FIBROID TUMORS OF THE UTERUS. 



layer of parenchyma. The womb itself is usually hypertrophied as 

 if pregnant, and the portio vaginalis is soon obliterated. Practically 

 it is of great importance to distinguish between submucous growths 

 having a broad attachment to the womb, and those which project 

 into it so completely as to be held by a mere pedicle. The latter, the 

 so-called fibrous polypi, are a subject for surgical treatment. The 

 interstitial, intraparietal, or intramural tumors tend less to project 

 from the uterine wall ; but, where they become large, they cause a 

 bulging of both inner and outer wall, thus taking an intermediate 

 position between the two extraparietal forms of fibromyoma. 



The same variation as to seat holds good with regard to the far 

 rarer fibromyomata of the neck and vaginal portions of the womb. 

 Submucous fibromata of the cervix usually appear as fibrous polypi. 

 These must not be confounded with the more common mucous poly- 

 pus, which is merely a product of catarrhal relaxation of the mu- 

 cous membrane with cystic enlargement of the follicles (ovula Na- 

 bothi). The latter are easily distinguishable from the fibromyomata 

 by their softness and smallness, rarely exceeding a hazel-nut in size. 



Uterine fibromyomata may undergo many further transforma- 

 tions. The commonest one is an accumulation of liquid in the lymph- 

 spaces, which dilates them, causing an oedematous softening of the 

 tumor, and sometimes a cystic metamorphosis. In the latter case we 

 find either numerous small cysts, or else a large cavity whose ragged 

 sides and trabeculge announce it to be the product of the blending 

 of several smaller cysts. Heteroplastic action may also arise, such 

 as myxomatous or colloid degeneration, sarcoma, or cystosarcoma. 

 True cancer probably does not occur, except as a secondary disease, 

 by metastasis or by propagation in continuity from a cancer of the 

 uterus proper. 



SYMPTOMS AND COURSE. The symptoms of a fibromyoma vary 

 greatly, according to the size and seat of the tumor. Small subse- 

 rous growths, or those which are completely extraparietal, and 

 which, being merely attached by a thin stem, have ceased to grow, 

 often give no symptoms at all. Sometimes a small growth flexes or 

 upsets the womb by its weight, either backward or forward, accord- 

 ing as its seat is in the front or back wall of the organ. A large 

 extraparietal tumor,, on the other hand, displaces the womb in the 

 direction away from its geat, or sometimes draws the womb up with 

 it into the abdomen. The pressure exerted by a dislocated womb 

 or by a voluminous tumor upon adjacent parts may cause various 

 evils backache, incontinence or retention of urine, obstruction of 

 the rectum, swelling of the feet, neuralgia, or even paresis of a leg. 

 The irritation often causes local peritonitis, with consecutive incap- 



