FIBROMATA AND FIBRO-MYOMATA.
The results of close histological examination of the tumors belonging in this category have been stated in such a limited number of the cases, that a differentiation between the muscular and the pure connective-tissue forms for the purpose of classification of the reported cases is scarcely possible. With the exception of Paget, who has described an instance of a tumor consisting of pure connective tissue, recent authors have found, with great regularity, smooth muscular fibre in sessile vaginal fibromata, and have hence compared them with uterine fibromyomata (Virchow, Klebs).. These tumors are rarely met with, and probably develop in the submucous tissue, or in the deeper layers of the mucosa. According to Virchow's observation they grow from without inwards, and so seldom towards the lumen of the vagina, that this most expert anatomist never met with a myomatous polyp of the vagina.
As these tumors increase in size they spread towards the vagina, become polypoid, and hang outside of the vulva (Scanzoni, Porro, Neugebauer, Lambl, Dufour, Demarquay's case), and therefore in this respect, also, they are analogous to uterine myomata. Kleinwfichter is the most recent writer who has collected the cases reported in literature. In 1882 he collected fifty instances, to which number he afterwards added three fur ther eases, two from preparations in the Prague anatomie,a1 collection, and the third a personal case. To ,these fifty-three cases I am able to add five others: A case of Hermann's, two reported by Gaye from A. Martin's practice, one from Caswell, and one personal unpublished case. The history of this patient is: Thirty-seven years of age, and one delivery four teen years previously. She nursed her child for nine months. The patient complained of hEemoptysis, and there were signs of tuberculosis at the apices. She menstruated regularly and suffered from profuse leucor rhos. The tumor in the vagina was the size of a small date, hard, and adherent, partially covered by movable mucous membrane, and occupying the anterior fornix. I extirpated the growth on June 29th, 1883, by cutting into its capsule and lifting it out of its bed. A profuse arterial hemorrhage was checked by ligation. The sac was sutured, and iodoform tampons inserted into the vagina. Microscopically the tumor proved to be a pure myoma.
These five additional cases were all examined microscopically. Cas well's e,ase was a fibroma, Hermann's and Martin's were fibromyomata, and mine a myoma. In 39 of the cases collected by Kleinwitchter, the
seat of the tumor was noted, and adding these to the five additional cases, of the 44 the tumor was on the anterior vaginal wall in 28, in 11 on the posterior, and in 5 on the lateral wall. In general the upper vaginal seg ment was implicated by the growth.
In many instances these tumors attain great size, in a number of cases over 2+ pounds, and in two of the older cases (Baudier and Gremler) over 10 pounds. In the frequent polypoid form, the pedicle was usually thick, and but rarely thin (Scanzoni). Large polypoid fibromata, which re main in the vagina only because of narrowness of the canal, are gener ally expelled under energetic muscular pressure of the abdominal walls (Triitzl, W. Greene); in the majority of cases the expulsion is gradual. The growth of these vaginal tumors is a slow one, and in Neugebauer's case the patient had borne the tumor for twenty-two years.
In regard to the influence of menstruation and pregnancy on fibrous tumors of the vagina, nothing definite can be stated. Softening and se rous infiltration, the result of interference with the circulation, and occa sional ulceration of the surface, have been frequently noted, aside from menstruation or pregnancy'. (Paget, Honing, Chadwick.) As regards age, the majority of the patients were in the years of greatest sexual activity. The oldest patient (Greene's) was fifty-one years old and had known of the tumor for fourteen years. Three instances of fibroma tous polyps in small children have been recorded. (Tritzl, Wilson, A. Marti n. ) In a fifteen months' old child, who had been unable to either micturato or defecate for a day and a half, Trittzl found a soft, elastic, grayish-blue tumor impacted in the introitus vagina3 and compressing the urethra and the rectum. The bladder was greatly distended, the external genitals hot, reddened, and cedematous. By careful traction he pulled the tumor downwards and a small amount of urine was passed spontaneously. At tempts to deliver the growth were not successful. On the following morn ing the tumor had been spontaneously expelled. It was the size of a man's fist, shaped like a pear, and the pedicle was as thick as the little finger. Its surface was bluish-red, smooth and shiny in part, and in part furrowed. It was very vascular. Tratzl ligated the pedicle and on the sixth day the tumor dropped off. It was fibrous in structure. The child • convalesced well.