ANATOMY OF SARCOMA OF THE UTERUS.
That term is now usually applied, at least in Germany, and according to the classification of Virchow, to all those tumors which be long to the connective-tissue series, and are characterized by abundant proliferation of the cellular elements which more or less displace the inter cellular tissues. Such connective-tissue tumors of the embryonic type (Cohnheim) are observed in the uterus, and when occurring here are always reckoned among the malignant growths. They certainly present the clinical features of malignant connective-tissue tumors. It has as yet been impossible to establish a strict distinction between round-celled and spindle-celled sarcomata of the uterus, although, as we shall see, pure forms of the latter have certainly been observed.
Two forms of primary uterine sarcoma may, however, be easily distin guished by their clinical and anatomical features. These are fibro-sarco mata and diffuse sarcoma of the uterine mucous membrane.
The fibro-sarcoma, sarcoma fibrosum, s. nodosum, appears in the form of a firm or sometimes of a soft, globular tumor, which is developed from the uterine parenchyma. It may, like the pure fibroma, be either sub mucous, sub-serous or interstitial. These tumors consist in nodules of fibrous or muscular tissue, in which an abundant cell formation has oc curred, and seems to have gradually displaced the original tissues. The growths are either sub-mucous, in which case they constitute broad-based polypous tumors, or they are interstitial. The predominant form is that of the round-celled sarcoma, but myxosarcomata are occasionally ob served. Leopold, Grenser, Simpson and Schrader, (lac. cit.) each observed a simple isolated spindle-cell sarcoma.
Certain sarcomatous infiltrations of the uterine tissues, which do not proceed from sarcomata of the mucous membrane (soon to be described) but are found isolated in the uterine parenchyma, must be included among this group of the fibro-sarcomata. (Ilegar.) The entire organ may be uniformly permeated by infiltrations of this kind. (L.
While some isolated cases of this kind are reported in earlier literature, and well characterized by the term " recurrent fibroid," attention was not specially directed to this form of tumors until Virchow's time.
This form seems, on the whole, to be rare—at all events less frequent than diffuse uterine sarcoma, which we shall soon consider. Kunert could discover only nine such cases. ( Vide ante.) Since that time only the following cases have been reported. Leopold and Grenser, each one case of spindle-cell sarcoma of the portio vaginalis. G. Muller, Schwartz (Dissert. of Beermann), Schroder, Scanzoni, Gusserow (unpublished), each one case. A. Simpson two cases, and six of Frankenhauser (Die Bert. of Itogivue).
In addition to these, Breisky, Johannowsky, Zweifel and Garrigues have each reported one case, and Jacubasch four cases. Including the nine cases collected by Kunert, the total number of cases, therefore, amounts to thirty-two.
We must at once make the statement, however, that such statistics are of a somewhat arbitrary nature, because it is by no means possible to de cide with certainty, from the literature cited, whether any given case was one of genuine fibro-sarcoma, or of single irregular hyperplasia, in a soft sarcoma connected with the mucous membrane. It can not even be definitely settled whether combinations of both forms may not frequently occur. (Hegar.) The anatomical characteristics of fibro-sarcomata are easily stated. They occur as roundish, isolated tumors, usually of firm, but sometimes of very soft consistency. The microscope shows evidences of their fibrous and muscular structure, which is more or less replaced by the abundant proliferation of cells, which are usually round. The pure spindle-cell sarcomata are an exception to this rule.
These sarcomata occur with the least frequency, as do fibromyomata, in the cervix. Only Spiegelberg, Leopold, Grenser, Scanzoni, Schwartz (Heermann, loc. cit.) and Zweifel have described undoubted cases of cer vical fibro-sarcomata.