678 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



it undergoes flexion or version. The tumors may sink downward and 

 become attached to the posterior wall of the vagina. 



Myomata may undergo a variety of secondary alterations. The mus- 

 cle fibres may undergo fatty degeneration and the tumor diminish in size, 

 or may even it is said be entirely destroyed. Calcification may occur, 

 converting a part or the whole of the tumor into a stony mass. The in- 

 traparietal and submucous myomata may give rise to profuse haemor- 

 rhages ; they may suppurate and become gangrenous. 



Sometimes the tumors or circumscribed portions of them are very 



vascular, constituting the telangiec- 

 tatic or cavernous variety. These 

 tumors, which possess some of 

 the characters of erectile tissue, 

 may suddenly change in size from 

 a variation in the amount of blood 

 which they contain. Larger and 

 smaller cysts may develop within 

 these tumors fibro -cystic tumors. 

 These may be multiple and may 

 communicate ; they may be filled 

 with a clear or bloody fluid. These 

 cystic myomata may reach an im- 



FIG. 430.-ADENOMATOU Su OR R GLANDULAR MYOMA m ^^ S i ze ^0. fill the abdomilial 



cavity. The cysts may be lined 



with ciliated epithelium. ' Combinations of myoma and sarcoma some- 

 times occur myosarcoma. Lipomyoma has been described. a 



Myomata of the cervix are rare. They may grow as polypi beneath 

 the mucous coat, or produce enlargement of the anterior or posterior 

 lips, or may grow outward into the abdominal cavity. 



Myomata of the uterus, either subserous, iutraparietal, or submucous, 

 containing glandular structures of the type of those in the uterine mucosa, 

 are of occasional occurrence (Fig. 430). These glandular or adenoma- 

 tous myomata are sometimes directly connected with the uterine mucous 

 membrane, but are often so distant and so entirely separated from it as 

 to justify the conjecture that they are derived from some embryonal ab- 

 normality associated with the development of theWolffian body. 3 Simi- 

 lar tumors have been described in the round ligament. 4 



Sarcomata may occur as primary tumors in the mucous membrane of 

 the uterus, either in the form of a diffuse infiltration or as a circumscribed 

 nodular or polypoid mass. They frequently involve the muscular wall, 

 are liable to haemorrhage and gangrene, and, particularly in the diffuse 



1 Consult monograph by Breus, "Ueber wahre Epithel fuhrende Cystenbildung d. 

 Uterus-Myomen," Leipzig, 1894. 



2 See Knox, Johns Hopkins Hosp. Bull , vol. xii., p. 318 



3 Cullen, Johns Hopkins Hospital Reports, vol. vi., p. 133. 1897, bibl. ; also Cullen, 

 Monograph as supplement to Orth's "Festschrift," 1903. 



4 Cullen, Bull. Johns Hopkins Hospital Reports, vol ix., p. 142 1898. bibl , also 

 Blumer, Am. Jour. Obstetrics, vol. xxxvii., p. 37, 1898 



