Although these tumors, therefore, at first laid claim to a separate classi fication, farther anatomical and clinical observations soon proved their relation to carcinomata. It is due to this fact that papillomata, as has been above explained, are either erased from the list of uterine tumors or simply designated as epithelioma of the cervix. Neither course is correct.
Virchow deserves the chief credit of having first microscopically demonstrated that extensive epithelial proliferations, usually of an atypical nature, are already present in many of these " papillomata." He also showed that nests of epithelial elements are found in the tissue of their deeper layers, and that, in fact, the tumors are carcinomata, which have assumed the form of a papilloma. He accordingly made a positive dis tinction between benign papilloma and malignant papilloma, i.e., epithe lioma.
C. Mayer then demonstrated, by clinical, investigations, that these cauliflower growths " constitute the first stage of cancer." Such papil lomata doubtless become transformed into cancers by the proliferation of their epithelial elements, after having existed for a long time. One often
encounters carcinomatous infiltration on extirpating a supposed papil loma, or the tumor recurs soon after its removal, either at the site of the operation or in its vicinity. Cases such as that so well described by E. Wagner (Gebirmutterkrebs, p. 13) unquestionably occur, in which, after the removal of a pure papilloma, such as those described above, and in which most careful examinations failed to detect any epitheliomatous tissue, death nevertheless resulted from pronounced uterine cancer five months after the operation It is, therefore, certainly justifiable to recognize the connection between cauliflower growths and cancer, and, perhaps, to simply characterize them as initial stages of the latter. (Conf. also Gusserow, Carcinoma Uteri, Volkmann's glin. Vortrag, p. 10.) It seems, however, practically im portant to dignify this initial stage of uterine cancer, which is so well defined in regard to both its anatomical and its clinical features, with a special name. The treatment of these new growths is identical with that of epithelioma, and the reader is accordingly referred to the chapter treating of that subject.