A total of 366 consecutive modified radical mastectomy specimens were studied for determination of multicentricity. The authors found that 187 samples (49.1%) were multicentric. Ten specimens contained in situ carcinoma without an infiltrating component; eight of them were multicentric. Multicentricity was correlated with various laboratory and clinical features, including patient age, tumor size, histologic type of breast cancer, tumor grade, presence and values of estrogen and progesterone receptors, the amount of solid tissue in the breast, and the family history. The data were organized in eight independent dimensions, four ordinal and four cardinal. Correlation analysis was applied to a cross tabulation supplemented with other statistical tests. The authors found that the factors related to multicentricity were the age of the patient, the size and the histologic type of the tumor, levels of the progesterone receptors more than 50 fmol/mg of protein, and the amount of solid tissue in the breasts. Tumor grade, estrogen receptors levels, and family history were not related to multicentricity. It was concluded that multicentricity is a frequent property of breast cancer. It is more common in young and perimenopausal women. Multicentricity occurs in small tumors but is, more common in larger ones.

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Histologic material from 75 cases of uterine cervical cancer was studied with particular emphasis on the morphology of the regional lymph nodes. Sixty‐seven cases were squamous cell and eight were adenocarcinomas. Sixteen were metastatic and 59 non‐metastatic. Five‐year survival data were available in 42 cases. We found that lymph nodes could be classified in four distinct histologic patterns which we designated “lymphocyte predominance,” “germinal center predominance,” “lymphocyte depletion,” and “unstimulated.” Correlation of the histologic pattern with the presence or absence of metastasis and the survival data demonstrated that lymphocyte predominance was common in non‐metastatic cases and in cases with high survival rate. The “lymphocyte depletion” pattern was common in metastatic cases and in cases with low survival rate. The “germinal center predominance” pattern was associated with an intermediate survival rate. The possible relationship of these patterns to host cell‐mediated and humoral immune responses is discussed.

A VAST amount of work has been done on the morphological grading of malignant tumours and its correlation with post-operative survival. The value of such work has been doubted by some authors, e.g. Willis (1960) who considers that tumour morphology can give only a general impression of malignancy. The prognostic use of grading, however, is one of the justifiable aims of pathology, and the results obtained by Bloom and Richardson (1957) in breast cancer using the method devised by Scarff (Patey and Scarff, 1928) are encouraging. They are especially impressive when grading is taken together with staging. These results, however, are statistical and not sufficiently constant to be confidently used in individual cases, possibly because they express only one aspect of the problem.More and more it is being recognised that the course of the cancerous process is not simply dependent upon the intrinsic malignancy of the growth but is the resultant of a complicated interplay between opposing groups of factors: those which are intrinsic in the tumour, associated with different degrees of aggression, and those in the host associated with different degrees of resistance. On the basis of this assumption it would be possible for a tumour of high malignancy to be associated with high resistance and to simulate in its behaviour a tumour of low malignancy. This conception has been given by MacDonald (1951) the designation "biological predeterminism ". Such a defence mechanism against tumour growth has been put forward by Black, Kerpe and Speer (1953), Black, Opler and Speer (1954) and Black and Speer (1960) who studied sinus histiocytosist in lymph nodes draining various neoplasms, especially those of the breast, and who found a close relationship between this condition and long survival after resection. These authors found that sinus histiocytosis was more frequent in cases without metastases. They also found that in metastatic cases survival was better when sinus histiocytosis accompanied the metastatic growth. These observations prompted Black and his associates to think that the low metastatic ratio and good prognosis were both directly due to sinus histiocytosis. The observations have been confirmed by many workers, including Berg (1956, 1959), Wartman (1959), Mass6, Mass6 andChassaigne (1960) and Masse and Chassaigne (1962). Berg hotly denies that sinus histiocytosis is due to host resistance but his argument seems obscure. Wartman regards sinus histiocytosis as a resistance factor but in his series of cases he found it most frequently with Grade I tumours, with which of course survival tends to be good.

The histological grading of tumours according to their intrinsic malignancy is very important in the prognosis of breast cancer but within each grade the ultimate prognosis depends mainly on the age of the tumours. We have shown that tumour fibrosis is an indication of this time factor, increasing with the age of the tumour. Within each grade the metastatic ratio is higher and the 5 year and 10 year survival less with the scirrhous than with the non-scirrhous tumours. The establishment of axillary metastases is closely connected with both the degree of malignancy and the time available, the unfavourable effect upon survival being greater in the scirrhous than in the non-scirrhous tumours. Another consequence of the passage of time, as indicated by fibrosis, is the gradual diminution of lymphoid infiltration (LI) which is mostly present in young tumours, especially those of high grades. The favourable effect of LI upon survival is demonstrated in the non-scirrhous tumours of grade III, possibly because of its great intensity, but this influence upon survival is lost as fibrosis increases and the intensity of the reaction diminishes.