CANCER OF THE BODY OF THE UTERUS.
Pichot col lected, mainly from French and English sources, forty-four cases, the analysis of which furnishes the basis of his above-mentioned monograph. Until 1878 there were reported, in addition to that number, thirty-six others, in all eighty cases. Since then a much larger number of cases has been placed on record, so that I have found 122 cases, including three unpublished ones of my own.
A certain number of these must be deducted as being true sarcomata of the uterus. In the literature of older date disintegrating and slough ing fibromata have not infrequently been mistaken for carcinomata of the fundus, but these cases have also been excluded by Pichot. Of course we exclude all those cases of cancer of the body of the uterus in which the affection is merely secondary to primary carcinoma of some other organ. Thus Oswald observed the propagation of the disease from an ovary, and ere& from the rectum to the uterus.
As an illustration of the rarity of isolated cancer of the body and fun dus of the uterus, Szukits met with but one instance of it in 420 cases of cancer of the uterus. Schroder' estimates that there were 28 cases of cancer of the fundus in 812 cases of carcinoma of the uterus, that is 3.4 per cent. According to Pichot's statements there would appear to be 6 cases of carcinoma of the corpus uteri in 100 of cancer of the uterus. Schatz' found the body of the uterus affected twice in 80 cases of cancer of the womb.
Just as in cancer of the cervix, we may divide the cor pus uteri into two great classes. The parenchymatous or infiltrated variety (following Bleb's' nomenclature) seems to occur most frequently. This form is made up of more or less numerous, isolated, roundish de posits, which consist of soft, succulent masses (encephaloid cancer) contain ing polymorphous and sometimes cylindrical epithelial cells imbedded in a sparse interstitial tissue. In this manner large, spheroidal tumors form in the substance of the uterus, distending it just as fibromata do, but always presenting a smooth surface, as they are not made up of single protuberances, like some myomata. These cancer-nodes, moreover, sel dom break through the enclosing muscular tissue of the uterus, to pro ject into the uterine or peritoneal cavity. As seldom do they undergo
purulent disintegration and ulceration. Blebs also points out correctly, that a large number of these cases have probably been mixed tumors, car cino-sarcomata. It certainly militates for, rather than against this opinion, that this variey of neoplasm not very infrequently gives rise to multiple metastases.
The second variety of cancer of the corpus uteri begins in the mucous membrane, probably in the glandular tissue, and either presents as a widespread infiltration of the mucous membrane, extending into the deeper layers, or beyond them into the muscular substance, or it manifests itself in the sbape of isolated, polypoid excrescences which project into the cavity of the uterus. In either case necrosis and ulceration set in, ap parently very early.
In regard to both forms of this rightly-named mucous cancer (Schleim hautkrebs) of the body of the uterus, recent investigations seem to show the possibility, to say the least, of their origin from newly-formed glands. Breisky' detected in a patient suffering from uterine hemorrhages, nu merous diffuse, polypoid excrescences attached by broad bases to the uterine mucous membrane, the cervix being healthy. On scraping away some of these growths as a therapeutic measure, and submitting them afterwards to microscopic examinations, Er ginger found that they pos sessed a typical adenomatous structure, consisting of hypertrophic utri cular glands, lined with cylindrical epithelium. A succession of hemor rhages recurring about four months later, more excrescences, similar to the previous ones, were scraped away, which were, however, softer and more friable, and possessed, even microscopically, a greater resemblance to cancer. On microscopical examination it was seen that the previously empty tubules were now choked up with cells, and even that tubules which were invested with cylindrical epithelium at their periphery con tained pavement epithelium and cancerous plugs in their centres. I am indebted to Professor Breisky for his kindness in allowing me to reproduce his illustrations of these specimens in this place.