THE REPRODUCTIVE ORGANS OF THE FEMALE. 



677 



According to their position we may distinguish subserous, submucous, 

 and iutraparietal forms. 



The subserous myomata, often multiple, grow from the outer muscular 

 layers of the uterus in the form of little nodules. As they increase in 

 size they may become separated from the uterine wall and remain at- 

 tached only by a narrow pedicle or by a little connective tissue ; or may 

 even be entirely free. They may work their way between the folds of 

 the broad ligament until they are at some distance from their point of 

 origin. The tumors may become very large, but remain firmly attached 

 to the uterus ; this organ may then be drawn upward, the cervix and 

 vagina being elongated and narrowed. The traction may be so great that 

 the body of the uterus is 

 entirely separated from 

 the cervix. The bladder 

 may also be drawn up- 

 ward. 



The submucous myomata 

 grow from the inner mus- 

 cular layers of the uterine 

 wall, most frequently in 

 the fundus. They may 

 project into the uterine 

 cavity and remain sessile 

 or become pediculated ; 

 the uterus dilates with the 

 growth of the tumor, and 

 its wall may also be thick- 

 ened. 



They are usually single, 

 although there may be at 

 the same time subserous 

 and intraparietal tumors. 

 They are frequently soft. 

 If they are of large size 

 and polypoid in form, 

 they may project through 



the cervix and drag down the fundus of the uterus, producing inversion. 

 The mucous membrane covering them may be atrophied or hypenemic, 

 with dilated blood-vessels, and may thus give rise to severe and repeated 

 haemorrhages. In some cases the pedicle of a tumor is destroyed and it 

 is spontaneously expelled. 



The intraparietal myomata grow in the substance of the uterine wall, 

 but, if they attain a large size, project beneath the serous or the mucous 

 coat (Fig. 429). They are found in every part of the uterus, but are 

 most frequent in the posterior wall. 



The shape of the uterus is altered in a great variety of ways by the 

 presence of these tumors ; its cavity is narrowed, dilated, or misshapen ; 



FIG. 429. I.NTRAPARIKTAL MYOMATA OF THE UTERUS. 



