Kraske (1) in 1897 stated that there is no satisfactory evidence that cancer arises from a hemorrhoidal tag or a fistula. Ewing (2) quoted Kraske and is apparently of the same opinion. Opposing this view are a number of reports in the recent literature which conclude or imply that fistulae and other rectal abnormalities cause the development of cancer. The literature on this subject shows little in the way of histological detail which might establish a causal relationship between the rectal abnormalities and the cancers. The case of Fitchet (3) was a squamous-cell carcinoma, demonstrated by histological study to have originated from the lining epithelium of a fistulous tract. A probable case has been reported by Rosser (4), in which curettage of a fistulous tract disclosed squamous epitheliomatous tissue. The reports of cases by Moon (5), Lockhart-Mummery (6), and of other cases by Rosser (7) give no satisfactory histological evidence. Consequently, the only statement which can safely be made on the basis of these reports is that there may be an association of cancer with fistulae. In a series of 779 cases of rectal cancer, Mandl (8) was able to find only 3 cases in which a fistula preceded the cancer. Jacobs (9) found 5 cases of ischiorectal abscess and fistulae associated with cancer in 91 cases of cancer of the rectum collected over a period of ten years at Montefiore Hospital. The reports of Rosser (7) and others would indicate a greater frequency of such an association. The indecisive aspect of these studies stimulated a detailed histological study of a case of multiple fistulae associated with a mucinous carcinoma which came to autopsy at the Cleveland City Hospital.