PA PILLARY TUltORS.
In addition to the not uncommon condylomata which are found in the vagina, generally as the result of a virulent catarrh, and which, particu larly in the gravid, often develop greatly, there are a few cases recorded of diffuse papillomatous degeneration of the vaginal mueons membrane. The papillary excrescences described by Slob are not properly tumors, but simple hyperplasia of the papilbe in the neighorhood of ulcers, analo gous to the enlargement of the villi around ulcers of the intestine. Al though in these formations we are dealing with simple lengthening of papillm on inflamed surfaces, Mfillerklein, Marsh, and Crook have de scribed characteristic forms of new growths, the histological formation of which has not been definitely stated. They are, however, differentiated by their clinical phenomena. Mfillerklein's case concerned a woman of thirty-eight, greatly weakened from protracted leucorrhcea and metror rhagia. Mullerklein found on the upper portion of the posterior vaginal wall, a cauliflower-like tumor, the size of a hen's egg, with a pedicle an inch thick. He extirpated it with the scissors, and it had not recurred at the end of a year. Anatomically it was found to be a characteristic cauliflower growth. Marsh saw a two year old child, in whom for a long time many formed and colored new growths had projected from the vulva and the urethra, and had constantly recurred after extirpation. The child died speedily from exhaustion. The growths consisted in " a poly poid swelling of the mucous membrane of the bladder and the vagina, with fibrous base, in part smooth, in part covered with epithelium, and generally very vascular." Sanger has since stated that Marsh's case had
again been carefully examined, and that Beck's report pronounced the specimen to be hyperplasia of the cellular tissue in the vesico-vaginal septum associated with hyperplasia of the mucous membrane. In no part of the specimen was tissue found which did not correspond to simple hyperplastic swelling of the normal tissue.
In Billroth's case, which is only briefly reported, the child, aged eighteen months, had suffered for two months from bloody purulent discharge from the vagina, and the vagina was filled with soft, pediculated, polypoid vegetations, which could not be determined as sarcomatous.
Although, therefore, we are not justified in classing those cases muler sarcoma, still the clinical course suggests their analogy with genuine sar coma. The development is similarly rapid, the course malignant, the sit,e the same on the vesico-vaginal septum where the infiltration is most marked, and here also there exist polypoid growths of the mucous mem brane towards the vagina and to a less degree towards the bladder. It seems as though in the histological formation of these growths this locality is favored, and that occasionally a fibroma results, and then a sarcoma. In Hauser's case there was simultaneous development of sarcomatous, myxomatous, and rhabdomyomatous elements. In regard to Muller klein's case, we have no exact anatomical explanation, and the possibility exists that it may have been carcinoma or sarcoma, although there had been no recurrence at the end of one year. I have not been able to sea the history of Crook's case.