700 



UTERUS AND ITS APPENDAGES. 



peritoneum (fig. 426. 433. o). the cancer mat- 

 ter does not so easily penetrate through this, 

 not at least until adhesions have formed.* 



But cancer may commence in the f'undus 

 or hody, instead of in the cervix, although 

 this is rare ; or it may extend to the uterus 

 from the ovary. In this way extensive dis- 

 organisation of the adjacent parts may occur, 

 the cervix remaining intact. f 



Cancer, when thus developed, especially in 

 the encephaloid variety, assumes often the 

 form of distinct masses or tumours, rather 

 than of an infiltration of the tissues. 



These tumours may be imbedded in the 

 uterine walls, or form numerous irregular 

 rounded and sometimes pedunculated masses, 

 variously attached to, or projecting from their 

 surface. On the other hand such a distinct 

 mass formed in the substance of the uterine 

 walls, or beneath the mucous membrane, may 

 in the course of growth push the latter before 

 it, and, subsequently acquiring a stem, may 

 fill the uterine cavity or protrude into the 

 vagina, and constitute a malignant polypus. 



In most cases of uterine cancer the uterus 

 is the primary, and except in those instances 

 where the disease has spread by direct ex- 

 tension to adjacent parts, it may remain 

 throughout the sole organ attacked. Or 

 uterine cancer may be associated with like 

 formations in the stomach, mamma, ovary, 

 &c., and be developed concurrently with or 

 consecutively to these. 



Cancroid. Epithelial cancer. Cauliflower 

 excrescence. Cancroid of the uterus is li- 

 mited in its commencement to the vaginal 

 portion of the cervix, and presents the follow- 

 ing principal varieties. It may appear under 

 the form of papillary growths, resembling con- 

 dylomata, which spring from the mucous sur- 

 face, and form little compact masses that 

 gradually, by the growth and elongation of the 

 papilla?, become soft, pulpy, and brittle, and 

 easilv bleed on being touched. After a time 

 a basis of cancroid is developed in the cervical 

 tissues, or the papillary growth appears upon 

 a larger scale, forming a hard, knotty, and 

 brittle mass, which grows with tolerable ra- 

 pidity, and ultimately more or less fills the 

 vagina or protrudes from the vulva. In form 

 the growth often resembles a cauliflower, to 

 which it was likened by Dr- John Clarke. The 

 surface is of a bright flesh colour, and is 

 covered with small projections or granules. 

 These again are united into larger masses or 

 lobes, set upon short and broad stems, that 

 ultimately coalesce into a common basis 

 formed by one or both lips of the cervix. 

 The whole tumour has a certain firmness and 

 solidity ; but the superficial granules are so 

 brittle that slight handling causes some to 

 break away, a free haemorrhage resulting. Or 

 the cancroid, after being developed in and 

 beneath the mucous membrane of the cervix 

 in the form of little granular masses, gradually 



* Dr. West is, T believe, the only author who has 

 hitherto pointed out the true cause of this difference. 

 ) See case, p. 5l>3. 



breaks through the surface ; while in the 

 course of time ulcerations form upon the 

 most prominent portions, and these coalescing, 

 while increased deposits of cancroid take 

 place in the sublying tissues, which in turn 

 are also destroyed, a sore, more or less ex- 

 tensive, is formed that in its further aspect 

 and progress very nearly resembles encepha- 

 loid cancer. 



Regarding the structure of these cancroid 

 formations, they are, according to Virchow, 

 at the commencement simple papillary growths, 

 and later assume the characters of cancroid. 

 At first they appear in the form of small vil- 

 lous projections from the surface, composed 

 of an outer very thick layer of peripheral 

 epithelial plates, and an inner one of cylinder 

 ephithelium, the interior of the villus consist- 

 ing of large blood-vessels. These vessels are 

 chiefly colossal thin-walled capillaries, which 

 either form simple loops at the extremities of 

 the villi between the layers of epithelium, or 

 ramify in compound loops over the surface, 

 or lastly, present a retiform arrangement. 

 The great size, tenuity, and superficial posi- 

 tion of these vessels explains the profuse dis- 

 charge of watery fluid, and frequent bleedings, 

 which constitute such striking features in the 

 progress of the cauliflower excrescence, as 

 well as the entire collapse and almost total 

 disappearance of those tumours after death, 

 so that only slight traces of them are found 

 on post-mortem examination. 



At the commencement the papillae are 

 single and close-set, so that the surface, as 

 Clarke describes it, is merely granular. The 

 peculiar cauliflower form is occasioned by the 

 branching of the papillae, which ultimately 

 form fringes an inch in length. After this 

 superficial process of growth has continued 

 for a certain time, cancroid alveolar spaces 

 begin to be formed at the base, between the 

 fibrous and muscular layers of the organ. At 

 first these appear as simple spaces, with 

 epithelial contents, but later are found alveoli, 

 from whose parietes new papillae spring, 

 which also become ramified, constituting 

 arborescent proliferous growths. 



Corroding ulcer. Here may be noticed an 

 affection of the uterine cervix, whose exact 

 pathological relations have not been deter- 

 mined with sufficient accuracy- The corrod- 

 ing ulcer, first described by Dr. John Clarke, 

 and compared by Rokitansky to a phagede- 

 nic (cancerous) sore of the skin, differs 

 mainly from cancer in the absence of a cancer 

 basis, or of cancerous infiltration of adjacent 

 tissues, while it resembles the destructive 

 march of cancer in its mode of gradually dis- 

 integrating, and destroying the os and cervix, 

 and even portions of the body of the uterus, 

 and extending to the bladder, rectum, and ad- 

 jacent structures. The characters of this 

 ulcer are those of a ragged, irregular-margined 

 sore, with a brownish or greyish base, from 

 which issues a thick purulent or copious 

 watery secretion. The margins and base may 

 be thickened by inflammation, but there are 

 no granulations. 



