Among the very rare sequels of pressure by these tumors, is their growth into contiguous organs, the so-called hernia of the tumor. The hitherto reported descriptions of this occurrence are the more unreliable, the less attention has been paid to the condition of the neoplasm.
Nothing is more common than the rupture of a tumor into the neigh boring viscera, after it has undergone suppuration or putrid liquefac tion. These cases will be discussed later. But in the cases to which we have reference at present, the unaltered tumor has made its way into the bladder, rectum, etc., by causing pressure-atrophy of their walls. When we closely examine large tumors which are sitaated in the cervical canal, or which have passed the external os, we not infrequently observe, as an initial stage of perforation, an atrophic excavation in the opposed wall with erosion of the mucous membrane. Bennett, Montgomery, Churchill and others have described this condition.
Thomson relates the case of a fibroma growing into the bladder, the intervening tissues having undergone absorption from pressure. In Fleming's case a diagnosis was made during life of vesical calculus, which proved post-mortem to be a calcified fibroma growing from the anterior wall of the uterus. Lieiranc reports the growth of a fibroma through the vagina into the bladder, from which the tumor could not be dislodged. In the last mentioned and other cases the tumors filled out the false passage so as to completely prevent the escape of urine through the latter. Monod • describes a case in which a tumor tunneled its way through the anterior wall of the uterus and through both walls of the bladder, leaving a hole as large as a five-franc piece, through which some urine escaped by way of the uterus, only a small amount passing off by the natural outlet. The tumor lay directly against the symphysis pubis, which could be felt on passing the finger into the uterus, and thence through the three per forations. This patient died of peritonitis. Rokitansky (quoted by Klob) mentions perforation of the rectal wall. Lisfranc also describes an in stance of perforation of the rectum by a uterine fibroid, the tumor pro truding from the anus during every act of defrecation, after which it could be pushed back. It finally dropped off spontaneously. Larcher ' observed
attenuation of the uterine walls, with and without absorption of the peritoneal envelope. A not very large tumor which had developed in the region of the os internum, bored a passage through one side of the uterus into the vagina, projecting into the latter canal. The tumor had also pushed forward in another direction until it penetrated into the abdominal cavity, giving rise to fatal peritonitis. In a case of retro-va ginal fibroma of the uterus, Roux observed perforation of the posterior roof of the vagina. It must remain undecided whether in the above mentioned and in other similar cases perforation has been accelerated by uterine contractions. The cases in which this factor has undoubt edly played some part have been observed during and after childbirth,' and will be considered later on.
Matthews Duncan observed a case of fatal peritonitis excited by a fibroma which had worn away the wall of the uterus as far as the perito neal envelope. Most of the other reported instances of perforation do not concern us at present, as they have either been associated with a sloughy condition of the tumor, or are, to say the least, doubtful, like the case of Demarquay,' who found a large, oval hole in the posterior wall of the bladder and anterior wall of the uterus, with ragged edges, the growth being situated in the anterior wall of the uterus. In this case Huguier's dilator had previously been employed. Loir's 6 case is equally doubtful. In this instance a fibroma, after causing perforation of the walls of the uterus and abdomen, was thrown off as a " black mass." Dumesnil's' case was undoubtedly one of expulsion of a gangrenous tumor. There were several brownish spots on the most attenuated portions of the skin of the abdomen, covering a tumor of the uterus which reached high as the umbilicus. Pres sure on this point gave rise to distinct emphysematous crackling, while the percussion tone in the same situation was tympanitie. A few months later ulcers formed at these points, through which fungoid masses of the tumor sprouted. The various openings finally coalesced into a single large aperture, through which the gangreneseent tumor protruded and was at length expelled spontaneously, the patient recovering.