SA RCOMA.
The recognition of this variety.of new growth in the vagina belongs to very recent times. It appears in the form of a circumscribed round tumor in the sub-mucous tissue, and also as a diffuse superficial degeneration of the vaginal walls. Without question instances of the first sort may, with out close histological examination, be ranked with fibromyomata, and those of the second sort with carcinomata. Further, primary sarcoma of the vagina, as is proved by Stinger's case, may develop, in a similar manner to the rare forms of papillary sarcoma of the cervix (Spiegelberg, Winck ler,) into polypoid papillary excrescences. It is interesting to note at what an early age this growth has appeared in the few recorded cases, and also that in a single case (Demme's) it is stated that at birth a tumor the size of a pea was found between the labia. In case Babes's instance of primary endothelial sarcoma, (a movable, walnut-sized, readily enticle ated tumor, which returned after three years as a spindle-celled sarcoma), which existed in the introitus vaginte, be classed here, then I find six instances of sarcoma of the vagina in small children, as certified by microscopic examination. In Hauser's e,ase the age was two years; in Soltmann's two and a half years; in Siinger's and Babes's three years re spectively; in Ahlfeld's three and a half years; in Demme's five and a half years. Of the instances observed in adults, the youngest patient was seventeen (Baschewarowa), the oldest fifty-eight (Spiegelberg.) The anterior vaginal wall was entirely or largely the seat of the grovrth in six instances (four times in children), and in the histories to which I have had access the posterior vaginal was affected twie,e, the right lateral wall once, and the entire circumferene,e of the vagina once. Ordinarily, and five times in children, the first sign was the appearance between the labia, without subjective symptom, of a small polypoid tumor. In the adult the symptoms appear to have been slight until the tumor began to grow rapidly and to partially break down. When the growth was accom
panied by increased secretion, atypical hemorrhages, dysuria, bearing down sensations, then it had attained considerable development. When suppuration and extension to the neighboring organs had occurred, then the symptoms were dependent on the local changes, and in children, es pecially, the pressure symptoms on the pelvic organs were very marked.
Although in many instances the growth of this tumor extended over a number of years, especially the fibro-sarcomatous form, yet in the majority of cases the malignancy of vaginal sarcoma was most apparent. In every case, except Spiegelberg's, .the growth recurred with great rapidity after extirpation (in Demme's case, where the record states that .there was as yet no recurrence, this was written a short time after ex tirpation). Although the quick recurrence in many instances may have been due to imperfect extirpation, yet there is not a single case on record where recurrence did not set in, and this is characteristic of this variety of tumor.
Owing to the variety of these tumors we will record a number of in stances.
Kaschewarowa reports two cases. The one concerns a strong multipara, in whom two years previously there had appeared a small tumor on the posterior vaginal wall near the fornix, which slowly increased in size, re sisting all local measures, and which was as large as a gulden and was ulcerated on the surface. Professor Kieter extirpated it, and it proved to be a spindle-celled sarcoma lying in the mucous membrane and extend ing scarcely at all in the submucosa. Recurrence speedily set in. Kieter's second case, of a similar nature, was seen in the Moscow .Marien hospital, and concerned a maiden of seventeen. On the posterior vaginal wall was a soft, easily torn, tumor, the size of a goose-egg, and in four months after extirpation it had recurred and was the size of a fist. The very anEemic patient died shortly after the second operation.