of this new blood coagulation defect.

The hallmarks of diagnosis of medullary breast cancer (MedBC) used by the authors since 1977 have been that the tumor is well circumscribed, has syncytial architecture in greater than 75% of its surface, contains diffuse inflammatory infiltrate, has atypical nuclei, and forms no glandular pattern. In order to assess the clinical utility of these criteria, we studied a series of 95 previously untreated, surgically operable patients with breast carcinoma at the Institut Gustave-Roussy (IGR) between 1960 and 1979. A diagnosis of MedBC was initially made for these patients or suspected based on abundant inflammatory stroma observed in a histologic evaluation. Using these criteria, 26 cases were identified as typical medullary carcinoma (TMC), 23 cases as atypical medullary carcinoma (AMC), and 46 cases as nonmedullary carcinoma (NMC). The 26 cases of TMC represent a very small fraction of the total infiltrating operable breast carcinomas diagnosed at IGR during the same time period. The prognosis for these 26 patients was much more favorable than for the other groups. They had a 10-year disease-free survival of 92% compared with 53% for the AMC group and 51% for the NMC group. Neither distant metastasis nor secondary primaries of the same histology were seen. Therefore, it is possible with the use of strict histologic criteria to distinguish a group of patients with a much more favorable prognosis. This histologic diagnosis alone renders a most favorable prognosis for the patient even if other factors such as large tumor size and lymph node involvement are present and, by inference, the only therapy needed is the removal of all tumor. In contrast, atypical forms have a prognosis no different from other atypical types of breast carcinomas without inflammatory stroma, and adjuvant therapy appears to be justified if other factors warrant it.

Ewing's sarcoma (ES) of bone may occasionally display rosette-like textures mimicking Homer-Wright ones, as seen in neuroectodermic neoplasms (neuroblastoma, peripheral neuroepithelioma). Of a group of 39 cases of ES, reviewed with electron microscopic study, the authors have isolated five atypical ES, which histologically also possessed neuroectodermic traces. These tumors were composed of small round blue cells with rosette-like figures and cytoplasmic glycogen. The immunohistochemical analysis showed positivity for neuron-specific enolase (NSE) as well as for HNK-1 (leu-7) monoclonal antibody. Electron microscopic examination confirmed the tumor cell as being of small round type, with a dense chromatine pattern and the presence of isolated dendritic processes, as well as synaptic-like buttons; intermediate filaments, neurotubuli, and dense-core neurosecretory granules also were seen. Moreover, in two cases basement-like condensations surrounded some cells. Scanning electron microscopic study in one case confirmed the presence of rosette-like figures and cell elongations with short dendritic projections of the cytoplasm. Clinically and radiologically these cases showed features similar to ES of bone; one case, located in the chest wall, had a local relapse after treatment, with the histologic features of a pleomorphic neuroblastoma. The authors conclude that these tumors resemble closely immature neuroepithelioma of soft tissue but, being primary to bone, are superimposable on those described as "neuroectodermal tumors of bone."

7 cases of mammary granular cell tumor have been studied, and some pitfalls on frozen section diagnosis are described. Erroneous diagnosis of mammary infiltrating carcinoma leads sometimes to an useless mutilation. Over-diagnosis is possible because of: --gross features like induration and ill-defined circumscription of the tumor, --histological features and especially infiltration of the lobules and fat by granular tumor cells.

The observation of a coagulation defect which has been observed in an adult French woman is reported. This deficiency which induces no bleeding tendency is characterized by a considerable lengthening of the activated Partial Thromboplastin Time and an abnormality of the fibrinolysis activation. Circulating anticoagulant is absent. The levels of HF, PTA, AHF, PTC are normal and mutual correction with Fletcher factor deficient plasma is obtained. This result leads to the conclusion that patient's plasma is dificient in a hitherto undescribed coagulation factor. This factor seems to interfere, in vitro process, at the level of glass activation, and after the activation of Hageman factor.

The propositus, a 50 year-old woman of French Caucasian extraction, was the product of a consanguineous marriage. Her plasma, obtained at the time of a surgical procedure, exhibited prolonged whole blood clotting time and prolonged activated PTT (618 sec); the one-stage prothrombin time was normal. Her plasma contained normal amounts of coagulation factors XII, XI, IX, VIII, VII, X, V, II, I and Fletcher factor. Full correction was obtained upon mixing with normal plasma, excluding a circulating anticoagulant. The defect of the propositus, surname Flaujeac, was designated Flaujeac Trait. Three of the patient’s children had reduced amounts of the factor (23%, 27%, 30%) while a fourth child was at the lower limit of normal (55%).Flaujeac trait plasma was also found to have prolonged euglobulin lysis (194 min), failure of kaolin-activated kinin formation or generation of the permeability globulin PF/dil. Each of these deficits was corrected by addition of a factor separable from Hageman factor or Fletcher factor (prekallikrein). The Flaujeac factor was identified as a heat stable, α-globulin which eluted from Sephadex G-200 corresponding to a MW of 170,000. The factor corresponded exactly with fractions containing HMW kininogen. The half-life in plasma following transfusion was 6.5 days. Kininogen antigen was markedly reduced in Flaujeac plasma, only some partially cross-reacting material remained. Antibody to kininogen depleted the factor from normal plasma.The intrinsic coagulation, fibrinolytic and kinin-forming pathways and the formation of PF/dil are dependent upon plasma HMW kininogen.

A retrospective study is realized including 14 cases of clear cell sarcomas of tendons and aponeuroses, found in the files of Institut Gustave-Roussy (1969-1983). The main microscopic features are emphasized. In comparison with other soft tissue sarcomas, clear cell sarcomas are clinically characterized by a great frequency of local lymph node metastases (4 of 14 cases). The prognosis is usually particularly poor. The exact histogenesis remains obscure, but the results of special stains, support origin from migrated neural crest cells: melanin is visualized in 2 out of 12 tumors in which Fontana-Masson is performed. S 100 protein, a neuroectodermal marker, is positive by immunoperoxidase technique (PAP) in 6 of 10 tested cases. A better diagnostic approach is allowed with the help of ultrastructural study performed in 3 cases. These tumors must be separated from synovialosarcomas. Because the histogenesis is not actually sure, it is preferable to call them "soft tissue clear cell sarcomas".

Most pathological changes in the mammary gland that are not tumours are fibrocystic diseases. Their classifications, at first purely descriptive, can now be used to predict the risks of cancer. All the same, there is no real parallel between these classifications and the difficulties in differential diagnosis that these lesions present for the pathologist. This is so true that the risk has to be defined by more objective markers than one morphological finding.

Peripheral neuroectodermal tumours (PNET) of bone are rare and mimick those seen in soft tissue (peripheral neuroepithelioma of soft tissue). Their differential diagnosis from Ewing's sarcoma (Es) is extremely difficult by optical means. Here we report 14 new cases of PNET of bone (other than Askin's neoplasm) located primarily in the limbs, pelvic girdle and scapula. Clinically and radiologically they displayed Ewing's sarcoma-like features: mean age was 14.4 years, male/ female ratio being 3:11. Metastasis was present in 6 cases at diagnosis (5 with bone metastasis). Prognosis was poor; thirteen patients died; only one with a metatarsal located tumour is alive and free of disease. The mean survival rate was 25 months following diagnosis and treatment with radio- and multimodal chemotherapy. Histologically the 14 cases displayed Homer-Wright rosettes and pseudorosette-like structures, as well as a fibrillary background and lobular pattern. Immunohistochemistry revealed positivity in a number of neural markers when using paraffin-embedded material: NSE, B-2-microglobuline, HNK-1 (leu-7) and E-36 antibodies. At EM level the cell cytoplasms evidenced dense-core granules with neurosecretion, neurotubules and intermediate filaments like those seen in peripheral neuroepithelioma.

A review of 20 cases of malignant lymphomas and other hematopoietic sarcomas initially localized in the mammary gland permitted us to determine some main clinical and morphologic features. Ages range from 14 to 74 years. Clinical features consist of two principal aspects: a radiologically homogeneous, well circumscribed mass or an inflammatory tumor. After staging, one half of the cases remain localized only in the mammary gland (extranodal stage I). Granulocytic sarcoma, monoblastic sarcoma and Hodgkin's disease are very rare. Non Hodgkin's lymphomas are the most frequent. In 40 per cent of the cases, it is a diffuse, large non cleaved cell type, according to the working formulation for clinical usage (centroblastic in the Kiel classification). These are probably B cell derived malignant lymphomas. Eleven per cent of the cases fall into the large cell with multilobated nuclei type according to Pinkus, which probably is a T cell derived malignant lymphoma. Treatment consists of radiotherapy and/or chemotherapy, mastectomy is not advisable. Like any malignant lymphoma localized in other sites, prognosis depends on two main data: clinical stage of the disease and histologic type. Ten patients are in complete remission, the median survival being 3.5 years.

Six sacrococcygeal chordomas were studied with CT at the Institut Gustave-Roussy. Only one was examined at the time of the initial diagnosis and CT made a valuable contribution to this. In other cases, CT determined the possibility of initial surgical excision and the field of radiotherapy and helped make a reliable diagnosis of local recurrences. CT seems to be the best examination to use for the early diagnosis of chordomas and recurrences, which will perhaps help improve the prognosis of this serious disease.

Two cases are reported in which the diagnosis of Hodgkin's Disease was revealed after a bone biopsy of an apparently primary lesion. In fact, the disease was already generalised and the authors question the existence of purely osseous varieties of the disease. Of the two reported cases, one died rapidly and the other had a long-term remission.

Flaujeac trait plasma resembled Hageman trait or Fletcher trait, in that the intrinsic coagulation pathway, plasma fibinolytic pathway, kinin-forming system, permeability factor of dilution (PF/dil) phenomenon were abnormal. The defect in each assay was reconstituted by afactor separable from Hageman factor or Fletcher factor. This substance was an alpha-globulin with an approximate mol wt of 170,000. Flaujeac plasma did not release a kinin upon incubation with kallikrein and was deficient in total kininogen antigen. Antiserum to kininogen inhibited the activity of the factor in solution. Flaufeac factor was identified as a kininogen of high molecular weight (HMW-kininogen). The mean total kininogen antigen in four children of the proposita was 51% (range 34-62%) of normal. A functional coagulation assay of HMW-kininogen in the children was 34% (range 23-55%). The results were consistent with autosomal recessive inheritance. The plasma pathways of intrinsic coagulation, fibrinolysis, kinin formation, and PF/dil generation are dependent upon HMW-kininogen. We believe this is the first demonstration of biological function for a kininogen apart from its role as a substrate for kallikreins.

The authors report the case of a 30-year-old man with granulocytic sarcoma of the chest wall presenting as a swelling with axillary lymphadenopathy followed by pleuropericardial effusions. The myeloblastic nature of the tumor cells was confirmed on the adenogram by the detection of granulations, rare Auer bodies and myeloperoxydase activity. It was confirmed by the presence of numerous granulations by electron microscopy and by that of a chloracetate esterase activity detected using Leder's protocol (9) on sections of material mounted in paraffin wax after formol fixation. Four marrow biopsies form different sites were normal. The course was fatal in six months, despite multiple chemotherapy, with massive invasion of the thorax by the tumor without the presence of myeloblasts in the circulating blood. The autopsy confirmed the preponderance of thoracic involvement (greenish in colour) and the presence of diffuse marrow myeloblastosis. In the light of this case, the rare instances (of the order of 10) of aleukaemic chloroma recorded in the literature are reviewed, emphasising the difficulties of diagnosis of these tumours and the ways in which they may be overcome.

Magnetic resonance (MR) imaging was used as a follow-up technique in 60 patients who underwent surgery and/or radiation therapy for primary malignant musculoskeletal tumors. MR imaging was performed on a 1.5-T imager with T1- and T2-weighted imaging sequences; MR imaging findings were confirmed by means of posttreatment surgery and histologic analysis or follow-up for at least 1 year. If a low-signal-intensity lesion was seen on T2-weighted images in a patient who had undergone radiation therapy or surgery, the patient usually did not have active tumor (sensitivity, 96%). If a high-signal-intensity lesion was seen after a patient had undergone only surgery, the patient had active tumor (six of six such cases). In patients who had undergone only radiation therapy, however, the presence of a high-signal-intensity lesion may indicate either active tumor or radiation-induced inflammatory changes. Thus, in such cases, differential diagnosis of active tumor may be difficult, if not impossible, to make from MR images.

"Le Centre de Prolifération d'Aschoff" (CPA) has many synonyms: radial scar, benign sclerosing ductal proliferation, non encapsulated sclerosing lesions, fibroelastic center, fibroadenosis with fibroelastic core etc... In a retrospective study from the files of the Gustave-Roussy Institute, 88 cases were found: 18 cases between 1955 and 1959 and 70 cases more recently, between 1976 and 1981. CPA is an unusual lesion, observed in 2% of benign breast lesions, and in less of 1% of malignant breast lesions. Macroscopically, when CPA is not associated to a carcinoma, it has either a pseudotumoral feature (46% of the cases), or only a microscopic appearance (54% of the cases). In these last cases, it is always found by chance at the time of the examination of specimens of fibrocystic disease. When it is associated to a carcinoma, these two features are less well individualized. Mammographically and macroscopically, they are often problematical. They cause considerable diagnostic problems because of their pseudotumoral features, being similar to small stellate carcinomas. Two cases were misinterpreted at the time of the extemporaneous examination for a carcinoma and in 36 other cases, the diagnosis was uncertain and the definitive report was delayed. For the non-pseudotumoral form, a relationship was found in this series between previous cytological aspirations and CPA. The evolution of this lesion was difficult to evaluate because of the great number of the patients lost to follow up in this series. Although a slight trend was observed for patients to subsequently develop a breast carcinoma, no statistically significant difference was observed. From this study, close follow-up of these patients is considered necessary.

The pathologist today has an important role in the treatment of osteosarcoma. He contributes during the operation by advising about the extent of the tumour and after the operation by studying the operative specimen to assess the extent of the tumour, and, when primary chemotherapy has been used, to estimate the effectiveness of the treatment by counting the percentage of viable tumour cells so that the type of chemotherapy used subsequently can be adapted to the situation. Only trained teams can make the best use of these studies.

The appearance of hematopoietic malignancies and the level of viremia were studied in mice of different inbred strains and their F1 or F2 hybrids inoculated with the Moloney leukemia virus (MLV) The viremia was regularly measured in individual mice by radioimmunoassay of the major internal virion component p30. A complex genetic control was found. (1) The level of circulating virus was controlled by at least two genes. An H-2 linked gene, tentatively called Rmv-1, displayed a dominant sensitivity. Alleles for resistance existed in H-2b and H-2r haplotypes and alleles for sensitivity in H-2a, H-2d and H-2f. Another gene with dominant resistance mapped outside the H-2 complex and probably interacted with Rmv-1. (2) A good correlation existed between viremia and the appearance of leukemias, the most viremic strains being also the most leukemic. (3) Nevertheless, additional genes which were not involved in the viremia control could be determinant in the induction of malignancies. One of them with a resistant allele in DBA/2 mice seemed to inhibit the appearance of leukemia despite a high level of viremia. Another gene controlled the spleen involvement resulting in generalized leukemias in sensitive lines contrasting with mainly thymus-localized tumors in resistant animals.

Flaujeac trait is the functional deficiency of a plasma protein of the intrinsic coagulation, kinin-forming, and plasma fibrinolytic pathways. The Flaujeac factor in man has been isolated and tentatively identified as a kininogen of high molecular weight (HMW). Highly purified bovine HMW-kininogen, but not bovine low molecular weight kininogen, repaired Flaujeac factor deficiency. The two subspecies of this molecule, HMW-kininogen a and HMW-kininogen b, also corrected Flaujeac factor deficiency. When bovine HMW-kininogen was incubated with bovine plasma kallikrein, kinin-free HMW-kininogen, bradykinin, and a glycopeptide fragment (peptide 1-2; 12,584 daltons) were rapidly released. None of these fragmentation products corrected Flaujeac factor deficiency alone or in mixtures. The function of HMW-kininogen appeared to depend upon the structural integrity of the native molecule. When injected in concentrations of 2 pmol-8 nmol/0.1 ml, peptide 1-2 caused increased vascular permeability in rabbits, rats, or guinea pigs. The enhanced permeability was maximal within 1-2 min and terminated in 5-10 min, differing from that of bradykinin or histamine. Injected together in equimolar amounts, peptide 1-2 and bradykinin produced a synergistic permeability response which was immediate in onset as well as prolonged in duration. Peptide 1-2 is a rapidly acting, highly basic glyco-peptide which mediates increased vascular permeability in a complementary and synergistic manner with bradykinin.

The authors report three cases of intraparenchymatous neuroepithelial cysts, which did not communicate with the ventricular system and the subarachnoid space. They were located in (1) the right frontal lobe, (2) the left cerebral peduncle and pons, and (3) the right cerebellar hemisphere. All of them were asymptomatic, despite their volume and location, and presented as incidental autopsy findings. A developmental origin is likely for these non-neoplastic cysts.

The dosage of estrogenic receptors (ER) was performed on 80 cytosols of human breast carcinomas "immediately operable", by using a methode consisting of a single saturating dose (5 nM) with carbon-dextran and a new immuno-enzymatic method commercialized by ABBOTT laboratories using anti-ER monoclonal antibodies. The concordance is excellent between the two methods in terms of positivity. The results are significantly higher with the ER-IEA method than with the biochemical method (p. less than 1.10(-5]. The regression of the ER-IEA method as compared to the biochemical method is linear with a regression line: Y (ER-IEA) = 0.82 X (ER-Biochem) + 0.76 (logo10 conc. fmoles/g tissue). The correlation is good between the two methods (r = 0.90). A significant relationship (p less than 0.01) has also been observed with the histological grade of the carcinoma. Finally, the immuno-enzymatic technique seems particularly well adapted to small biopsies and slightly positive tumors.

We report 7 cases of unusual fibroadenomas of the breast. They are characterized by an exuberant cellular proliferation within the ductal lumens. They appear in young women from 20 to 40 years old. These lesions are histologically identical to those described by Azzopardi (1979) under the name of "Argyrophilic cells in fibroadenomas" and by Eusebi and Azzopardi (1980) and by Govoni (1981) and called "Lobular endocrine neoplasia in fibroadenoma of the Breast". An immunohistochemical study reveals a major positivity of these cells, in all cases, with Antikeratin Antibody (anti Kl1) and with Epithelial Membrane Antigen (anti EMA) proving the epithelial origin of these cells. There cells cannot yet be regarded as belonging to the neuro-endocrine group, because of the negativity, in all cases of Grimelius and Bodian stains, and of the very heterogeneous positivity observed with Neuron-Specific Enolase antibody (anti NSE) and with anti Human Natural Killer antibody (anti HNK). These cellular proliferations seem to us, on the microscopical point of view related to the atypical epithelial hyperplasias of the breast, and different from the in situ lobular carcinoma. Thus we propose to call these lesions "variant of the breast fibroadenoma" characterized by an atypical epithelial clear cell hyperplasia. The treatment of these lesions merely consists of a lumpectomy. Only one case is associated with an eleven years free of disease follow-up: a follow-up comprised between on to fifteen months is observed in the others cases. The knowledge of these benign lesions appears to us very important, to avoid improper treatment caused by an erroneous diagnosis of carcinoma developing in a breast fibroadenoma.

The hallmarks of diagnosis of medullary breast cancer (MedBC) used by the authors since 1977 have been that the tumor is well circumscribed, has syncytial architecture in greater than 75% of its surface, contains diffuse inflammatory infiltrate, has atypical nuclei, and forms no glandular pattern. In order to assess the clinical utility of these criteria, we studied a series of 95 previously untreated, surgically operable patients with breast carcinoma at the Institut Gustave-Roussy (IGR) between 1960 and 1979. A diagnosis of MedBC was initially made for these patients or suspected based on abundant inflammatory stroma observed in a histologic evaluation. Using these criteria, 26 cases were identified as typical medullary carcinoma (TMC), 23 cases as atypical medullary carcinoma (AMC), and 46 cases as nonmedullary carcinoma (NMC). The 26 cases of TMC represent a very small fraction of the total infiltrating operable breast carcinomas diagnosed at IGR during the same time period. The prognosis for these 26 patients was much more favorable than for the other groups. They had a 10-year disease-free survival of 92% compared with 53% for the AMC group and 51% for the NMC group. Neither distant metastasis nor secondary primaries of the same histology were seen. Therefore, it is possible with the use of strict histologic criteria to distinguish a group of patients with a much more favorable prognosis. This histologic diagnosis alone renders a most favorable prognosis for the patient even if other factors such as large tumor size and lymph node involvement are present and, by inference, the only therapy needed is the removal of all tumor. In contrast, atypical forms have a prognosis no different from other atypical types of breast carcinomas without inflammatory stroma, and adjuvant therapy appears to be justified if other factors warrant it.

The authors have seen 41 instances of chondrolysis following slipped capital femoral epiphyses. Most of the cases were followed-up for more than five years. The main clinical features are reviewed. There is joint stiffness and generalised narrowing of the joint space during the year following the initial lesion. The evolution of the lesion is unpredictable. A number of possible radiological changes may develop including renewal of the joint space, modifications in the femoral head with a tendency towards protrusio, and osteophyte formation at the lateral margins of the acetabulum. In five cases a biopsy was performed which showed a non-specific dystrophy of the acetabular and femoral cartilage, with sub-chondral bony change different from that found in epiphyseal necrosis. The synovium did not show inflammatory change. The treatment should not be surgical at an early stage but the effectiveness of traction was uncertain. Later, corrective osteotomies may be indicated. Definitive surgical procedures such as arthrodesis or arthroplasty should not be made early because late clinical recovery has been noted. Cup arthroplasties gave deceptive results. The etiology of this disease is discussed.