GRANULOMA OF THE PUDENDA 223 



the labia majora, and backwards along the perineum, 

 surrounding and extending up the anus. In such cases, 

 where both the vagina and rectum are involved, incurable 

 recto- vaginal fistulae are common. The growth may 

 continue for many years, and the general health of the 

 patient is not affected. The lymphatic glands are not en- 

 larged, though there is evidence of lymphatic obstruction. 

 There is always a considerable formation of hard fibrous 

 tissue beneath the growth, and when healing occurs 

 naturally the growth is entirely converted into dense 

 fibrous tissue. Very rarely complete cicatrization takes 

 place ; more frequently it is partial and extension of the 

 growth at the edges takes place. Spontaneous healing 

 of the mucous surfaces does not take place. 



The diagnosis has to be made from other diseases of 

 the same part. On the penis it is frequently mistaken 

 for epithelioma. In the groin it may be mistaken for any 

 form of ulceration, syphilitic or otherwise. In the vagina 

 it is usually mistaken for chronic gonorrhoea. The 

 chronicity of the growth, the dense fibrous base, and the 

 absence of glandular enlargement are important points 

 in the diagnosis. In cases of doubt, microscopic 

 examination will exclude epithelioma. 



Prognosis as regards life is good. The growth is not 

 malignant. Natural cure is highly exceptional, and it 

 is only when complete removal of the growth can be 

 effected that recovery is probable. 



The most troublesome complications are stricture of 

 the meatus of the urethra, which can only be treated 

 effectually by amputation of the glans penis ; recto-vaginal 

 fistulae, which are not suited for operations, as the tissue 

 betxveen the rectum and vagina is mainly composed of 

 the growth ; and stricture of the anus with ulceration 

 of the lower part of the rectum. If the growth does not 

 extend too high, excision of the rectum gives good results 

 in the last complication. 



Pathological Anatomy. The growth is a vascular 

 granuloma. The cells are round cells with a single 



