By way of appendix we here mention the new growths described by R Maier,' under the title deciduoma. They were small, polypous tumors which projected from the cervix uteri and had been removed. They consisted of decidual tissue.
In one of the cases the patient was pregnant, so that it was probably not a case of tumor in our sense of the word. The other patient was not pregnant, and the supposed tumor, which consisted of decidual tissue, was a hollow cylinder. Farther observations are necessary before a new class of uterine tumors called deciduomata can be established.
Kiistner' has described a case, called by him deciduoma, in which a tumor actually took its origin from a remnant of the decidua. He holds that this name should only be applied to such cases as he has described.
A unique case of uterine polypus has been recorded by Zahn.' The tumor was unquestionably composed of placental tissue, and had taken its origin from a piece of retained placenta. The neoplasm grew through the walls of the uterus, producing by their perforation a fatal peri-uterine Immatocele.
The symptoms produced by those erosions which have been described as adenoma, do not differ from those of catarrh of the cervix and body of the uterus. Follicular hypertrophy of the lips of the os gives rise to the same phenomena observed in polypus. But adenoma diffusum as well as adenoma polyposum lead to hemorrhage. At first the bleeding usually re tains the menstrual type, but in the farther progress of the disease, metror rhagia appears.
In this way extreme ansem.a may rapidly supervene. In addition to the bleeding, these new formations are characterized by their tendency to recur after removal, and by the undeniable fact that, in a certain pro portion of cases, they eventuate in cancer. Observations confirming this have been recorded by Breisky, Schrader, Maslowsky, Winekel, Schatz and others.
The symptoms produced by the various kinds of polypoid growths are almost without exception simple and identical. Only when the polypus is in the uterine cavity does it occasion pain, and then only when it is un usually large, and has not passed through the cervical canal. When it has passed through this canal, or when its original seat is the cervix, as is usually the case, it produces no painful sensations. If the polypi are
large enough to fill the vagina, or if in virtue of their long peclicles they have protruded between the external organs of generation, they occasion in the latter symptoms of pressure and of irritation.
Two symptoms which are, however, very constant and of great impor tance, are seldom or never lacking. These are hemorrhage and a muco purulent discharge. The hemorrhages due to the vascularity of these little tumors, and to the tenuity of the epithelium covering them, occur particularly in the beginning at the menstrual epoch. They are, how ever, often irregular and may be violent or trivial. Slight hemorrhages are especially liable to occur after every injury inflicted upon the polypus as it hangs in the vagina, as, for instance, after violent exertions, straining at stool, after every coitus, etc.
Any given hemorrhage is seldom dangerous, but frequently repeated losses of blood produce severe chronic anaemia Besides the hemorrhages the patients are, almost without exception, afflicted with a copious muco-purulent discharge, which is partly secreted by the tumor, but is chiefly due to the chronic catarrh of the uterine and cervical mucous membrane. When the tumors are located in the cervical canal, or have escaped from it, and are situated at the os externum, the so-called erosions of the os, desquamation of the cervical epithelium, ul ceration and extrusion of the swollen cervical mucous membrane are rarely absent.
Even very small polypi frequently cause sterility partly as a result of the conditions just described, and partly by occlusion of the os. When situated near the uterine opening of the Fallopian tube, they may oc casion tubal pregnancy by mechanically opposing the exit of the ovum from the tube, or by producing catarrh of the tubal mucous membrane through their irritant action on all adjacent tissues. Such a case is de tailed by Breslau,' in which the polypus, which was situated near the opening of the left Fallopian tube, had caused intense tumefaction of its mucous membrane, thus preventing the advance of the ovum.