These connective-tissue tumors are the largest neoplasms which occur in this locality. They may attain the size of a goose's egg (Velpeau, Scanzoni, Simon (Rostock). They are of rare occurrence.
d. A glandular and connective-tissue proliferation of the mucous mem brane gives us the so-called myxadenoma, a case of which has been described and pictured by Biegel. The scarlet-colored, cherry-sized vascular tumor was composed of a loose-meshed myxomatous tissue which contained the remains ot the degenerated glands.
e. Beigel has also described and figured the single case of sarcoma urethrEe that is recorded. The tumor (T.) was walnut-sized, composed of thin lobes, and was attached to the outer border of the meatus (17.). (See Fig. 14.) The dense portions of the tumor showed a delicate stroma, the meshes of which were filled with very small cells. In the peripheral portions of the tumor, the tissue was looser, the meshes larger, and there were numerous spaces of varying size, filled with a colloid fluid. It waa extirpated; but our author does not say whether it returned.
f. If there is much enlargement of the urethral. veins, the varices tnay drag with them a portion of the urethral mucous membrane, and form tumors of considerable size, as we have already in G. Simon's case of pro lapsus of the urethral mucous membrane. The growths are bluish-red, painless, and compressible, are covered with normal mucous membrane, and may be situated anywhere in the urethral canal. They are in fact true urethral hemorrhoids. Riehet, who has lately studied urethral angiomata, and who claims to have seen 8 cases, lays special stress upon their resemblance to rectal hemorrhoids. They may, as in Simon's case, cause considerable hemorrhage on catheterization. If such a varix breaks without rupturing the mucous membrane that covers it, the blood is poured into the tissue of the tumor, and a hrematoma polyposum urethrre is found. I have seen one such case, the history of which is as follows: An old widow, sixty years of age, who had not menstruated for several years, had never had urinary difficulty, had had six easy confinements, her last pregnancy ending in abortion fifteen years ago, carried suspended to a yoke two heavy pailfuls of fluid on April 19th, 1867. While stepping across a narrow ditch, she suddenly felt a pain in the anterior portion of the vulva, followed immediately by involuntary emission of urine and some hemorrhage. The pain at the spot increased, and soon the patient
noticed a tumor. On April 26th I saw- her, and found the urethra di lated, and a walnut-sized, dark-blue, painless tumor projecting from it. Its surface was apparently fenestrated, but smooth, and it was attached by a thick pedicle to the posterior urethral wall. Judging hy palpation, it seemed to be mainly composed of effused blood. In several places the mucous membrane covering it was necrotic. On April 29th in the clinic I applied the ecraseur to the growth, the patient being narcotised. There was but little hemorrhage. A cotton plug was put into the vagina, so as to moderately compress the urethra. Urine was passed voluntarily, the patient soon recovered, and, when I saw her years later in Rostock, had had no recidive. Section of the tumor showed it to be composed of a coagulum covered with mucous membrane. The blood had hardened in layers, as in a placental polypus. No large vessels were to be seen.
Undoubtedly this was a case of ruptured urethral varix, since there was nothing abnormal save dilatation of the urethra and relaxation of its mucous membrane. The rupture was caused by the extra exertion of a long stride while carrying a heavy load. If I should have another such case, I should use the Paqu6lin cautery or the galvano-caustic wire, as A. Martin did; or I should use the knife, excise the MEM, and suture the wound. This Martin has repeatedly done successfully with larger urethral tumors.
Besides these, venous angiomata and other vascular growths around and in the urethra have been described. Ch. Clarke, Ashburner, Rigby and Langier have described bulbous swellings of the urethra, some of which attained the size of a walnut. Pain, erectibility (Langier's case) and varicosity of the veins have been noticed. V irchow is of opinion that two conditions have here been confounded; that hemorrhoidal urethral tumors and congenital malformations have been classed together. The rudiments of the embryonal duplexity of the vagina sometimes un dergo considerable development, and fall into a true telangiectatic con dition.