PAPILLOMA OF THE UTERUS.
Virchow's ' statement that both connective-tissue tumors (fibromata) may occur in the form of condylomata and papillary tumors, and that cancerous and epitheliomatous formations may assume the cauliflower appearance is, doubtless, true. Since, however,the mere outward form of a tumor does not justify the estab lishment of a special class of neoplasms, i.e. the cauliflower growths of the os, this term, which since J. Clarke's time, has produced. much confusion, should be simply dropped. From what follows it will, however, be seen that it is proper, viewed from either a clinical or an anatomical stand point to apply the name cauliflower tumor or papilloma of the uterus to a certain class of neoplasmata.
Fibrous papillary tumors of the portio vaginalis are not frequent, and may be characterized as benign growths. They consist of enlarged and proliferating preexisting papilke, and their surface is usually covered with squamous epithelium. Their fibrous character is shown by the fact that their pedicles are composed of connective tissue and muscular fibres.
These papillary fibromata thus completely resemble a " polypus," par ticularly in that they seldom attain any considerable size. Their symp toms are those of " polypi," viz., hemorrhages and muco-purulent se cretions. They rarely become gangrenous. They do not recur after removal. The purest example of this variety is described by G. Simon' un der the title " wing-shaped elongation of the anterior lip with simultaneous abnormal elongation of the entire portio vaginalis of the cervix." The tumor, which was attached to the hypertrophied anterior lip, was pedicu lated and composed of a layer of dense connective tissue from which closely approximated, slender papillae projected.
The papillae are covered with a thick layer of epithelium cells, super imposed upon each other in_several strata. There is no trace of follicles or of mucous glands to be seen. The relations are more complicated and the diagnosis of the tumor more difficult if the glands are involved in the morbid process. This was the case with the tumor described by Acker
mann,' as a "glandular polypus of the anterior lip." The tumor was as large as an apple, was attached by a pedicle to the anterior lip, and consisted chiefly of connective tissue, which formed the pedicle and the ramifying papillary processes of the new growth. The papillae were clothed with a thick coating of pavement epithelium ar ranged in numerous layers. In other places the surface was dotted with slender villi, covered with a single layer of cylindrical epithelium.
Sections from the interior of the tumor showed long cavities, opening, in part, toward the periphery and clothed with cylindrical epithelium. There was, therefore, a proliferation or new formation of the cervical follicles, together with the papillary growths. Two years after the tumor had been excised, on account of profuse hemorrhaged, the cicatrix showed no noteworthy appearances. Two small, pediculated tumors, of the same kind had, however, been developed on the portio vaginalis and had been removed.
A case described by Rindfieisch,' by the name " papilloma cysticum," certainly also belongs in this category. In his case, however, the cavities lined with epithelium were said not to have originated from the follicles, but by coalescence of papillae, at their apices.
Thiede's' tumor, called by him " fibroma papillary cartilaginescens," also belongs in this class, as do also the previously described papillary sarcomata.
It is certainly unjustifiable to erect these tumors into a special class, and even to call them cauliflower tumors, although they have many char acteristic features, and can hardly, on account of their form and clinical history, be included with the fibromata.
Still less is this justifiable in the case of papillary cancer of the cervix,.
or epithelioma, although the error is daily committed and has found its way into many text-books.