The appearance of a so-called " fibroid," at the time of the menopause, or the sudden growth and increase at this time of a tumor which had previously been of small size, and had produced few symptoms or none at all, should arouse the suspicion that the tumor was originally a fibro sarcoma, or has been transformed from a fibroid into a sarcoma.
The occurrence of hemorrhages in cases of so-called " fibroid," long after the cessation of the menses, has an important bearing on the diag nosis. While hemorrhages from fibromyomata frequently diminish or cease at the menopause, those due to fibro-sarcomata are most profuse at that epoch, since these tumors frequently make their first appearance then. An abundant sero-sanguinolent discharge is even more charac teristic of fibro-sarcomata than these hemorrhages, for it is really never produced by simple fibroids unless they are undergoing gangrene. It is however, not a constant phenomenon in cases of fibro-sarcomata. The chief reason for the difference between the two varieties of new growths, in this particular, is probably that fibroids possess a so-called capsule, which fibro-sarcomata almost always lack. Another prominent reason is that sarcomata are very vascular, and fibromata almost always but slightly so, or that only vascular fibroids are predisposed to sarcomatous degen eration.
The rapid growth of a doubtful tumor, particularly if it take place during the climacteric years, in which fibroids hardly ever grow to any considerable extent, is another evidence in favor of fibro-sarcoma. Un usually violent pains and soft consistency are also characteristics of the latter tumors.
If the tumor be accessible to direct palpation, the softness referred to above, which often permits the finger to penetrate the new growth, or to break off small portions of it, is almost pathognomonic of fibro-sarcoma. Gangrene of a fibromyoma must be excluded by a careful investigation of the case. The diagnosis is usually easy if, in addition to the points mentioned, marked emaciation, asthenia, cachexia, and anaemia make their appearance.
In the event of a successful extirpation, the microscopical examination, and, above all, distinct recurrences, afford definitive evidence concerning the nature of the neoplasm.
The diagnosis of diffuse sarcoma is not so comparatively easy iu every case. A differential diagnosis between this variety of sarcoma and car cinoma of the fundus, may be at first impossible. This distinction is,
however, practically useless, since a strict differentiation between diffuse sarcoma and carcino-sarcoma can not always be made, even by anatomi cal appearances.
Sarcoma of the cervix is easily distinguished from cervical cancer, by the healthy condition of the portio vaginalis.
The sarcomatous tissues occasionally protrude so far beyond the os ex ternum that they quite cover the border of the os, and seem to completely fill the latter. Careful examination with the finger, and the speculum, must decide the question in such cases.
The differentiation of a diffuse sarcoma from certain benign hyper trophies of the uterine mucous membrane, especially that form recently described' by the name endometritis fungosa, is more important, and in fact more difficult. This disease occurs less frequently after the meno pause than sarcoma, but the age of the patient is not a decisive diagnostic feature, inasmuch as the development of diffuse sarcoma is not exclu sively confined to the period in question.
The general condition of the patient, when subjected to long-continued observation, is more significant. In benign fungous cndometritis the patient may, it is true, become anemic, but she never develops a pro nounced cachexia.
Endometritis fungosa is rarely attended by any considerable discharge, especially since spontaneous gangrene, so common with sarcoma, never accompanies it. In sarcoma the os uteri is almost always permeable, in endometritis it is usually closed. In sarcoma the uterus is large, infiltrated, and ordinarily painful when it is moved. These points are absent in endo metritis. In sarcoma the new growth often projects beyond the os, after the fashion of a polypus. This appearance is never observed in benign hy perplasia of the uterine mucous membrane. Endometritis always remains as a superficial proliferation of the mucous membrane, and never involves the parenchyma; while sarcoma, being originally developed, as a rule, in the deeper structures, always invades them, and extends into and through the uterine parenchyma. Genuine recurrences of endometritis, such as occur with sarcoma, are not observed. The differential diagnosis between these two morbid conditions ought not, therefore, to be very difficult.