692 



UTERUS AND ITS APPENDAGES. 



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Section of a polypus formed of the muscular tissue of 

 the uterus. (After Wedl.} 



The fibres, arranged in bundles, run in different 

 directions. At a a, they have been divided trans- 

 versely, and in other parts obliquely. Compare 

 with/0. 436. 



The malignant polypi, and those which are 

 formed of hypertrophied mucous structure, 

 belong to another category, and will be de- 

 scribed hereafter. 



4. Pathological conditions of the mucous coat. 

 a. First under this head may be noticed 

 simple hypertrophy of the uterine mucous 

 membrane, followed often by a partial shed- 

 ding of that structure in the form of the so- 

 called 



Dysmenorrhceal membrane. The term men- 

 strual decidua would probably form a more 

 appropriate title for these structures, which 

 consist of a greater or less thickness of the 

 mucous membrane lining the uterus, differing 

 in no respect from that membrane in its ordi- 

 nary condition *, except in the one particular, 

 that it has undergone a certain degree of 

 hypertrophy. (Fig. 443.) The hypertrophies 

 which the mucous membrane of the uterus 

 undergoes in various circumstances form a 

 most interesting subject for study, but all 

 of them are not pathological. The most 

 familiar example of normal hypertrophy of 

 the uterine mucous membrane is that which 

 occurs in ordinary pregnancy. Here, no 

 sooner does the uterus begin to enlarge, 

 than the mucous lining also expands, arid 

 its tissues become opened up by an in- 

 creased flow of blood, and a consequent 

 rapid development of the simple elements 

 composing this structure. This hypertrophy 

 occurs in every pregnancy where the ovum 

 enters the uterus. But it also happens very 

 generally in those cases where the ovum 

 never enters the uterus at all, but is developed 

 externally to that cavity (extra-uterine gesta 

 tion). Here a most perfect decidua is usually 

 found lining the uterus. The exceptions are 

 few in which the uterine mucous membrane, 

 under these circumstances, does not exhibit 

 anj r increase of thickness, but retains or nearly 

 so, its ordinary characters 



* See on the structure of the uterine mucous 

 membrane, p. 635. of this article. 



But a state of pregnancy is -not necessary 

 to produce evolution of the uterine lining, for 

 this may occur when the body of the uterus 

 is enlarged from other causes. Thus, in an 

 example in my possession of uterine fibroid, in 

 which the body of the uterus has undergone 

 the hypertrophy already described (p. 491.), 

 as common in that state, the hypertrophy 

 has extended to the mucous membrane, so 

 that the uterine cavity, which had also been 

 occupied by one of these tumours, exhibits a 

 delicate decidual lining. 



The decidual membranes occasionally cast 

 off from the uterus under circumstances of 

 dysmenorrhcea, consist of fragments, or, more 

 rarely, of entire membranes forming casts of 

 the uterine cavity. The structure of all these 

 is nearly similar, and they differ chiefly in the 

 greater or less thickness of membrane de- 

 tached. All present upon their inner surface 

 the peculiar cribriform markings already de- 

 scribed as constituting the orifices of the 

 uterine glands, while their outer surfaces are 

 rough and shaggy, like the outer surface of 

 aborted ova, for this surface has been de- 

 tached or torn off from the uterus. Fig. 443. 

 represents a portion of such a membrane, as 

 seen from its inner or cribriform surface. The 

 microscopic characters of these membranes 

 are precisely those of ordinary decidua. 



b. Hypertrophy of the follicular structures 

 of the uterine mucous membrane. Follicular 

 polypi. Mucous polypi. Cysts. The patho- 

 logical formations which take their origin in 

 the mucous membrane lining the uterus, con- 

 sist chiefly in hypertrophic growths of that 

 membrane, and of its follicular structures. 

 They present usually two varieties, according 

 as the follicular or the ordinary mucous tissue 

 abounds in their composition. Many of these 

 growths acquire a peduncle, and then consti- 

 tute the mucous or follicular polypi. 



The follicular structure is most apparent in 

 those growths which spring from the body, 

 and especially from the fundus uteri near the 

 orifices of the Fallopian tubes. These vary in 

 size from a pea to a small plum. They have 

 usually a rounded or oval form, and become 

 partially flattened by the external pressure of 

 the uterine walls. A short and narrow pe- 

 duncle connects them with the spot from 

 which they arise. Externally they are smooth 

 and covered by a layer of epithelium, beneath 

 which is a thin extension of the uterine mu- 

 cous membrane. This is often sufficiently 

 transparent to render visible numerous opa- 

 line spots, indicating the seat of groups of 

 uterine follicles distended and elongated, and 

 containing a semitransparent gelatinous fluid. 

 Between these elongated follicles there is a 

 loose fibrous tissue connecting them together, 

 and giving substance to the mass. These 

 tumours possess little resistance, and are usu- 

 ally soft and elastic. 



The more solid mucous tumours very ge- 

 nerally acquire a stem, and early take the 

 form of polypi. These mostly arise from be- 

 tween the folds of the lining membrane of the 

 cervix, and are evidently mere hypertrophies 



