Tumors of the Uterus.
Myoma of the Uterus.—Uterine my oma consists of one or more masses of fibromyomatous tissue developed in or upon the uterine walls. According to their location they are called polypoid, submucous, intramural, subserous, pedic ulated, and intraligamentous.
The polypoid tumor develops near or just under the mucous membrane, and, as it grows larger, projects into the uter ine cavity. It remains attached by the mucous membrane and a few connective tissue fibres, which form a pedicle of greater or less size and density, according to the amount of fibrous tissue dragged with it from the uterine wall. The sub mucous starts a short distance from the mucous membrane and projects more or less upon the surface. The uterine cav ity in these two varieties enlarges as the tumor grows. The intramural develops well within the uterine wall and retains a thick covering of uterine fibres. The uterine cavity enlarges in proportion to the relation of the tumor to the mucosa. The subperitoncal variety is developed near the peritoneal cover ing, and causes a projection upon the serous surface without increasing to a great extent the size of the uterine cav ity. The pediculated tumor develops just under the peritoneum and projects from the surface. The in traliga incur ous tumor projects into the connective tissue of the broad or sacro-uterinc liga ments. From 5 to 10 per cent. develop in the cervix. :Hymns may he single or multiple, each with a capsule, or several masses may be developed in one capsule.
Symptoms.—In the polypoid, submu cous, and interstitial varieties menorrha gia and metrorrhagia are the most promi nent symptoms, with or without mucous or watery uterine discharges between. The menopause may be delayed beyond the fiftieth year. Such tumors may be accompanied by painful uterine contrac tions either from pressure of the polypus upon the cervix (acting like a foreign body in the uterus) or from obstruction of the cervix by the projection of a tumor growing near the cervix. The inter stitial and submucous varieties may cause ovarian hyperplasia with its symptoms; or painful pressure upon the rectum, bladder, or pelvic nerves; or even ob struction of one or both ureters.
Sterility, early abortion, and dystocia are apt to be present. Anaemia is a com mon result of the loss of blood.
Fibromyomatous tumurs distinctly predispose to sterility. _More than One third of the patients having these tumors have during their married life but one child, while in a series of 2000 cases of women who had other pelvic diseases, but 5 per cent. show the same compara tive sterility. Interstitial tumors have the greatest influence in preventing con ception. Next in importance are sub serous, while least effective are sub mucous. Frankel (Monats. f. Geburts.
u. Gyn., Bd. viii, H. 2, '9S).
Report of 35 cases of tibromyoma of the uterus. But 13 of these patients had borne children. They were found in 3 unmarried sisters, over thirty years of age, whose histories were given. is fibromyomata degenerate early, their re moval is indicated as soon as a diagnosis is made. Enueleation may be performed, but in 34 ea,,e, total hysterectomy was performed, G times per raginam. with successful recovery in all. Of the 25 abdominal hysterectomies, but 1 patient died — of ketnorrhage. Debersa clues (Jour. de Chir., lice., 1901, •Jan., 1902).
The subperitoneal and intraligament ous growths have but few symptoms until large enough to press upon the surround ing organs, when they cause pelvic pain, vesical and rectal distress, constipation, and, in rare instances, serious impaction of farces in the colon.
Diagnosis.—Single intramural, submit cons, and polypoid myomata enlarge the uterus symmetrically, and must be differ entiated from pregnancy, luematometra, flexions, carcinoma, sarcoma, and subin volution. The introduction of the sound when pregnancy is excluded, and, in case of large tumors, the introduction of the finger, reveals the increased size of the cavity and perhaps the presence of a polypoid or sessile growth. In case of flexion the sound passes directly into the supposed tumor instead of over or behind it. The signs and symptoms of the above mentioned conditions should be looked for.