690 



UTERUS AND ITS APPENDAGES. 



mass, so that a muscular rather than a fibrous it may be easily detached and turned out of 

 tissue results. A small quantity of clastic its investing capsule (/%. 475 ). 

 fibre is also occasionally found in these ute- 



rine formations. 



Fig. 475. 



Fig. 474-. 



Section of fibroid tumour of the uterus. (Ad Nat.) 



The structural variations observable in 

 fibroid of the uterus, are dependent chiefly 

 upon the peculiarities in arrangement of these 

 component elements. In the more dense 

 formations, the white shining fibrous bands 

 enclosing little pellets of the browner sub- 

 stance, form numerous small compact masses, 

 which are again closely united together by a 

 somewhat looser fibrous tissue that serves to 

 combine the whole into lobes or lobules, va- 

 rying in size from a pea to that of a man's 

 head. The variation in density of these 

 masses depends, further, upon their vascula- 

 rity. In the softer kinds, bloodvessels that 

 may be injected permeate the mass, running 

 along the bands and layers of fibrous tissue 

 connecting the lobules. Such tumours are 

 sometimes of a deep red colour. The denser 

 masses, on the other hand, are apparently 

 nearly bloodless ; at least, injections cannot be 

 made to penetrate them. 



The different configurations which these 

 masses of uterine fibroid assume, appear to 

 depend in a great measure upon accidental 

 conditions. In this particular three varieties 

 may be noticed. 



1st var. Interstitial fibroid. The mass 

 here forms a growth, sometimes of immense 

 size, but still contained within the proper 

 boundaries of the organ, occupying one or 

 other uterine wall, but -neither encroaching 

 upon the uterine cavity, nor protruding ex- 

 ternally. Such is the case represented in 

 Jig. 475., in which the external appearances 

 were those of the ordinary gravid uterus in 

 the seventh month. Such masses appear oc- 

 casionally at their periphery to merge gra- 

 dually into the healthy tissues of the uterus, 

 but more commonly there exists a distinct 

 boundary formed by loose cellular tissue with 

 which the tumour is so lightly connected that 



Interstitial fibroid of the uterus. (Ad Nat.) 



The tumour is formed in the substance of the 

 posterior wall, which is so attenuated at one spot as 

 to be nearly broken through. The cavity of the 

 uterus is shown in the lower part of the figure un- 

 altered in size. 



2nd var. Subperitoncal fibroid. In this 

 variety the fibroid mass or masses protrude 

 from the external surface of the uterus. Here 

 one or several round or oval tumours are 

 formed which seem to grow out of the uterine 

 substance by a narrower or broader base, or 

 they remain attached to it by a peduncle. 

 These masses consist entirely of fibroid, 

 having either simply an investment of perito- 

 neum, or beneath that also, in many instances, 

 a layer more or less thick of uterine sub- 

 stance which is usually laminated, so that a 

 capsule composed of the natural tissues of the 

 uterus is formed around the tumour (fig. 476.). 



3rd var. Sub-mucous fibroid. In this va- 

 riety the fibroid mass quits its bed in the 

 uterine walls, and projects into the cavity of 

 the uterus ; it becomes covered by an exten- 

 sion of the lining membrane of the uterus, 

 and sometimes also beneath this by a layer of 

 healthy uterine tissue. These tumours, when 

 they possess a peduncle, constitute the fibroid 

 polypi of the uterus. 



A distinction has been made in these po- 

 lypi between such as form continuous out- 

 growths from the substance of the uterus, and 

 those in which the polypous mass forms a 

 discontinuous tumour, connected only by a 

 narrow stem of mucous and muscular tissue. 



The original position of the fibroid growth 

 in the uterine walls, whether in the middle or 

 nearer to their inner or outer surfaces, proba- 

 bly determines, in a great measure, the direc- 

 tion and form which these growths ultimately 

 take, and is consequently productive of the 

 three varieties above noted. 



The different forms which fibroid assumes 

 are in accordance with these varieties of po- 



