NOTE.-Died tenth day from hæmorrhage. The patient was doing exceedingly well up to three minutes before death occurred. RRRRR R. R. Well. Well. Well. Well. No recurrence as yet. Died eighteen months after. Return and death in twenty months. Well two years after. Died six months after operation. Well. Well. Well. Died, one year later, from return of disease. Died, in two years, from return. Unknown. Unknown. or vegetate, but undergoes degeneration. There are also two forms of the interstitial variety,—one characterized by a hypertrophy of the entire uterus, as also an augmentation of the diameter of the uterine cavity; the vessels are greatly enlarged, and the affection is often liable to be mistaken for fibroma. The second form is more common; the sarcoma is usually quite circumscribed; it occupies the surface or the interior of the muscle. As it enlarges, its projecting part assumes the form of a glossy mushroom, with few protuberances, being connected with the body of the uterus by a pedicle. In this variety the uterus is always hypertrophied. Another variety of sarcoma is the cystic. It is formed in the mass of the tumor. In the cavities of the cyst a sanguineous liquid is found, containing shreds of sarcomatous tissue. The age of the patient appears to have a bearing upon this affection, varying from 30 to 50 years. It occurs more frequently in women who have never borne children. It grows very rapidly. The general condition of the patient is not much affected by the presence of the tumor. It is possible for a fibroma to degenerate into a sarcoma. The patients rarely live over two years. Death is due to compression from the size which the tumor rapidly attains; after removal relapse is the rule after six or eight months. The diagnostic symptoms are an almost constant sanguineous discharge, augmentation in the volume of the uterus, and notable enlargement of the cavity. The treatment consists in total removal. Its removal per vaginam is applicable only in incipient intra-uterine sarcoma, otherwise a supra-vaginal hysterectomy becomes necessary. When the total removal is contra-indicated, the local symptoms can be relieved by dilatation, curetting, and cauterization with chloride of zinc and perchloride of iron. Pfannenstiel reports a case of grape-like sarcoma of the cervix. It occurred in a woman of 53, who had always been healthy. She had two children and two abortions. The affection. began, five years after the menopause (Mundé), with pains in the back and a discharge. Examination revealed a polyp in the vagina extending to the vulva. It was found to start from the anterior cervical wall. This was cauterized. One and a half years later it appeared again. This time it was removed with a sharp spoon and the cervix touched with a Paquelin cautery. Half a year later it returned again, larger than before and in the form of masses. Microscopical examination showed it to be a sarcoma. The uterus was then totally extirpated. The patient made an excellent recovery. After another six months had passed the affection returned in the left half of the vaginal cicatrix. The author was only able to collect 11 cases in literature. In all of these cases the tumor assumed the shape of a bunch of grapes. This shape is due to the formation of numerous polypoid excrescences from the mucous membrane, and these become œdematous. Microscopically, spindle- and round- cells are observed in the middle of normal connective tissue. Occasionally, smooth and striped muscular fibres and hyaline cartilage are scen. The growth forms upon the most superficial layer of the cervical mucous membrane, close to the os externum, and grows down in the vagina. It may affect the uterine body and the parametrium when of long duration. Death is usually due to cachexia and perforating peritonitis. In half of the cases it occurred in nulliparæ, coming most frequently at puberty and at the menopause. The symptoms in the beginning are discharge, increased menstruation, and irregularity of the menses. When the tumor increases greatly in size pressure symptoms appear. The duration of the disease is one and one-half to two years. It grows rapidly, and when removed returns in a few months. In no case, even where operation was performed, was a cure established. This was attributed to the fact that the diagnosis was made too late. Treatment should be early total extirpation of the uterus. 154 M 19 Mar 21 29 Kaltenbach, Goodell, and Sänger and Müller, all report cases of sarcoma upon which they had operated. In Sänger's cases the sarcoma was designated as of the decidual variety, or, better, sarcoma-deciduo-cellulare uteri. Chiari had seen 3 of these cases and Sänger 2. The symptoms are similar to those of carcinoma. Anatomically, the tumor is composed of polymorphous decidual cells, giant-cells, a pseudo-alveolar group, or a narrowmeshed net-work. The entire muscular structure becomes destroyed. Sacral Resection for Malignant Disease.-The method known as Kraske's has been discussed by a number of writers, and reports of cases thus treated are given. Montgomery 10 advocates this method in malignant disease of the uterus and rectum. He makes 1003 Oct. |