I have been unable to find Wilson's description of a, large vaginal polyp in a child two and a half yea,rs old.
A. Martin has latterly recorded the third instance. The child was two days old, and at full term. The midwife had noticed at once a bright red growth the size of a lentil projecting from the vagina. Martin found it surrounded by the rima pudendi, its surface reddened, and pulled it out with a dressing forceps. It was about I of an inch long, with slender pedicle inserted above the hymen, to the left of the mid-line at the level of a fold of the posterior columna rugarum. The pedicle was ligated as near its base as possible, and the polyp cut off. There was no hemor rhage, and on the third day the lig,ature dropped. The child's general condition was not affected. The polyp wa43 very hard to the touch, was covered with squamous epithelium and with papillEe arranged like those of the vagina. Glands were not discovered, but in the centre were nu merous large blood-vessels, imbedded in firm, connective tissue. Mus cular fibres were not detected.
The symptoms depend on the size, the early or late expulsion of the tumor, and on the complications. Usually, when small, fibromata of the vagina are not recognized. Gradually they lead to catarrhal secretion, cause dragging sensations, and as they increase in size, they produce dysuria, and finally retention of urine. Tumors which project from the genitals, are not alone troublesome by the traction they exert, but they are subject to the same irritant causes as prolapsus. They become swollen from venous stasis, and painful from ulceration and erosion of the surface.
Van Doeveren found a polyp weighing one and a half pounds inserted on the anterior vaginal wall, and obstructing labor in a primipara. He *was able by manual traction to push the tumor out of the way of the fEetal head. According to their seat and size, these tumors are likely to interfere with cohabitation, and in case of conception to interfere with the progress of labor. In a case operated upon by Pelletan, the physician was able to pull down the partially expelled tumor, and the fo3tus was born spontaneously. In Gentrul's ca,se the foetus was delivered by the forceps, the tumor tearing away from its upper vaginal attachment at the same time. The most unfavorable result was in the case the specimen of which is in the Berlin pathological collection, and has been described by Virchow. An oval myoma, the size of two fists, was situated in the pos
terior vaginal fornix, and proved an obstacle to labor. In the attempt at delivery of the ketus, the vagina was ruptured and the pubic bone frac tured. The woman died in four weeks from necrosis and suppuration of these parts. In other reported cases the fibroma did not prove an ob stacle to delivery. In McClintock's thirty-nine year old patient, where, with Johnston's assistance, a fibroma two and a half inches long and of the same breadth, seated on the anterior wall, was removed by a ligature, delivery took place without difficulty. Neugebauer's patient was deliv ered a number of times, notwithstanding the presence of a tumor. In Porro's case the tumor was driven "by the pains in front of the fcetal head, delivery was spontaneous, and after enucleation of the tumor the woman passed through a normal puerperium. A few cases have been noted dur ing pregnancy, and in three the fibroma was extirpated, and in Gremler's case it weighed over ten pounds. In McClintock's case, the pregnancy was not interrupted, as also in Gremler's, and the women were, happily, confined at term. Another case of McClintock's was not so fortunate. Before operation the tumor had begun to break down, and had begun to project back into the vagina. Twenty days after its removal by the ecra seur, the woman was delivered of twins, and died of exhaustion in twenty four hours. At the autopsy septic endometritis was found.
The diagnosis is readily made, seeing that the uniformly round, isolated, or pediculated form, with surface covered with smooth mucous membrane, and elastic to the touch, is characteristic. The surface may be lobulated, or narrowed by constriction at the orifice of the vagina, or there may be changes in consistency, the result of ulceration. Important diagnostic points are the slow growth and purely mechanical disturbance. These growths may be simulated by faintly fluctuating cysts with thick contents, and with other tumors of slow growth, and the latter particularly cannot always be differentiated before extirpation. Demarquay satisfied himself that he was not dealing with a cyst by resort to the exploratory puncture, and this device also assisted Pelletan. In the living it will often be im possible, before operation, to differentiate from many forms of sarcoma.