The third variety of neoplasms belonging to the adenomata differs entirely from those already described. It consists essentially of a pro liferation of the mucous membrane of the cavity of the uterus, and quite rarely of that of the cervix.
Besides simple catarrhal swelling of the uterine mucous membrane (endometritis chronica), conditions have long been recognized in which more or less diffuse proliferations of the membrane have been particularly noticeable. Olshausen " has only recently described these conditions, and with perfect propriety has separated them, under the name miotnetrilis funyosa, from the genuine new formations of the uterine mucous membrane.
Those symmetrical proliferations of the whole mucous membrane, which are usually connected with moderate dilatation of the glands, may occur isolate in various parts of the body of the uterus. They then appear as small, flat tumefaction of the mucous membrane, as large as a pea or a bean, with broad bases, and not only closely resemble an ordinary mucous polypus, but even produce the same symptoms as the latter. These simple mucous prominences consist of normal, symmetrically hypertrophied mucous membrane, and have been described and depicted by Virchow.' Gusserow,' Olshausen (L c.) and Schroder' have called attention to morbid states of the uterine mucous membrane, which, on the whole, completely correspond to endometritis yet differ essentially from it in the active participation of the uterine glands. The name diffuse adenoma of the uterus has been applied to these conditions, and their malignancy has been maintained by many observers.
Schroder has observed a similar condition, but more in the nature of isolated, pediculated growths, and he has designated it adenoma poly posum. Similar morbid changes have been described by Duncan' and Slaviansky, (the cases of Klobl and Adolph Schulz might also be placed in this category), by Maslowsky,' Winckel,' Kuhn,' Schatz,' and others.
Aside from the above-described molluseum uteri (Virchow), those cir cumscribed tumefactious of the uterine mucous membrane, which usually proceed from a chronic catarrh of the cervical mucous membrane, and more rarely from the body, and lead to closure and dilatation of the cous follicles, have been known as simple mucous polypi. The formation of the pedicle, which is the essential part of the " polypus," is due to the closure and protrusion of the mucous follicles produced by swelling of their tissues. The ovula nabothi are the simplest and clearest example of this process.
We have here to deal with a retention cyst, which has, at first, a broad base, and is elevated above the mucous surface. In its farther growth it elongates its base, by traction on it, and finally protrudes from the os as a mucous polypus with a slim pedicle. The more such cysts combine with each other, and the more the proliferating mucous membrane is attenuated by traction, the larger and more complicated does the mucous polypus appear, and the thicker is its pedicle.
These tumors, the smallest of which are as large as a pea, and the largest the size of a hen's egg, are composed of the elements of the uterine mucous membrane, and are covered with layers of both cylindrical and pavement epithelium. They contain between their connective-tissue trabeculaa numerous cavities, visible to the naked eye, which are dilated glands. The cavities are filled with mucus, which is thick or thin accord ing to the period of its retention. There are usually no large vessels in the pedicle. The superficial vessels have ordinarily numerous ramifica tions and thin walls. This is the reason why the little neoplasms so readily occasion profuse hemorrhages. The favorite seat of mucous polypi is the cervix, which they often widely dilate and transform into a membranous, flaccid sac. They also protrude some distance beyond the os externum. Large-sized formations of this kind are much more rarely found in the mucous membrane of the uterine body. When they do exist they frequently protrude through the os internum or even present the appearance just described. In other cases the os internum does not dilate and the growths remain in the uterus, often without occasioning inconvenience. • The development of numerous small cystic proliferations in the mucous membrane is oftener observed than the formation of one or more large sized uterine mucous polypi. In aged persons it is not very rare to find the entire uterine mucous membrane covered by numerous isolated, small cystic polypi, resembling the ovula nabothi. These polypous growths produce the same symptoms, infra vitam, as diffuse hypertrophy of the mucous membrane, with which they were earlier often confounded. Endometrit is fungosa may, however, as already explained, be anatomi cally distinguished from endometritis eystica polyposa. (Virchow.) Meixner and Kfichenmeister' have given a good clinical history of such a case of multiple, small mucous polypi of the uterine body.