b. Cysts of the bladder wall occur in the mucosa and in the ureters. Fuenta says that Paget (Surg. Path. II., p. 84) mentions& case of dermoid cyst of the bladder. Not having access to the original article, I cannot tell whether the cyst originated from the walls of the bladder or whether, as is not uncommon, a dermoid cyst of the ovary had penetrated the bladder. (Page 153.) Camila has described a case in which a serous cyst almost entirely filled the bladder; it contained 8 to 10 pints of a serous, non-albuminous, lactic-acid containing fluid. We have already men tioned (page 80) the occasional communication of large urachus-cysts with the bladder cavity. Finally we may refer to a case of Wagstaffe's, where there was found in the fundus ve,sicm a cavity 2 inches in diame ter lined with pavement epithelium, and communicating with the tuba and the rectum. It was supposed to be a constricted portion of the vagina (?). The bladder was tremendously dilated.
c. Papillomata vesicte occur as stnaller or larger pedunculated or flat tumors with granular raspberry-like surfaces. They are most frequently located at the posterior bladder-wall in the neighborhood of the trigonum lieutaudii. They consist of papillary excreacences containing well-de veloped blood-vessels and a fine, loose, connective-tissue net-work, covered upon the surface with layers of hypertrophic epithelium. Birkett found them covered with layers (?) of cylindrical epithelium and some ciliated cells (?). Slobs is of opinion that from the small amount of stroma pres ent, we must conclude that the blood-vessels form the basis of the new growth. The rest of the mucous membrane is usually trabecularly hyper topb.ied, in consequence of interference with the emptying of the bladder by the growth. Klebs also mentions a kind of fibro-adenoma which he has found in the region of the vesical neck and the trigonum lieutaudii. Dr. Heim-Vogtlin has successfully operated per urethram upon 2 cases of vesical papilloma occurring in women of fifty-four and sixty-four years of age respectively.
d. Fibroid tumors and fibromyomata are extremely rare in the bladder. Faye has recorded the only case of fibromyoma in a woman, situated between the anterior bladder-wall and the fascia transversa, and so closely connected with the wall of the organ that it may well have originate(' there. It was the size of a man's head, had existed for many years, was situated on the right side over the true pelvis, and sent a prolongation the size of an egg along the urethra. It had a tough fibrous capsule and contained muscular elements. Not long ago a myoma of the bladder was succesafully removed in Billroth's clinic from a twelve-year-old boy; ' and R Volkmann recently extirpated by epicystotomy a lemon-sized polypoid myoma from the bladder of a man. Myoma of the vesical walls thus occurs. Schatz removed a fibro-myxoma telangiectases from the pos terior bladder-wall, and Brennecke observed the spontaneous expulsion of a tumor at least as large as a child's liver by a pregnant woman, with bearing-down pains, which microscopic examination proved to be a fibro myxoma. The patient made a good recovery, and in spite of the size of
the tumor, did not suffer from any incontinence. In the first case, de scribed by Ed. Mtiller (see next page, carcinoma of the bladder), a fibro myoma was present also.
e. Senfleben has published the only case of sarcoma of the female blad der that was known up to 1877. The growth was crumbly, was tom in the effort at extraction, and had to be removed piecemeal. 4 days later the patient died of purulent peritonitis, and the necropsy revealed a per foration of the bladder-wall on the right side of the fundus vesicle, below the opening of the ureter. Since that time there have been several maes of primary and secondary vesical carcinoma. Thus, we may refer to the ease from the clinic of Pemice at Griefswald, described by Siewart. The girl was three years old, and a spindle and round-celled sarcoma started from the anterior bladder-wall; it was driven by contractions of the blad der into the urethra, and dilated it to such an extent that even the mouth of the womb was distended. Thereupon followed necrosis of portions of the tumor, purulent cystitis, atresia of the left ureter with hydronephro sis, pylonephritis dextra, and purulent peritonitis. Inside of three weeks there were three times removed portions of the tumor as large as the palm of one's hand; bnt it always grew again quickly. Another case of primary vesical carcinoma has been described by Dr. Heim-Vogtlin; she operated upon the patient, who was only fifty-six years old, and who died a ye,ar afterwards. Secondary sarcomata from the vagina are not very uncommon; they have been described by Ahlfeld,' Bajardi, 1880. Battini 1880, Sanger (Archiv. XVI. 58). Soltmann.* f. Carcinoma is the commonest of all the new growths of the female bladder. It occurs sometimes as a diffuse schirrhus infiltration of the bladder throughout its entire extent, sometimes in circumscribed nodules, and sometimes as fungating cancer. The latter is the commonest of the secondary forms. It is most frequently situated between the mouths of the ureters and the urethra. It appears as very soft and spongy excre scences and prolongations from the mucous surface, with a wide capillary net-work, and an epithelial covering. (Fig. 59.) It is liable therefore to be mistaken for polypoid fibroma of the bladder. In seven primary cancers of the bladder, Heilborn found fungating carcinoma three times, myocarcinoma once, cauliflower-cancroid once, and cancroid once. Fir ster has published a couple of cases in which papilloma vesica3 was compli cated with fungating carcinoma.