Their case was that of a tumor which had been diagnosticatod as a uterine myoma with cystic degeneration, and which yielded, on punc ture, 1500 gm. of bright yellow fluid, which immediately coagulated when exposed to the air. The reaction of the fluid was alkaline, and its a. g. 1023. Its composition was as follows: Water 93.1, solids 6.9, salts 0.7, albumen 6.0, fat 0.04, fibrin 0.1.
A characteristic ingredient of the fluid is, therefore, fibrin. The microscope showed that the tumor was a myo-sarcoma filled with cavities, which were lined with a fine endothelial covering, so that the case was plainly one of lymphangioma. • Only one similar case has been reported since that one, by Rhein." This case makes the identity of the three forms of cysto-fibromata which have been considered probable, and sug gests the propriety of regarding them all as lymphangiomata.
In Rhein's case there were large and small cavities filled with masses of tissue and a spontaneously coagulable fluid resembling blood. Microscopi cal investigation showed that the smallest cavities possessed no wall of their own, but were here and there connected with spaces covered with endothelium, and which were, therefore, lymph channels. Rhein mentions still another case, that of Heintze, in which the wall of such cavities, in a fibromyoma, possessed a plain endothelial layer.
However deficient our knowledge may be regarding the pathological genesis of cyeto-fibromata, and however doubtful it is whether there be any anatomical distinctions between the different groups of these tumors, there is at least one class which can be anatomically, although not clini cally separated from them. These are the myomata telangiectodes seu cavernosa of Virchow.
The characteristic of this form is the abnormal development of blood vessels in the myomata. Thoughout the whole, or in certain parts of the tumor, the blood-vessels dilate into cavities as large as a hemp-seed or a pea, so that the neoplasm presents a spongy tissue, filled with blood, and closely resembling the corpora cavernosa penis.
Virchow,' who first called attention to this form of myoma, quotes cases of this variety reported by Cruveilhier, Krull, R. Lee and Klob. He also remarks upon the marked difference in the volume of the tumors before and after menstruation.'
Since that time there has been, strictly speaking, only one carefully observed tumor of this kind reported, that of Leopold.' The tumor was very large, sub-serous and attached to the fundus uteri. Even its capsule contained numerous vessels as large as a goose-quill. The neoplasm itself consisted of a dark, reddish .ljrown, spongy mass containing innumerable cavities of variable size. All the cavities contained soft, brownish red thrombi. The parietes of all the spaces were of a dark, reddish-brown color, tender, thin, and nowhere possessed of a structure resembling that of a vein or of an artery.
These large blood-spaces connected intimately with each other, had no peculiar channel of supply. The system of vascular cavities resembled that of the pregnant uterus, and was directly connected with the large blood-spaces in the capsule of the tumor. The cavities had thin walls invested with endothelium, so that they proved to be enormously dilated capillaries. Leopold believed that the thickness of the capsule, the bundles of muscular fibres which interlaced, in most instances, at right angles, and the weight of the tumor itself, could have produced such a venous congestion, that dilatation of the capillaries was the result. Simi lar cases aro reported by Weber' and Grammatikati.' Although the so-called fibro-cystic tumors are, anatomically speaking, of dissimilar nature, it has thus far been impossible to establish clinical dis tinctions between the different classes. The diagnosis and treatment of these neoplasms will, therefore, not be discussed separately, but the com mon term cysto-fibroma will be applied to all the varieties.
These tumors rarely occur in the uterus. 0. Schroder (Dissert. Strass burg) collected thirty-one cases and 0. Beer (Dissert. Zurich) seventy, from the whole domain of literature. This gives an idea of the compara tive rarity of these neoplasms. They are sub serous, in the great majority of cases. 0. Heer found only five interstitial and two intrauterine tumors among his seventy cases. Coussat ' mentions a cysto-fibroma, which sprang from the os uteri. These neoplasmata often attain enor mous dimensions, especially when they contain several cysts, and have been known to weigh twenty-nine, forty, and even eighty pounds.