700 



UTERUS AND ITS APPENDAGES. 



peritoneum (fig. 426. 433. G). the cancer mat- breaks through the surface ; while in the 

 ter does not so easily penetrate through this, course of time ulcerations form upon the 

 not at least until adhesions have formed.* most prominent portions, and these coalescing, 

 But cancer may commence in the fundus while increased deposits of cancroid take 

 or body, instead of in the cervix, although place in the sublying tissues, which in turn 

 this is rare ; or it may extend to the uterus are also destroyed, a sore, more or less ex- 

 from the ovary. In this way extensive dis- tensive, is formed that in its further aspect 

 organisation of the adjacent parts may occur, and progress very nearly resembles encepha- 

 the cervix remaining intact, f loid cancer. 



Cancer, when thus developed, especially in Regarding the structure of these cancroid 

 the encephaloid variety, assumes often the formations, they are, according to Virchow, 

 form of distinct masses or tumours, rather at the commencement simple papillary growths, 

 than of an infiltration of the tissues. and later assume the characters of cancroid. 



These tumours may be imbedded in the At first they appear in the form of small vil- 

 uterine walls, or form numerous irregular lous projections from the surface, composed 

 rounded and sometimes pedunculated masses, of an outer very thick layer of peripheral 

 variously attached to, or projecting from their epithelial plates, and an inner one of cylinder 

 surface. On the other hand such a distinct ephithelium, the interior of the villus consist- 

 mass formed in the substance of the uterine ing of large blood-vessels. These vessels are 

 walls, or beneath the mucous membrane, may chiefly colossal thin-walled capillaries, which 

 in the course of growth push the latter before either form simple loops at the extremities of 

 it, and, subsequently acquiring a stem, may the villi between the layers of epithelium, or 

 fill the uterine cavity or protrude into the ramify in compound loops over the surface, 

 vagina, and constitute a malignant polypus. or lastly, present a retiform arrangement. 

 In most cases of uterine cancer the uterus The great size, tenuity, and superficial posi- 

 is the primary, and except in those instances tion of these vessels explains the profuse dis- 

 where the disease has spread by direct ex- charge of watery fluid, and frequent bleedings, 

 tension to adjacent parts, it may remain which constitute such striking features in the 

 throughout the sole organ attacked. Or progress of the cauliflower excrescence, as 

 uterine cancer may be associated with like well as the entire collapse and almost total 

 formations in the stomach, mamma, ovary, disappearance of those tumours after death, 

 &c., and be developed concurrently with or so that only slight traces of them are found 



on post-mortem examination. 



At the commencement the papillae are 

 single and close-set, so that the surface, as 

 mited in its commencement to the vaginal Clarke describes it, is merely granular. The 

 portion of the cervix, and presents the follow- peculiar cauliflower form is occasioned by the 

 ing principal varieties. It may appear under branching of the papillae, which ultimately 

 the form, of papillary growths, resembling con- form fringes an inch in length. After this 

 dylomata, which spring from the mucous sur- superficial process of growth has continued 

 face, and form little compact masses that for a certain time, cancroid alveolar spaces 

 gradually, by the growth and elongation of the begin to be formed at the base, between the 

 papillae, become soft, pulpy, and brittle, and fibrous and muscular layers of the organ. At 

 easily bleed on being touched. After a time first these appear as simple spaces, with 

 a basis of cancroid is developed in the cervical epithelial contents, but later are found alveoli, 

 tissues, or the papillary growth appears upon from whose parietes new papillae spring, 

 a larger scale, forming a hard, knotty, and which also become ramified, constituting 

 brittle mass, which grows with tolerable ra- arborescent proliferous growths, 

 pidity, and ultimately more or less fills the Corroding ulcer. Here may be noticed an 

 vagina or protrudes from the vulva. In form affection of the uterine cervix, whose exact 

 the growth often resembles a cauliflower, to pathological relations have not been deter - 

 which it was likened by Dr. John Clarke. The mined with sufficient accuracy. The corrod- 

 surface is of a bright flesh colour, and is ing ulcer, first described by Dr. John Clarke, 

 covered with small projections or granules, and compared by Rokitansky to a phagede- 

 These again are united into larger masses or nic (cancerous) sore of the skin, differs 

 lobes, set upon short and broad stems, that mainly from cancer in the absence of a cancer 

 ultimately coalesce into a common basis basis, or of cancerous infiltration of adjacent 

 formed by one or both lips of the cervix, tissues, while it resembles the destructive 

 The whole tumour has a certain firmness and march of cancer in its mode of gradually dis- 

 soiidity ; but the superficial granules are so integrating, and destroying the os and cervix, 

 brittle that slight handling causes some to and even portions of the body of the uterus, 

 break away, a free haemorrhage resulting. Or and extending to the bladder, rectum, and ad- 

 the cancroid, after being developed in and jacent structures. The characters of this 

 beneath the mucous membrane of the cervix ulcer are those of a ragged, irregular-margined 

 in the form of little granular masses, gradually sore, with a brownish or greyish base, from 



which issues a thick purulent or copious 



* Dr. West is, I believe, the only author who has ^atery secretion. The margins and base may 

 hitherto pointed out the true cause of this difference, be thickened by inflammation, but there are 

 f See case, p. 593. no granulations. 



consecutively to these. 



Cancroid. Epithelial cancer. Cauliflower 

 excrescence. Cancroid of the uterus is li- 



