CYSTO-FIBROMATA OF THE UTERUS.
They are either changed fibromyomata, or belong to the group of fibroids. Their common feature is the accumulation of fluid within the substance of the uterus.
The special practical significance of these tumors is found in the fact that they have usually been mistaken for ovarian tumors, by reason of their location and of their fluid contents.
Aided by Virchow (Geschwulstlehre, III., p. 124) we have recently but just begun to establish pathological distinctions between the various tumors included in this class. Only uterine myxomyomata may, with propriety, be considered as constituting a special species of myomata. These are characterized, according to Virchow, as myomata with abundant interstitial tissue which is rich in fluid and closely resembles simple oedema. The microscope, however, shows that proliferation is oc curring in the tissue of the neoplasm, since nucleated, round cells are found in the interstitial fibres. The fluid contains mucin. I have been unable to find, in literature, any statements regarding this subject, other than those of Virchow, and consider it difficult to separate myxomyomata from the sarcomata.
The other forms of the fibro-cystic tumors are fibromyomata in which certain pathological changes have occurred. The most frequent change consists in cedematous infiltration of the tumor. At the same time the intramuscular connective tissue undergoes changes, apparently consist ing at first in cedematous swelling. Finally, however, the tissue is corn pletely disintegrated, and there appear spaces filled with clear fluid, similar to and in many cases identical with lymph, in its chemical com position. The muscular fibres of the neoplasm are pressed together, and become atrophic. The tumor fluctuates plainly, but usually contains no large cavities, so that puncture only furnishes a little fluid. In some cases the fluid is more abundant.
In many cases the fluid possesses the peculiar property of spontaneous coagulability, and this might lead to the assumption that the tumors in question belong to the class of lymphectatic myomata, soon to be de scribed. That they are not akin to these, is proven by the fact that all observers have failed to find any endothelial lining of the spaces contain ing the fluid. These alveolle must, therefore, be simple interspaces in the
tissues, and not genuine cysts. It is true that Plan (loc. cit. p. 84) at tributes to Ranvier and Melassez the discovery of a lining composed of " pavement epithelium " in the spaces. The tumors they examined were, however, probably lymphectatic myomata, to the connection between which and this form of tumors we shall immediately recur. Although only a few well-investigated cases are to be discovered in litera ture, the majority of the fibro-cysts probably belong to this class of in filtrated fibromata.
Spiegelberg' describes a case belonging in this category as follows: " Thick and transparent, easily isolated membranous folds, permeated with numerous vessels, visible to the naked eye, and with connective tissue bands, separate, complete and other incomplete cavities, varying in size from the head of a pin to a walnut, or from the boundaries of ir regularly shaped cracks and orifices. In the solid portions between the connective-tissue fibres, are found numerous round, stellar or fusiform cells, of various sizes, and with one nucleus or several nuclei, together with muscle fibres, either entire or disintegrated. Nuclei, blood cor puscles and detritus are also seen. The membranous parts of the spongy tissue are composed of young connective tissue, permeated by a close meshed capillary plexus, and by vessels of larger calibre. Pavement epithelium was absolutely lacking. The fluid is dark yellow.. Its s. g. is 1020 and its reaction neutral. About one-fourth of its total quantity is composed of large gelatinous, yellowish coagula, consisting of fibrin. The fluid portion contains large quantities of serum albumin. Paral bumin and mucin are wanting." The second case of Frankenhausee in which the fluid coagulated on evacuation, appears to belong here, although it was not anatomically in vestigated. Similar cases were those of Baker-Brown,' Spencer Wells,' Storer,' Schuh, Thomas Bryant,' and probably most of Atlee's' cases. One case of this kind reported by myself was carefully investigated.