The follicular structure is most apparent in those growths which spring from the body, and especially from the fundus uteri near the orifices of the Fallopian tubes. These vary in size from a pea to a small plum. They have usually a rounded or oval form, and become partially flattened by the external pressure of the uterine walls. A short and narrow pe duncle connects them with the spot from which they' arise. Externally they are smooth and covered by a layer of epithelium, beneath which is a thin extension of the uterine mu cous membrane. This is often sufficiently transparent to render visible numerous opa line spots, indicating the seat of groups of uterine follicles distended and elongated, and containing a semitransparent gelatinous fluid. Between these elongated follicles there is a loose fibrous tissue connecting them together, and giving substance to the mass. These tumours possess little resistance, and are usu ally soft and elastic.
The more solid mucous tumours very ge nerally acquire a stern, and early take the form of polypi. These mostly arise from be tween the folds of the lining membrane of the cervix, and are evidently mere hypertrophies of that structure, including a variable propor tion of the sublying cervical fibrous tissue. In size they range from a pea to a walnut, and occasionally their eeduncle measures se veral inches in length, so that they may pro trude to a considerable distance beyond the vulva. Their form is generally that of an elongated pear. The surface is smooth, though not uniform, being usually nodulated or lobed, and in parts roughened by minute papillary growths. Sometimes one or two of the cer vical folds or rugx, scarcely altered in cha racter from their ordinary condition in the healthy cervix, are distinctly visible upon them. These more solid tumours are covered by cylinder or pavement epithelium and hy pertrophied mucous membrane. Internally they are composed of loose inelastic fibrous tissue, containing a few enlarged and ob structed follicles, one or two of which may grow more than the rest, and form a cavity distended by a slimy fluid.
The growth of both these forms appears to be limited, and they never attain to the size which the fibrous polypi often reach. With the hypertrophies of the follicular structures are also to be classed those single cysts, of the size of a pea, or larger, and sometimes pedunculated, which are very commonly found ly ing between the cervical folds, or protrud ing from the os uteri. These consist almost exclusively of distended Nabothian follicles.
c. Hypertrophy of the fliform papille of the cervix. — A variety in the condition of the filiform papilhe upon the vaginal portion of the cervix has been described at p. 639. These papillw, 'instead of being short, and covered by pavement epithelium up to the very margin of the os uteri, as they are upon the rest of the cervical lips, may present the same condition which they have within the cervix, where they are longer and larger, and are not bound down by a continuous lay er of covering epithelium. These papillm often
appear at the margin of the os, and form there little tufts, cr extend over the lips of the cervix in the crescentic manner already described at p. 639. They 'then constitute one of those conditions to which, in the pre sent day, the term ulceration is very fre quently applied ; yet thereNs no more reason for asserting that these are pathological for mations or conditions, than there is for as serting the same of the villi within the canal, for both are identical in form. They can only be regarded as pathological structures when they obviously exceed the natural conditions already described. Then, indeed, they may be classed among the hypertrophies of special structures of the cervix, and they will bear the same relation to the natural papillm, that the hypertrophied follicular structures, forui ing the cysts and poly pi recently described, bear to the cervical follicles in a healthy' con dition. Both the hypertrophied and the na tural papillw give to the finger that peculiar velvety or mossy sensation which is usually classed among the diagnostic signs of ulcera tion of the os uteri.
d. Simple kflammatory hypertrophy, with extroversion of the cervical mucous menibrane.
— The mucous membrane lining the canal of the cervix uteri under chronic inflammation becomes frequently partly everted, so that a portion of the inner surface of one or both walls of the neck is rendered visible at the lower orifice, taking here the place ordinarily occupied by the inner border of the lips of the os tincm. This affection is usually com bined with a corresponding hy pertrophy of the proper tissue of the cervix, and may be compared in its effects to that thickening of the upper lip common in strumous children, which causes the part to become everted.
Figures 7. and 8. Plate IX. in Boivin and Dliges' Atlas represent an extreme degree of this affection, in which the cervical mucous membrane protrudes to an unusual extent, so that the palmm plicatm and middle raphe on both sides are seen. In the more cominon minor degree of hypertrophy with eversion, a crescentic protrusion only of the cervical mu cous lining occurs. The unevenness of the surface, caused by the slightly swollen and prominent rugx, and as often by the numerous little depressions consisting of enlarged mu cous crypts, according as one or the other of these is the predominant normal structure in the cervix *, gives to the part during life the appearance of a raw or granular surface, while the natural boundary between the lower edges of the cervical canal and the lips of the os tincm being now transferred on to the latter in consequence of this eversion, an abrupt semicircular line becomes visible, which, while it only indicates the natural termination here of the vaginal epithelium (see p. 640.), is fre quently mistaken for the margin of an ulcer.