THE NEW GROWTHS OF THE FEMALE ITRETHRA.
Attention was early directed to them, Morgagni describing some in 1719. But they excited Universal attention when Clarke, in 1814, described their symptoms and importance, and des ignated them by the appropriate name of vascular tumors. It is true that since that time a number of growths have been included under this name; and though not by any means alike in structure or importance, they have either been called carunculse (John Hunter), or spongy excrescences, or fleshy or varicose growths (Schiitzenberger), or cellulo-vascular tumors (Boivin-Duges) or fungous excrescences (Kiwisch.) They should be di vided into various groups in accordance with their structure. They almost without exception grow from the mucous membrane of the canal; and hence we may disting-uish them as those in which the papillary bodies are especially involved, without much vascular hypertrophy, or condylo mats; those in which the glands are diseased or enlarged, retention cysts, myxadenomata, mucoid polypi; those in which the chief disease is in the connective tissue, fibromata, and sarcomata; those formed by affec tions of the vessels, angiomata, varices, phlebectases; those in which papillae and vessels together are involved, fungous or vascular tumors and polypi; papillary and polypoid angiomata, erectile tumors; and, finally, tumors originating in the epithelium, epitheliomata, carcinomata. With the exception of sarcoma and tnyxadenoma, Kiwisch had already distinguished these various tumors from one another. We will now pro ceed to a more detailed description.
a. The condylomata have a warty surface, are reddish or bluish-red, pedunculated, not sensitive, do not bleed readily, and project singly or in numbers from the orificium urethrie. They consist of a fibrous or homo geneous connective tissue, a capillary network, and a thin epithelial covering.
b. The retention cysts of the female urethra have lately been described by EngHach. They have been found in the foetus at 6 to 7 months; in new-born girls they are seen at the anterior, in later years at the posterior portion of the urethral canal. They do not always project above the
surface; sometimes their orifices only can be seen as a small black point. They are composed of a substantia propria, the inner surface being coy ered with pavement epithelium, and being papillated. If they are of large size, they may protrude as round tumors from the urethra, and may ac quire a stalk and become polypoid. They are then usually covered with a normal mucous membrane.
c. If the connective tissue is especially involved, more solid tumors or fibromata, are formed; they have been described by Neudorfer, Metten heimer, and Hennig. Neudarfer extirpated such a growth in a syphilitic woman, which was the size of a pigeon's egg, and which was composed of connective tissue with pyramidal processes, concerning the exact nature of which N. does not make himself very clear. The pedicle of the tumor was attached to the canal, near the orificium vesicale. Mettenheimer found the surface of the tumor he described covered with a thick layer of pavement epithelium, the stroma being a fibrillated connective tissne. Hennig relates two cases of congenital polypoid excrescences of the female urethra, one of which had a pedicle 1.2 inches and the other one line in length. Hardened in methylated spirit they showed a fine net-work of connective tissue. I myself have seen an exactly similar case, No. 544, 1876, in which in a newborn girl a cyst the size of a grain of corn hung from the meatus attached to a pedicle about 2 lines in length.
C. Ruge found in a tumor the size of a hazel nut extirpated by A. Martin (see Stechaw) a central mass of firm, vascular connective tissue. From this centre there projected numerous papilla3 of two kinds, one being pointed, and the other broad and club-shaped. They were covered with pavement epithelium, the more superficial layers of which were composed of small flattened cells, while the deeper layers were composed of large, succulent and nucleated ones. Numerous nuclei were also present in the connective tissue.