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Colonic mucosa-like intestinal heterotopia in a urethral caruncle is reported in a 2 yr 7 mth old girl and three women; 55, 71 and 78 yrs old. The occurrence of the anomaly in a child supports the first two author's earlier suggestion that the condition is congenital in nature. In princip this could also be the case in post-menopausal women, although the possibility of metaplasia must also be considered. Perhaps the condition could be a precursor of some adenocarcinomas of the distal urethra.

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In view of uncertainty regarding the criteria and significance of gastric dysplasia as a precancerous lesion, members of the Pathology Panel of the International Study Group on Gastric Cancer (ISGGC) reviewed microslides of 93 gastric lesions showing varying degrees of mucosal abnormality, and reached the following consensus: (1) immature and proliferating gastric epithelium can be divided into two categories: hyperplastic and dysplastic; (2) the term dysplasia, especially of high-grade type, should be restricted to precancerous lesions, and hyperplasia is applied to regenerative changes; (3) regenerative hyperplasia may be simple or atypical, but dysplasia includes both moderate and severe abnormalities, since they often coexist and can not be sharply separated; and (4) occasionally the possibility of malignancy can not be excluded in a severely dysplastic epithelium; in such a case rebiopsy and diligent follow-up are necessary to establish the diagnosis. Criteria for diagnosing dysplasia and hyperplasia are presented and discussed. The opinions are offered as guidelines for establishing the diagnosis of gastric dysplasia and for prospective studies.

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The effect of one single dose of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) on the antigenic structures of gastric juice glycoproteins, was studied in dogs. Antisera to glycoproteins of the fetal alimentary canal were raised. Histologic mucosal specimens and glycoprotein fractions of gastric juice which were taken from four dogs during a 15.5-month period after MNNG administration, were examined immunohistologically and by immunodiffusion for the appearance of fetal-like antigens. Fetal-like structures appeared in a stepwise manner in both the acid and neutral glycoprotein fractions of the gastric juice, and showed gradual crossreactivity between macromolecules obtained from gastric juice samples obtained during the observation period. Eight immunizations carried out using physicochemically different glycoprotein fractions of fetal canine alimentary canal mucosa, produced a similar response, thus indicating that the same antigenic structures are incorporated into all mucus glycoproteins, even though they do differ physicochemically. It is suggested that this "omnipotential" incorporation picture could also be found after exposure to MNNG and is, by its nature, typically fetal.

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A clinicopathological analysis is presented of gastric cancer cases detected in a mass screening trial in Finland, using the oncofetal antigen, fetal sulfoglycoprotein antigen, as a marker. The survey covered a population of 53,020 between the ages of 40 and 70, the percentage of participation being 74.8%. Of these participants, 3,508 subjects (8.8%) were found to be fetal sulfoglycoprotein antigen secretors, and among them 36 gastric cancers, one gastric carcinoid, and 10 tubular adenomas were detected. Both main histological types of gastric cancer, intestinal and diffuse, were represented. There were 15 early cancers. In addition, there were three widely spread superficial cancers. Because of early diagnosis, the prognostic view for these cases is clearly better than that found in the clinic by conventional means, curative resection being carried out in 28 cases (78%).

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Samples from 56 resected stomachs, including 28 cases of intestinal and 14 of diffuse type gastric carcinoma, were studied by electron microscopy. The main ultrastructural features of intestinal and diffuse type gastric carcinomas were described and compared to the ultrastructure of normal gastric mucosal cells and cells occurring in intestinal metaplasia of the gastric mucosa. Many similarities were demonstrated between intestinal metaplasia and intestinal type carcinomas. The cells of diffuse type carcinomas closely resembled the goblet cells of intestinal metaplasia. Microvilli, similar to those in the brush border of the intestinal columnar cells, could be demonstrated in the carcinomatous surface epithelium and occasionally also in individually spreading cells of the diffuse type carcinoma. Intracellular cysts with microvilli on the cyst wall were occasionally found in both types of carcinoma. The histogenetic origin of gastric carcinoma was discussed.

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Intracellular cysts were often found in the tumour cells in gastric carcinomas of intestinal as well as diffuse type in specimens from stomachs resected for gastric cancer. In the light microscope, the cysts appeared usually as solitary cytoplasmic vacuoles. In the electron microscope, the intracellular cysts were seen as round cavities, often containing homogenous or granular mucous material which stained with the periodic acid-silver methenamine (PASM)-method. Relatively long microvilli were lining the cysts and, not infrequently, abundant cytoplasmic microfilaments would surround the cyst wall. Similar cysts have been observed in a number of other tumours and, accordingly, their diagnostic significance must be considered in connection with other methods such as differential staining of cellular mucosubstances.

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In a series of 235 autopsies, changes in the subcapscular thoracic fascia similar to elastofibroma dorsi (Järvi & Saxen 1959, -et al. 1969) were found in 39 cases, all at least 58 years old. In people over 55 years, the frequency was 24.4 per cent in females and 11.2 per cent in males. In addition to hypertrophy and secondary degeneration of elastic fibres, necrosis of collagenous-, adipose-, muscular-, and nervous tissue, as well as formation of clefts, cysts and bursae was found in 85 per cent of cases presenting elastic changes--both in connection with them and outside the degenerated areas--as well as in 39 per cent of cases where no elastic degeneration occurred. Other changes included extensive scarring of the tissue, followed by reduction of fat and, more seldom, oedema and inflammatory infiltration. Breaks in the elastic cage, necrosis and fibrosis of arterial walls were found in 44 per cent of cases of elastic degeneration and in 14 per cent of cases without degeneration. In veins, more extensive wall fibrosis occurred, leading to necrosis; in cases of elastic degeneration the adventitial elastic network was also involved. Venous changes were found in 90 per cent of the cases of elastic degeneration and in 30 per cent of cases without degeneration. Direct mechanical stress on elastic tissue may be an important cause of hypertrophy and secondary degeneration of elastic fibres, and also of diffuse increase of collagenous tissue. On the other hand, nutritional deficiency due to failing resistance of the vascular system against friction of the scapula and streching movements of the upper extremities may play a main part in necrotic tissue changes.

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