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EPORTED INSTANCES of metastatic tumor in the small bones of the R hands and feet are rare. This report concerns a woman who had perplexing symptoms and physical findings suggesting arthritis. Ultimately she was found to have breast carcinoma metastases in the small bones of the foot. CASE REPORTC.W., #296285, a 66 year old widow, was admitted to the Strong Memorial Hospital on August 15th, 1957. Two years before admission she noted the onset of an aching pain in the left ankle which occurred after Y trivial injury. Four months later she developed swelling, redness and increased heat in the region of the left ankle. The entire foot often became swollen and reddened with an extension of the process into the lower portion of the left leg. The pain was more severe after prolonged standing or walking. These symptoms were remittent at first; one week of severe discomfort was followed by one of relative comfort. One year after onset, her symptoms became more persistent and during the eight month period before admission nearly constant swelling, pain and redness werr present in the left foot and ankle. During this entire period the patient had no other joint symptoms and otherwise considered herself to be in good health. A diagnosis of rheumatoid arthritis was felt to be supported by roentgenologic evidence of osteoporosis of the bones of the left foot and ankle ( fig. 1 ). Therapy was nearly continuous and consisted of administration of gold therapy, steroids in therapeutic amounts, phenylbutazone, colchicine to the point of toxicity, intra-articular injections of hydrocortisone into the left ankle and the oral administration of salicylates. These treatments were given at different times, without appreciable influence on her symptoms.Past history.-The patient had an acute illness presumed to be streptococcal infection 10 years prior to admission. This consisted of a period of two weeks of fever and arthralgia. The patient recovered completely from this illness. Eight years prior to admission the patient noted a small nodule in the right axilla. This was removed and found to be a metastatic lesion probably from. a breast carcinoma. Examination of the breasts by two physicians failed to reveal any palpable tumor. Seven years prior to admission a small mass was discovered in the right breast and a simple mastectomy was performed. A very small primary carcinoma was disclosed. The patient had otherwise been in excellent health. Physical examination.-On admission the patient's temperature was 38 C., the pulse 72, respiration 18, and B.P. 164/92. The patient was a pleasant, cheerful woman who did not appear acutely or chronically ill. She was in moderate discomfort and was somewhat disabled by pain in the left ankle. This extremity presented an unusual appearance. The skin was edematous, reddened, and had an increased temperature. These changes extended up over the anterior tibia and over the dorsum of the left foot. The left foot showed a remarkable vascular pattern. There was an increased superficial venous dilata-

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