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Uterine fibroids after the menopause
REVIEWS
AND
285
ABSTRACTS
The tumors occur almost invariably during the childbearing period, although they do occur later and have been observed in infants. Virgins and ‘parous women seem to be equally affected. They are first seen as small,, firm, rounded and smooth or slightly lobulated, painless subcutaneous masses. Pedunculation is common, particularly in the larger tumors. Growth may be rapid, although it is more often slow. Degeneration and malignant transformations are more common in these tumors in this location than in similar tumors elsewhere in the body, probably because of their variable blood supply, pedunculation and position, which makes trauma more or less unavoidable. They originate in the connective tissue and may start anywhere in the vulvar structures or in the extraperitoneal portion of the round ligament or internal genitalia, and as they increase in size, they are forced into the line of least resistance down the inguinal canal or vagina and appear at the vulva. The case here reported concerns a married, multiparous negress, twenty-four years old, who was admitted to Lakeside Hospital complaining of irregular vaginal bleeding for the past four years. About four years ago she noticed a slight swelling just above the external urethral orifice. This had greatly increased in size. Since she first noticed the tumor, she has had irregular vaginal bleeding, never profuse. Since her marriage, one year ago, she has had moderate leucorrhea and some slight discomfort on voiding. For the past year she has had backache and more or less constant, though not severe, pain in her lower abdomen. Immediately beneath the normal clitoris a rather soft tumor mass completely filled the vestibule and bulged forward depressing the urethra backward and downward into the vagina so that the external meatus was almost invisible. The mass was about 3 cm. in diameter, circular in outline, and extended well up under the lower edge of the symphysis. Gonococci were found in the pus expressed from the urethra. The uterine fundus was normal in size, retroflered and adherent in the pelvis. The tubes were thickened and adherent. The left ovary was cystic, 6 to 8 cm. in diameter, and adherent. Wassermann negative. First operation: A vertical incision was made from clitoris to meatus, tumor shelled out, some difliculty being experienced in freeing it up under the symphysis. Cavity and mucosa were closed with chromic catgut. Tumor proved to be a cellular fibroma. Three days later, as the patient was doing nicely, a laparotomy was done and a chronic pelvic peritonitis revealed. Both tubes and left ovary as well as a badly adherent appendix were removed and the uterus suspended. Patient made an uneventful recovery. WM.
Meyer, J.: Handlingar.
A
Case of Fibromyoma 59: 43, 1927.
of
the
Tube.
Finska
C. HENSKE.
Laekaresaellskapets
Myomas of the tubes are very rare, there having been only 39 observations recorded in literature. This patient, forty years old, noticed a mass in right lower abdomen, which occasionally caused some pain. In operation a fibromatous uterus was removed to which was attached a right tube, I? cm. long, which contained a hard, nodular fibroid, the size of a fist. AUTHOR’S
Shaw, W. Fletcher: 919, 1927. the
Shaw reports incidence
of
Uterine
Fibroids
65 cases of uterine fibroids malignant disease and
After
the
Menopause.
ABSTRACT.
Brit.
M.
J.
, after states
the menopause. that a uterus
He emphasizes which contains
2:
286
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
S3YNECOLOGY
flbroids is much more likely to undergo malignant changes than one whiah is free from these tumors. The writer analyzed the eases as to signs and symptoms and feels that it is much safer for a woman with Abroids of moderate large size to have the uterus removed before the menopause than run the risk of malignant or degenerative changes which so frequently appear after the menopause. PROSHEK.
Seed, liixulon: Degeneration 41: 333, 1925.
of Fibromyomata
of the Uterus.
Surg. Gynec. Obst.
Gross degeneration occurs in approximately 13 per cent of fibromyomas. Two hundred specimens of grossly degenerated flbromyomas of the uterus were reviewed and the degeneration classified as follows: hyaline, 24 cases; edematous, cystic, and myxomatous, 80; red degeneration with total necrosis, 33; calcitlcation, 39; infected subserous and interstitial, 3; submucous, 13; miscellaneous, thrombotic sinus, 5; tuberculous, 1; and Abrolipomatous, 12. Edematous, cystic, and myxomatous degeneration are a pert of the same pathologic process, probably due to a gradual diminution in the blood supply. There are no clinical symptoms peculiar to it. Red degeneration is an aseptic necrobiosis characterized by fatty degeneration, thrombosis of the vessela, extravasation of red blood cells and blood pigment. Pathologically it is a “red infection, ” and can be explained by e sudden complete vascular obstruction affecting chiefly the venous system. The end-result is a total fatty necrosis with transform&ion of the hemosiderin into hematoidin, and subsequent ealoiflcation. The occurrence of symptoms depends upon the size of the tumor end the acuteness of the necrosis. There is local pain and tenderness, and a mild toxemia. Infection following necrosis of a submuoous fibromyoma is very diatinetive and probably accounts in itself for all symptoms. Calcification, which occurs in two forms, the peripheral deposition in a totally necrotic fibromyoma, and the bone-like formation scattered throughout the tumor, has little clinical significance. There is little evidence that the degeneration of fibromyomas prodnees a toxic effect on the other organs. WM. C. HENSKE. sel.lockaort
:
Brux&es-m&l.
Degeaeratiug Fibroid 7: 959, 1927.
in a Witsan
&reaty--19ina
Years of Ape.
Schockaert reports a case of degenerating fibroid tumors of the uterus. The patient was seventy-nine years old. Until four weeks before operation when there appeared a copious sero+anguinous discharge, the tumor had given rise to no trouble other than mild pressure symptoms. A supra-vaginal hysterectomy was performed under spinal anesthesia. The eonvelesenee was normal and rapid. In eoneluding, the author calls attention to the neeesaity of observing carefully fibroid tumors which are giving rise to no trouble, because of tke possibility of degeneration. Such observationa should be etmtinmd, even after the menopause. T~~&noau W. ADAMS. Xiaot:
St%pp?n?hting FUmids.
Brux.@ler-r&d.
7: 593, 1927.
The author reports two eases of infected gbroid tumors of the uterus. The ilref ease ilhxstratas the de3ger of opem6tlng on these eueea too early, eapeuielly where the infection has spreed to the surrouuding orgerm. In this instance the
AND
285
ABSTRACTS
The tumors occur almost invariably during the childbearing period, although they do occur later and have been observed in infants. Virgins and ‘parous women seem to be equally affected. They are first seen as small,, firm, rounded and smooth or slightly lobulated, painless subcutaneous masses. Pedunculation is common, particularly in the larger tumors. Growth may be rapid, although it is more often slow. Degeneration and malignant transformations are more common in these tumors in this location than in similar tumors elsewhere in the body, probably because of their variable blood supply, pedunculation and position, which makes trauma more or less unavoidable. They originate in the connective tissue and may start anywhere in the vulvar structures or in the extraperitoneal portion of the round ligament or internal genitalia, and as they increase in size, they are forced into the line of least resistance down the inguinal canal or vagina and appear at the vulva. The case here reported concerns a married, multiparous negress, twenty-four years old, who was admitted to Lakeside Hospital complaining of irregular vaginal bleeding for the past four years. About four years ago she noticed a slight swelling just above the external urethral orifice. This had greatly increased in size. Since she first noticed the tumor, she has had irregular vaginal bleeding, never profuse. Since her marriage, one year ago, she has had moderate leucorrhea and some slight discomfort on voiding. For the past year she has had backache and more or less constant, though not severe, pain in her lower abdomen. Immediately beneath the normal clitoris a rather soft tumor mass completely filled the vestibule and bulged forward depressing the urethra backward and downward into the vagina so that the external meatus was almost invisible. The mass was about 3 cm. in diameter, circular in outline, and extended well up under the lower edge of the symphysis. Gonococci were found in the pus expressed from the urethra. The uterine fundus was normal in size, retroflered and adherent in the pelvis. The tubes were thickened and adherent. The left ovary was cystic, 6 to 8 cm. in diameter, and adherent. Wassermann negative. First operation: A vertical incision was made from clitoris to meatus, tumor shelled out, some difliculty being experienced in freeing it up under the symphysis. Cavity and mucosa were closed with chromic catgut. Tumor proved to be a cellular fibroma. Three days later, as the patient was doing nicely, a laparotomy was done and a chronic pelvic peritonitis revealed. Both tubes and left ovary as well as a badly adherent appendix were removed and the uterus suspended. Patient made an uneventful recovery. WM.
Meyer, J.: Handlingar.
A
Case of Fibromyoma 59: 43, 1927.
of
the
Tube.
Finska
C. HENSKE.
Laekaresaellskapets
Myomas of the tubes are very rare, there having been only 39 observations recorded in literature. This patient, forty years old, noticed a mass in right lower abdomen, which occasionally caused some pain. In operation a fibromatous uterus was removed to which was attached a right tube, I? cm. long, which contained a hard, nodular fibroid, the size of a fist. AUTHOR’S
Shaw, W. Fletcher: 919, 1927. the
Shaw reports incidence
of
Uterine
Fibroids
65 cases of uterine fibroids malignant disease and
After
the
Menopause.
ABSTRACT.
Brit.
M.
J.
, after states
the menopause. that a uterus
He emphasizes which contains
2:
286
THE
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
S3YNECOLOGY
flbroids is much more likely to undergo malignant changes than one whiah is free from these tumors. The writer analyzed the eases as to signs and symptoms and feels that it is much safer for a woman with Abroids of moderate large size to have the uterus removed before the menopause than run the risk of malignant or degenerative changes which so frequently appear after the menopause. PROSHEK.
Seed, liixulon: Degeneration 41: 333, 1925.
of Fibromyomata
of the Uterus.
Surg. Gynec. Obst.
Gross degeneration occurs in approximately 13 per cent of fibromyomas. Two hundred specimens of grossly degenerated flbromyomas of the uterus were reviewed and the degeneration classified as follows: hyaline, 24 cases; edematous, cystic, and myxomatous, 80; red degeneration with total necrosis, 33; calcitlcation, 39; infected subserous and interstitial, 3; submucous, 13; miscellaneous, thrombotic sinus, 5; tuberculous, 1; and Abrolipomatous, 12. Edematous, cystic, and myxomatous degeneration are a pert of the same pathologic process, probably due to a gradual diminution in the blood supply. There are no clinical symptoms peculiar to it. Red degeneration is an aseptic necrobiosis characterized by fatty degeneration, thrombosis of the vessela, extravasation of red blood cells and blood pigment. Pathologically it is a “red infection, ” and can be explained by e sudden complete vascular obstruction affecting chiefly the venous system. The end-result is a total fatty necrosis with transform&ion of the hemosiderin into hematoidin, and subsequent ealoiflcation. The occurrence of symptoms depends upon the size of the tumor end the acuteness of the necrosis. There is local pain and tenderness, and a mild toxemia. Infection following necrosis of a submuoous fibromyoma is very diatinetive and probably accounts in itself for all symptoms. Calcification, which occurs in two forms, the peripheral deposition in a totally necrotic fibromyoma, and the bone-like formation scattered throughout the tumor, has little clinical significance. There is little evidence that the degeneration of fibromyomas prodnees a toxic effect on the other organs. WM. C. HENSKE. sel.lockaort
:
Brux&es-m&l.
Degeaeratiug Fibroid 7: 959, 1927.
in a Witsan
&reaty--19ina
Years of Ape.
Schockaert reports a case of degenerating fibroid tumors of the uterus. The patient was seventy-nine years old. Until four weeks before operation when there appeared a copious sero+anguinous discharge, the tumor had given rise to no trouble other than mild pressure symptoms. A supra-vaginal hysterectomy was performed under spinal anesthesia. The eonvelesenee was normal and rapid. In eoneluding, the author calls attention to the neeesaity of observing carefully fibroid tumors which are giving rise to no trouble, because of tke possibility of degeneration. Such observationa should be etmtinmd, even after the menopause. T~~&noau W. ADAMS. Xiaot:
St%pp?n?hting FUmids.
Brux.@ler-r&d.
7: 593, 1927.
The author reports two eases of infected gbroid tumors of the uterus. The ilref ease ilhxstratas the de3ger of opem6tlng on these eueea too early, eapeuielly where the infection has spreed to the surrouuding orgerm. In this instance the