STRIOCELLULAR MYOMA.--RHABDOMYOMA MYX0MATODES.
There exists only a single observation of this form of tumor. It was removed from a strongly built girl of fifteen, who had not as yet men struated, who came to Seyfert's clinic at Prague in 1869 for the relief of difficult micturition. On examination a polypoid tumor with rather large pedicle was found on the anterior vaginal wall, which was removed and the patient was discharged in ten days, the wound having healed. In six weeks she returned, since the tumor had grown again. She then con sulted Fr. Kaschewarowa. The maiden was in the full bloom of youth. The external genitals were not entirely developed, there was no hair on the pubes, but othemise they were normal, and the uterus was sound and in good position. On the anterior vaginal wall there was a tumor the size of a hen's egg, with fairly broad pedicle, lobular surface, and of red dish color. The substance of the tumor was so soft that portions could be removed with the finger, and this was painful. With the naked eye a superficial layer could be seen on the removed portions (mucous mem brane), and below it the loose tissue tumor. The latter had the color and consistency of soft wax, and it contained a large amount of blood. Neither by pressure upon, nor scraping a recent section with the knife, could turbid juice be obtained, but only a clear fluid, on great pressure, in which were particles of the tumor. During the patient's stay in the clinic the tumor increased in size. From time to time Seyfert removed small portions, and the etd. of May a piece the size of a hen's egg, which Fr. Kaschewarowa examined. The tumor turned out to be a rhabdo myoma (Zenker), combined with myxo'matous tissue. After the removal of a large portion, the patient was attacked with pelvic peritonitis. The growth necrosed in places, and then increased quickly in size until by the end of June it had. attained the size of a child's head. The patient's strength failed, she suffered constant pain in the lower part of the abdo men, and Rhe died on the twentieth of July. At the autopsy the lungs were found tubercular. As to whether a lentil-sized adherent nodule which was found in a calix of the kidney was a metastatic growth, or not, the history does not state. The specimen is in the Prague anatomical collection (No. 2069) and has been examined and described by Klebs. In the right half of the anterior vaginal wall behind the orifice of the urethra there was found a, nodular, broad-based tumor, the size of a fist, which extended about three-quarters of an inch towards the vaginal vault. It was broadest in front and diminished in size backward& The poste rior and left walls of the vagina were free. The mucous membrane spread over the tumor, and the surface was generally smooth. At the lower ex
tremity, which projected a trifle from the vagina, there was a funnel shaped cavity. On cross section, the surface was smooth and fibrous. The growth extended into the perivaginal cellular tissue to the right and posteriorly. The uterus was small, .body and cervix unchanged, the cavity one and a half inches deep. The adnexa were generally adherent, and Douglas's fossa contracted. The right tube and ovary could be freed from the adhesions, and were unchanged. The left tube was dilated, the left ovary unrecognizable. The bladder was healthy, the urethra was slightly pushed to the left by the growth. Kaschewarowa found in the examined sections all the developmental forms of striated muscular fibre. The muscular elements were armnged here and there parallel one to an other, and bound together in a species of bundle; in otber plaoes they were intermingled with myxomatous tissue. The surface of the growth was covered with flat epithelium. The mucous membrane contained neither papilla) nor characteristic cellular tissue or muscular elements, but these elements were scattered throughout the layer of the tumor under the epithelial stratum. Kaschewarowa concluded, hence, that the tumor had probably had its origin from the mucous membrane. Klebs, seeing that he was able to follow the young muscular fibres of the pare vaginal tumor into those which belonged to the levator ani, concluded with a greater show of reason that there existed rather a hyperplasia of normal muscular tissue. Thence there arose growth of the interstitial and muscular elements, some becoming myxomatous, others of striated muscular fibres deprived of the sarcolemma, while the more recent intra vaginal portions contained only spindle cells. The striated young spindle form muscular cells, detected by Kaschewarowa and also by Treitz and Ep pinger, in sections from the fresh preparation, were not found by Klebs in the alcoholic specimen. Neither can I find them in the sections kindly furnished me by Eppinger. I find, however, young striated cylinders next to the muscular bundles, as is shown in the illustration.
In the diagnosis of vaginal tumors this peculiar arrangement must be remembered, and on account of their rapid growth they suggest the pos sibility of the'existence of the malignant soft sarcoma. Indeed, in a case of Hauser's, of primary sarcoma of the vagina in a two year old child, the same long striated spindle-cells were found, passing into young striated muscular fibres. In such instances complete extirpation down to the base of the growth is indicated, and as to whether the knife, scissors, ligature, or gulvano-ca,utery is preferable will depend on the peculiarities of the individual case.