There are a few cases in which the hemorrhages, especially at the be ginning of the disease, were trivial, or in which there was a persistent although trifling escape of blood.
Together with the hemorrhages and in the intervals between them there is an exceedingly copious, sero-sanguinolent discharge, which usually has a repulsive, foetid odor, but is not the result of disintegration of the tumor. Disintegration of the sarcomata usually occurs, however, at an early period, and the discharge then assumes the character of the fluid emanating from gangrenous tissues. Most of the cases are characterized by the great severity of the pain, although pain may, in exceedingly rare instances, be absent.
The pains do not, as a rule, possess the characters of rhythmical uter ine pains. They are agonizing, tearing pains, which often cause the patients to cry out, and which are frequently difficult to control.
It seems as if the special intensity of these pains was dependent upon the depth to which the sarcomatous infiltration had penetrated, and that the pains were due to morbid changes in the terminal nerve filaments. In regard to other points in the history of this form of uterine sarcomata, the statements made concerning fibro-sarcomas may be reiterated. Re currences take place, at first, after long intervals. Later they follow each other with increasing rapidity. Death occurs sooner or later, as the result of antenna and cachexia.
Metastases are far rarer with diffuse sarcoma than with fibro-sarcomata, but the former often penetrates the uterus, invading the abdominal cav ity and attacking the pelvic connective tissue, the bladder, the vagina, the rectum and even the external genitals. Its similarity to carcinomIt is thus shown.
We herewith present Rogivue's figures, which furnish certain data concerning the course of this disease. Among fifty patients who sub mitted to an operation, six died soon after the operation, nine escaped farther observation, and three seemed permanently cured.
Recurrences were observed in thirty-two cases. In eight of these the recurrence took place very soon after the operation. In twelve within six months. In ten within one year. In two after one year. Forty pa
tients out of sixty-five died. Twenty-five of these died within a year after the first investigation, and some of them after three, four and six years. The entire duration of the disease varied between four months (Franken hanger, quoted by Rogivue) and ten years (Hagar). The average dura tion was, according to Rogivue, three years.
Reference should be made, at this point, to the frequency of inversion of the uterus in cases of sarcoma. Taking into consideration the small number of uterine sarcomata actually observed, the number of inversions, four in all, is, at all events, relatively large. These cases were studied by Langenbeck (loc. cit.), Spiegelberg and A. Simpson. W. A. Freund's case is very peculiar. Ho diagnosticated sarcoma with hydro metra in the occluded left half of a uterus septus and confirmed his diag nosis by the autopsy.' The diagnosis of uterine sarcoma or carcino-sarcoma can, doubtless, only be made by histological investigations. These researches are, how ever, often impracticable during the patient's life and never furnish pa thognomonic data for a diagnosis, unless an examination be made of the whole tumor or of the tumor and uterus while still connected. An ap proximately correct diagnosis, in cases of fibro-sarcomata, can only be made after extirpation of the tumor, while the small pieces, so readily obtained from a diffuse sarcoma, are by no means sufficient to positively establish a diagnosis.
Since, now, the question of extirpation is really decided by, and the prog nosis is chiefly dependent upon, the nature of the tumor, wo must attempt to establish the diagnosis by means of clinical data, utilizing microscopical examinations, so far as is possible. It follows from the fact that fibro sarcomata are often gradually developed from fibromyomata, that a differential diagnosis between them is frequently impossible. All fibro sarcomata which appear in the form of distinct and isolated tumors give rise to the symptoms of fibroids. We may, therefore, refer the reader to the earlier chapters for these phenomena.