Virchow first called attention to the primary development of the very soft, round-cell, medullary sarcoma of the uterine mucous membrane, but characterized it as very rare.
Cases of this kind have, however, been rapidly multiplied recently, and among them have been also included those in which the sarcomatous proliferation was not really diffuse, but rather polypoid, so that this form has not always been sharply differentiated from the variety previ ously described.
The proliferating tissues are always very soft, grayish-white, medullary, vascular and protrude, usually in forms resembling a cock's comb, above the healthy mucous membrane. Their surface is ordinarily undergoing disintegration. It is quite uneven and covered with blackish or brownish shreds. These new formations may be easily distinguished from benign hypertrophies of the uterine mucous membrane, i.e., granulation tissues, both by their anatomical and by their clinical features. The author and Hegar called attention, in the first publications of this kind, to the ad mixture of epithelial elements in these tumors, or, in other words, to the cancerous degeneration of the uterine mucous membrane. The number of cases of this kind has been so much augmented since that time, that Blebs (loc.cit.) properly points out the fact that most of these tumors are to be frankly styled carcino-sarcomata. Scanzoni calls attention to this fact as viewed from a clinical standpoint.
In most of these cases the uterus is enlarged, the os is patulous, which fact is particularly noticeable in nulliparte, and the palpating finger easily enters the uterine cavity, the mucous membrane of which is found to present, either throughout or at one point, the proliferation just described.
The fact that the cervical mucous membrane is very rarely the point of departure for the disease should be emphasized. (Veit, Spiegelberg, Schwartz, Zweifel.) In the great majority of the cases the sarcomatous degeneration originates in the sub-mucous connective tissue of the body of the uterus.
Among the sarcomata we must distinguish, as a separate variety, papil lary growths taking their origin from the cervix. But there is certainly
no reason why we should distinguish a separate class of tumors as " papil loma." We will return to this point later on.
Spiegelberg (1. c.) was the first to describe (in 1878) a case which he designated sarcoma colli hydropicum papillary.
It concerned a girl, aged seventeen, in whom papillary formations had rapidly grown from the. anterior lip of the os uteri. They bled easily, and recurred ten months after removal. Microscopical examination showed the growths to be sarcomatous. In consequence of the repeated recurrence of the tumors, Freund finally performed total extirpation of the uterus. The patient died. Rein (1. c.) has placed on record a similar case, calling it myxonta enchondromatodes arborescens colli uteri. There is no doubt that this was an instance of sarcoma and not myxoma. The patient was a girl aged twenty-one. The growths recurred and caused the patient's death by becoming gangrenous, and leading to septicaemia.
The next case of " papillary hydropic sarcoma of the cervix " is de scribed by Spiegelberg (I. c.). The patient was thirty-one years old. The sarcoma took its origin from the cervix, and consisted of papillary excrescences, covered by epithelial layers. The interior of the tumor had a myxomatous appearance, owing to the great distension of the inter papillary lymphatics. The growth having frequently recurred, Spiegel berg at length performed total extirpation of the uterus after the method of Freund. The patient recovered.
Winckler (1. c.) has also described a case of this kind observed by San ger. The patient died after repeated operations for recurrence of the growths.
These four cases are unquestionably instances of sarcoma of the cervix, that differ only in their papillary appearance and dropsical transforma tion from other cases of sarcoma. The anatomical structure of the cer vix (richness of papillae and lymphatics) sufficiently explains their pecu liar features.