Published reports of “adenoacanthoma” of the endometrium have usually included both those cases in which the squamous elements are histologically benign and those in which they are histologically malignant. In the present report, cases with the former appearance have been classified as adenoacanthoma (or adenocarcinoma with squamous metaplasia), but tumors with malignant‐appearing squamous cells have been grouped separately as mixed adenosquamous carcinoma. Of 148 consecutive cases reviewed, 71 (48.0%) were adenocarcinomas (AC), 44 (29.7%) were adenoacanthomas (AA), 26 (17.6%) were mixed carcinomas (MC), and 7 (4.7%) were clear cell carcinomas. Clinically, there were no major differences among patients with the three predominant tumor types, but there was a tendency toward later menopause and lower gravidity among those women whose tumors contained squamous elements (AA and MC). Despite similar treatment regimens and clinical staging, actuarial 5‐year survival was 56.3% for AC, 82.9% for AA, and 35.3% for MC. Patients with MC also had a higher incidence of persistent tumor after irradiation, deeper penetration of tumor in hysterectomy specimens, and a tendency to earlier recurrences. When the MC pateints were compared with only women with poorly differentiated AC (since the glandular elements were almost always poorly differentiated in MC tumors), these two groups were quite similar in most parameters, including 5‐year survival. Similar comparisons between AA and well‐differentiated AC reveal that, despite similarities in all other respects, the 5‐year survival remains significantly higher in AA (82.9% vs. 60.6%). Thus, it appears that the poorly differentiated (i.e., histologically malignant) squamous elements in MC are a function of poorly differentiated glandular elements and may not significantly worsen an already unfavorable prognosis. The ability of a well‐differentiated carcinoma to form histologically benign squamous elements, on the other hand, seems to improve a prognosis which is already relatively favorable. Tumors formerly indiscriminately classified as adenoacanthoma should now be separated into two distinct groups, and these relationships should be investigated further.

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Twenty-three patients with pathologic stage III Hodgkin's disease were classified with respect to the presence or absence of symptoms (III-A, III-B), the presence or absence of splenic involvement (IIIS+, IIIS-) and anatomic substage--the extent of disease within the abdomen (III1, III2). Stage III1 disease included disease limited to the upper abdomen, i.e., spleen, splenic node, celiac node, and/or portal node. All other more extensive disease was classified as stage III2. Symptoms and splenic involvement did not predict either disease-free survival or survival. However, 5 year actuarial disease-free survival was significantly better in III1 patients as compared to III2 patients (77% vs. 13%, p less than .001). Eight of nine stage III2 patients receiving total nodal radiotherapy alone relapsed. When considered along the previous studies of anatomic substage, these findings suggest that patients in stage III1 and III2 should receive different therapeutic approaches. Analysis of therapeutic results in stage III patients must consider anatomic substage.

The dose distribution due to absorption of photon energy fluence in a homogeneous water phantom irradiated by megavoltage x-ray beams has been analyzed with a semiempirical model. The method generalizes an analytical formalism for the scattering component of dose within a water phantom which was developed recently for monoenergetic photon beams. Contributions to dose via Compton interaction and pair creation form the essential structure of the secondary component formula. Both the central-axis percent depth dose and off-central-axis ratios can be determined for beams of different sizes, used at any value of source to surface distance. The input data include the values of linear attenuation and energy-absorption coefficients in water at energies between 10 keV and the equivalent energy of the beam. Predicted values of the central-axis percent depth dose and the off-central-axis ratios are compared with the measured data for 2, 4, 6, 8, 10, 14, 20, 35, 45, and 70 MVp x-ray beams. For the central-axis percent depth dose, agreement is within 3% for fields of sizes between 5 X 5 and 20 X 20 cm2, and 5% for larger fields, for beams of MVp up to 20. For higher energy beams, comparison was made only for the 10 X 10 cm2 fields and the discrepancies were within 3%. For the off-central-axis ratios, agreement between the predicted and measured values is within 5% over the umbra region but worsens in the penumbra region and geometrical shadow. This formalism requires large computer storage for generating data for all realistic beams irradiating normal-size phantoms.