POLYPI AND ADENOMATA OF THE UTERUS.
To day, however, it would perhaps be better, in the light of more thorough anatomical knowledge, to abolish this term, which is only based on external physical appearances. If, however, it be advisable to retain the expression uterine polypus for pedi culated tumors, which seems desirable from practical considerations, only those proliferations of the uterine mucous membrane, which have long been known as mucous polypi, should be designated by the above title.
Pediculated sub-mucous myomata, htematoma of the uterus (fibrinous polypi) and proliferations of the mucous membrane are still indiscrimin ately designated, in accordance with their symptoms and treatment, as " Polypi." We have already considered pediculated myomata as a special form of these neoplasmata, and we do not, from an anatomical standpoint, in clude uterine htematomata (placental polypi, etc.) among the new growths of the uterus. The term " polypus " must, therefore, be reserved to designate a pediculated proliferation of the uterine mucous membrane.
True, it is somewhat arbitrary, and only appropriate on account of practical reasons, to lay the greatest stress upon the pedicle, but only by it do these proliferations become tumors or neoplasmata in a clinical sense. The difference between a diffuse proliferation of the uterine mucous membrane and a mucous polypus, is only a rough anatomical one, based upon external appearances and not a genuine one, founded upon the structure of these formations. One may, perhaps, even say that we have to deal, in the case of mucous polypi, with isolated circumscribed hypertrophies of the mucous membrane, such as follow general tumefac tion of the membrane dependent upon chronic catarrh.
To define adenoma according to modern views is still more difficult.
In the first place we must mention, in this connection, most erosions of the cervix accompanied by ectropium of the mucous membrane. Buge and Veit' have shown that the majority of these conditions belong ana tomically to the new formations. Nevertheless we are not in the habit of regarding them in this light, from a clinical point of view. But it is
quite true, on the other hand, that as regards the treatment at present adopted by most gynecologists, these erosions are looked upon as growths to be dealt with by ablation, or even amputation of the cervix.
Another form of adenoma must be mentioned here. This variety has been known for a long time. Virchow described it as hypertrophy of the lips of the os, or as follicular hyperplasia. He has shown that these growths are follicular polypi, which produce considerable hypertrophy of the lip, from which they take their origin.
From simple hypertrophy of the cervix, these excrescences differ in being commonly pediculated and arising from a single point of the cervix or its mucous membrane.
The latter participates largely in the pathological alteration, there being crypts, dilated glands, but also new-formed or simply hypertrophied glandular structures. There can be no doubt that the primary affection has its seat in the mucous membrane, and that the hypertrophy of the lips of the os is secondary to that change. This hypertrophy is brought about by a kind of infiltration of new-formed follicles into the cervix. If this process is limited to a single point of the cervix, the diseased part becomes stretched and a pedicle results. But if the cervix is more uni formly affected, the disease has often been mistaken for epithelioma.
Since Oldham's observations, such growths are mentioned in English literature as canaliculated polypi. Not infrequently the large participa tion of the cervical papillae, covered by pavement epithelium, marks a transitional form between these and papillomatous tumors.
In addition to the cases of this kind described by Virchow (1. c.), the following authors refer to them. E. Wagner,' Martin,' Beigel,' Barnes,' McClintock,' Luna,' Demarquay and St. Vel (1. c.)., and A. Schulz.' The cases of Simon and Ackermann, placed by most writers in this cate gory, appear to belong rather to the papillomata, and will be referred to in that connection.