In Spiegelberg's first case a circumscribed fibro-sarcoma of the lower portion of the anterior vaginal wall, the size of a walnut, was extirpated, and pronounced by Waldeyer to be a spindle-celled sarcoma. The patient convalesced well, although she was in poor condition at the time of operation, and four years afterwards there was no recurrence. The patient had borne four.children, the last time four years previously.
Spiegelberg's second case concerned a woman of fifty-eight, who had been married twenty-two years, was sterile, and had reached the meno pause at forty. At fifty-seven she began to suffer from hemorrhage, which gradually became more profuse. The patient was aniemic but well nourished, and just within the introitus vaginee ..the mucous membrane was irregularly infiltrated, and bled readily. The condition suggested a superficial ulceration, epitheliomatous infiltration, nodular in places. The uterus was atrophied but healthy, the pelvic organs were not infil trated, the inguinal glands not enlarged, the abdominal and thoracic organs were sound. Excision was accompanied by profuse hemorrhage. Conva lescence was retarded by diffuse abscess of the inner surface of the left thigh, by lymphadenitis inguinalis of the same side, and by diphtheria of the wound. A deep abscess in the groin was repeatedly opened, hut the drain on the patient's strength was too excessive, and she died in a few weeks. Waldeyer examined the growth and reported that it had the character of a small-celled medullary sarcoma.
Bajardi's patient was twenty-five years old, of healthy parentage, and had menstruated regularly from her sixteenth year up to marriage. At the fifth to sixth month of her first pregnancy, she began to have the sensation of a foreign body in the vagina, and suffered from pain when she attended to her work, that of weaving, for a number of hours. Towards the end of the eighth month her suffering was so great that she entered the hospital. Raccaqui and Colombo found a tumor, the size of a hen's egg, projecting from the vagina, and growing by a pediele the size of the thtimb from the posterior vaginal wall. On the pedicle was a lobule the size of a bean. There existed in addition a smaller isolated tumor to the left of the middle of the posterior vaginal wall. The large tumor, since from its size it would prove an obstacle to delivery, was re moved by the galvano-cautery, leaving its base behind. Microscopically it proved to be a round-celled sarcoma. After two months, the patient having in the meantime been delivered, the pains recurred, and one month later she was seen by Nardi. He found two tumors in the pos terior vaginal wall, the larger the size of a hen's egg, of vary ing consistency. Examination caused neither pain nor hemorrhage, the inguinal and pelvic glands were normal. The tumors were not ulcerated. They were extirpated by the galvano-cautery. No hemorrhage. Before being discharged the growth slowly recurred, the glands throughout the body becoming affected, and metastases were present in the skin and the mammce. The patient died in eight months of peritonitis. There waa no autopsy. Microscopic examination of the larger tumor proved it to be a round-celled sarcoma, of the smaller a spindle-celled.
Of the instances seen in children, Sanger and Hauser have recorded histories of uncommon interest.
Seinger's three year old child was brought to the Leipsie clinic the 16th of August, 1879. The mother stated that the child had been well up to four months previously. It had then begun to lose flesh, and to complain of painful micturition and defee,ation, the bowels acting only at intervals of two days. It had a profuse foul vaginal dis charge, and occasionally a tumor the size of half a finger appeared at the introitus vaginte. On one occasion a body the size of a small apple had been expelled with hemorrhage of three days' duration. Attempt had been made to rape the child about five months previously, from which date the mother dated its complaint. From the vulva hung two bodies like mucus polypi, pediculated from the posterior hymeneal border. On bearing down there appeared at the introitus a still larger tumor, with ulcerated surface, distending the vagina and sessile on the anterior wall. There existed in addition a number of polypoid excrescences, like hydatids, occupying various portions of the mucous membrane and readily separa ble. These masses were curetted away with but slight hemorrhage. A few weeks afterwards examination under antesthesia revealed a number of the same polypoid excrescences. The broad ligaments were thick ened, and dense masses occupied the recto-vaginal septum. The curette was used again. Aficroscopically the masses proved to be typical round celled sarcoma. The child died in four months after Sanger first saw her.
Hauser'8 Case. —The child was of healthy parentage. At the age of six months, on crying or bearing down, a tumor the size of a bean would appear at the vulva; at the ninth month it had attained the size of a walnut, and it remained external, where it soon ulcerated and caused great pain. In April, 1880, it was removed by the family attendant; in flve months it had recurred; in October, 1880, it was again extirpated and recurred in four months, and grew rapidly. In January, 1881, the child was taken to the Erlangen clinic, and the tumor was the size of a medium-sized pear. The child's general condition was good. Zweifel removed as much as he could without injuring the bladder, and chloride of zinc was applied to its base. On the sixth day there was recurrence. The curette was used and the little one discharged on the 22d of January, 1881. In April she returned to the clinic, and the tumor was the size of a walnut and ulcerated. It was easily removed without hemorrhage. The vagina was enormously distended with soft papillary excrescences, which were readily removed. The patient was discharged in six days, but in May Hauser again noted recurrence. The case was then lost sight of. Microscopic examination proved it to be a round and spindle-celled sarcoma,.
The diagnosis can only be made by the microscope. The prognosis, hence, cannot be stated before extirpation. The myoma-like forms are more favorable, since they can be entirely removed, than the flat, diffuse forms, as is proved by Spiegelberg's case, where there was no recurrence at the end of four years.
As regards the treatment, the same measures are indicated for the round tumors as is applicable t,o fibromata, and for the flat, diffuse, the same as i xi carcinomata.