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The differential diagnosis of chancre and carcinoma of the cervix
333
REVIEWS AND ABSTRACTS
Wighsmith:
The Importance
of Early Diagnosis of Uterine 1921, x, 521.
Cancer.
Southern Medicine and Surgery,
The importance of early diagnosis lies in the fact that if the disease is diagnosed in time all patients are curable, while if not diagnosed in time, all must die. ‘W. K. FOSTER.
Prankl:
Early
Diagn.osis of Carcinoma, of the Uterus.
Dublin Jour-
nal of Medical Science, 1921, iv S., No. 21, p. 491. After a compilation of the cases of carcinoma o-f the uterus in Sehauta’s Clinic at Vienna, Frank1 states that early cases showed an increasing proportion from 1909 to 1913; while during the years of the war, the incidence of early carcinoma materially diminished ; but is once more, in 1920 and 1921, on the increase-showing that by reason of the economic stress of the war, patients neglected to consult physicians in regard to suspicious symptoms. But circumstances have improved in this regard with the change in economic life. The early cases are those in which the cancer can only be demonstrated microscopically, or those in which the tumor was present without invading surrounding structures. Obviously, the diagnosis depends upon test excision or curettage in all specific cases. The article (details the pathologic diagnosis of beginning malignancy. A. N. CREADICK.
Warthin and Noland: The Differential Diagnosis SCarcinoma of the Cervix. The American Journal
of Chancre and of Syphilis, 1921,
v, 553. Agreeing with Gellhorn and Ehrenfest, Warthin
holds that the priand pathognostic features clinically, and that the diagnosis and a differentiation from carcinoma can be made only through its characteristic histological picture. The finding of Spirochetae pallidae in a smear is not conclusive, as a syphilitic woman may have carcinoma of the cervix and it is known that the spirochetes occur in the cervical secreti.ons of syphilitic women. Finding them, however, in the tissues of the characteristic lesions offers valuable confirmatory evidence. A case is reported substantiating these facts. In a married woman, aged 42, examination revealed a cauliflower growth (covering the entire cervix, containing an ulcer which was covered by a grey membrane, the growth bleeding readily on examination. Since the Wassermann test was negative and the appearance of the growth seemed typical for a cervical carcinoma, a panhysterectomy was done in a private hospital. After leaving the hospital, the patient developed secondaries and brought suit against the hospital for $100,000, on the ground that she had contracted syphilis in the hospital from the needle used in drawing the blood for examination. Her husband brought suit for a like amount, since he had meanwhile also developed evidence of syphilis. The growth was sent to the University of Michigan, where Warthin found it to be a typical chancre of about fo-ur to six weeks’ duration. He also demonstrated the spirochetes in the tissues. Upon this evidence the suit was lost. The article contains some exceedingly good photomiscrographs, show-
mary cervical chancre offers no truly characteristic
234
THE
AMERiCAN
JOURNAL
OF
OBSTETRI68
AND
GKNECOLXlY
ing in detail the characteristic picture of such a lesion. According to Warthin, the tissue changes due to primary syphilis are more typical in the cervix than in any other tissue. R. E, Wonva.
Fi 1920, lxxxiii,
of gie,
iagnosis of ~h~r~~~e~~t~elioma Zeitsehrift ftir Geburtshilf 63.
The author believes that chorionepithelioma develops in all ca.ses in the early months of pregnancy while Langhan’s layer aud the synStium are both present. The tumor usually leads to abortion and :lenee the great majority of ea.ses are reported following abortion or hydatiform moles. Occasionally, however, pregnancy may continue There 60 near term, though the labor is usnally somewhat premature. !s frequently atonic bleeding immediately postpartum with acute or -chronic hemorrhages in the puerperium and subinvolution of the uterus. Any tissue removed from cases giving such a history should Se examined most carefully microscopically with this point in view. The author reports such a ease in a twenty-one-year old primipara who had had a severe attack of influenza in the second ha.lf of pregnancy. The labor was 3 to 4 weeks premature, severe bleeding followed the spontaneous separation of the placenta. Lochia still bloody and uterus subinvoluted on the elevent,h day postpartum. Severe hemorrhage on 18th day with removal on 20th da,y of polypoid growth from uterus, histologically suspicious of ehorionepithelioma. Cessation of bleeding until 40th day when she had another severe hemorrhage. Renewed examination of tissue confirmed diagnosis and .the uterus with left adnexa was removed by vaginal hysterectomy on the 43rd day. ~\IARGARI~T Xcmwm. ,&se : iagn,osis and Treatment of hQrio”~pi~~e~~Qma. gery, Gynecology and Obstetrics, 1921, xxxii, 426.
Sur-
WThile adhering to the eksifieation of Marehand, Geist prefers to term typical chorioepithelioma as choriocarcinoma and the atypical form as syneytioma. Between these, there are numerous transition stages and: in addition, there is a form presenting an exaggerated reaction to pregnancy without definite tumor formation, which he terms syncytial hyperplasia. The diagnosis from curetted or expelled material is extremely difficult except in the clear-cut cases of the two groups. In the transitional types prognosis is doubtful. A positive diagnosis of syncytioma would call for conservatism, yet, the clinical course might still necessit;ate hysterectomy. In choriocarcinoma and the transitional types, abdominal hysterectomy is indicated and offers a fair prognosis evea in the malignant type. R. E. Wosus. : r~p~y~i~ in a,rcin~~a ical Journal, 1921, cxiv, 384.
miley
of the
er-vix.
New
York
Med-
According to Bland’s statistics, one woman of every eight dies of taneer; one-third of all cancers in women are of uterine origin; 85 90 per cent of uterine carcinoma are cervical in type. Cervical careinomas are found almost exclusively (97 per cent) in women who have
REVIEWS AND ABSTRACTS
Wighsmith:
The Importance
of Early Diagnosis of Uterine 1921, x, 521.
Cancer.
Southern Medicine and Surgery,
The importance of early diagnosis lies in the fact that if the disease is diagnosed in time all patients are curable, while if not diagnosed in time, all must die. ‘W. K. FOSTER.
Prankl:
Early
Diagn.osis of Carcinoma, of the Uterus.
Dublin Jour-
nal of Medical Science, 1921, iv S., No. 21, p. 491. After a compilation of the cases of carcinoma o-f the uterus in Sehauta’s Clinic at Vienna, Frank1 states that early cases showed an increasing proportion from 1909 to 1913; while during the years of the war, the incidence of early carcinoma materially diminished ; but is once more, in 1920 and 1921, on the increase-showing that by reason of the economic stress of the war, patients neglected to consult physicians in regard to suspicious symptoms. But circumstances have improved in this regard with the change in economic life. The early cases are those in which the cancer can only be demonstrated microscopically, or those in which the tumor was present without invading surrounding structures. Obviously, the diagnosis depends upon test excision or curettage in all specific cases. The article (details the pathologic diagnosis of beginning malignancy. A. N. CREADICK.
Warthin and Noland: The Differential Diagnosis SCarcinoma of the Cervix. The American Journal
of Chancre and of Syphilis, 1921,
v, 553. Agreeing with Gellhorn and Ehrenfest, Warthin
holds that the priand pathognostic features clinically, and that the diagnosis and a differentiation from carcinoma can be made only through its characteristic histological picture. The finding of Spirochetae pallidae in a smear is not conclusive, as a syphilitic woman may have carcinoma of the cervix and it is known that the spirochetes occur in the cervical secreti.ons of syphilitic women. Finding them, however, in the tissues of the characteristic lesions offers valuable confirmatory evidence. A case is reported substantiating these facts. In a married woman, aged 42, examination revealed a cauliflower growth (covering the entire cervix, containing an ulcer which was covered by a grey membrane, the growth bleeding readily on examination. Since the Wassermann test was negative and the appearance of the growth seemed typical for a cervical carcinoma, a panhysterectomy was done in a private hospital. After leaving the hospital, the patient developed secondaries and brought suit against the hospital for $100,000, on the ground that she had contracted syphilis in the hospital from the needle used in drawing the blood for examination. Her husband brought suit for a like amount, since he had meanwhile also developed evidence of syphilis. The growth was sent to the University of Michigan, where Warthin found it to be a typical chancre of about fo-ur to six weeks’ duration. He also demonstrated the spirochetes in the tissues. Upon this evidence the suit was lost. The article contains some exceedingly good photomiscrographs, show-
mary cervical chancre offers no truly characteristic
234
THE
AMERiCAN
JOURNAL
OF
OBSTETRI68
AND
GKNECOLXlY
ing in detail the characteristic picture of such a lesion. According to Warthin, the tissue changes due to primary syphilis are more typical in the cervix than in any other tissue. R. E, Wonva.
Fi 1920, lxxxiii,
of gie,
iagnosis of ~h~r~~~e~~t~elioma Zeitsehrift ftir Geburtshilf 63.
The author believes that chorionepithelioma develops in all ca.ses in the early months of pregnancy while Langhan’s layer aud the synStium are both present. The tumor usually leads to abortion and :lenee the great majority of ea.ses are reported following abortion or hydatiform moles. Occasionally, however, pregnancy may continue There 60 near term, though the labor is usnally somewhat premature. !s frequently atonic bleeding immediately postpartum with acute or -chronic hemorrhages in the puerperium and subinvolution of the uterus. Any tissue removed from cases giving such a history should Se examined most carefully microscopically with this point in view. The author reports such a ease in a twenty-one-year old primipara who had had a severe attack of influenza in the second ha.lf of pregnancy. The labor was 3 to 4 weeks premature, severe bleeding followed the spontaneous separation of the placenta. Lochia still bloody and uterus subinvoluted on the elevent,h day postpartum. Severe hemorrhage on 18th day with removal on 20th da,y of polypoid growth from uterus, histologically suspicious of ehorionepithelioma. Cessation of bleeding until 40th day when she had another severe hemorrhage. Renewed examination of tissue confirmed diagnosis and .the uterus with left adnexa was removed by vaginal hysterectomy on the 43rd day. ~\IARGARI~T Xcmwm. ,&se : iagn,osis and Treatment of hQrio”~pi~~e~~Qma. gery, Gynecology and Obstetrics, 1921, xxxii, 426.
Sur-
WThile adhering to the eksifieation of Marehand, Geist prefers to term typical chorioepithelioma as choriocarcinoma and the atypical form as syneytioma. Between these, there are numerous transition stages and: in addition, there is a form presenting an exaggerated reaction to pregnancy without definite tumor formation, which he terms syncytial hyperplasia. The diagnosis from curetted or expelled material is extremely difficult except in the clear-cut cases of the two groups. In the transitional types prognosis is doubtful. A positive diagnosis of syncytioma would call for conservatism, yet, the clinical course might still necessit;ate hysterectomy. In choriocarcinoma and the transitional types, abdominal hysterectomy is indicated and offers a fair prognosis evea in the malignant type. R. E. Wosus. : r~p~y~i~ in a,rcin~~a ical Journal, 1921, cxiv, 384.
miley
of the
er-vix.
New
York
Med-
According to Bland’s statistics, one woman of every eight dies of taneer; one-third of all cancers in women are of uterine origin; 85 90 per cent of uterine carcinoma are cervical in type. Cervical careinomas are found almost exclusively (97 per cent) in women who have