THE ANATOMY OF MYO-FIBROMATA OR FIBROID TUMORS OF THE UTERUS.
The tumors of the uterus commonly known and described as fibroids, are chiefly composed of smooth muscular fibres, or, more correctly speaking, they consist of the same histological elements as the uterine walls themselves, riz., unstriped muscular fibres and connective tissue. All the neoplasms belonging to this class invariably contain both kinds of tissue. But the proportion of one to the other varies largely in different cases. If the tumor represents mainly a simple hyperplasia of uterine tissue, (such as is normally witnessed in pregnancy,) there is a prepon derance of muscular over connective-tissue elements. In that case the growth approaches the typo of pure myoma. On the other hand, if from the very incipience of the new formation, the connective tissue predomi nates, or if it does so secondarily by a process of fibrous induration, then the muscular tissue being held in abeyance, as it were, we get an almost pure fibroma.
Nevertheless it would not be in accordance with histological principles to divide these tumors into myomata and fibromas, since, as already stated, both varieties of tissue invariably coexist in them. A better plan, and one based on clinical symptoms, is to separate hard from soft fibromyo mats. A diagnosis in this sense is often possible, thus justifying the dis tinction recognized by English authors between white fibroids, and fleshy or red fibroids. The latter variety is always characterized by the prepon derance of muscular elements. Such tumors are also more abundantly supplied with blood-vessels, and contain only sparing amounts of loose connective tissue. These soft fibromyomas are intimately connected with the true substance of the uterus, and a separation can be accomplished only with considerable difficulty. Indeed they represent but a local by perplasia of uterine tissue.' With the preponderance of fibrous elements, on the other hand, we observe a lessened vascularity. The harder the
tibromyoma, the less firmly is it united to the uterine walls. As the lat ter, i.e., the hard variety, is the one most frequently met with by far. the claim of absolute non-vascularity, or at least an extreme paucity of blood-vessels, has obtained a wide currency. It is true that attempts to inject these hard tumors from the uterine vessels, have only very rarely proved successful. (Barnes, Klob, Schroeder, van der Kolk.) Turner,' however, alludes to the successful injection by Goodsir of a pediculated, subserous myoma. Large vessels were seen to enter the tumor through its pedicle, ramifying under the peritoneal investment. The loose interstitial tissue was likewise quite vascular, whereas the solid mass of the growth looked very pale. Taken as a whole the neoplasm was much less vascularized than the adjoining uterine tissue.
Kith* describes a peculiar arrangement of the muscular fibres of these tumors. For according to this author, they are connected with the ves sels in such a way that bundles of smooth fibres surround the larger capillaries, thus leaving spaces between the vascular sheaths and the muscles. Such crevices he regards as lymph-spaces. The growth of the tumors he then explains by a process of proliferation which begins in the connective tissue and muscle fibres that belong to certain vessels. In this way, he thinks a number of small growths originate, which by agglo meration at length produce a larger tumor.
Kleinwachter ' describes the evolution of fibroids from certain round cells, which occur alongside of slowly obliterating capillaries. These round cells are transformed into spindle-shaped corpuscles, which arrange themselves in such a way as to form myomatous nodules. The arrange ment of the interlacing fibres of these growths does not appear to be gov erned by any law.
Nerves, the presence of which had been previously assumed (Astruc, Dupuytren), were first actually found in fibroids by Bidder.