A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
RELATIONS AND STRUCTURE.--These tumors grow from the muscular and
connective tissues of the uterus, and consequently partake of the
character of these tissues. Sometimes the substance of the tumor
consists principally of connective, at others of muscular, tissue. The
variations in the relative proportion of these two fibrous substances
constitute the main differences in the characters and appearances of
the tumors, and lead to the different terms applied to them, as
myomata, fibromata, myo-fibromata, etc. The firmer the tumor the more
connective tissue it contains. When we inspect, either ante- or
post-mortem, a uterus with a fibrous tumor attached or contained within
its wall, it will be found to present a much darker hue than natural.
Instead of the normal light rose-color, it is generally dark, sometimes
almost of a purplish tint. The time of menstruation makes some
difference; just before it is darker than soon after the menstrual
flow. The color also varies with the character and size of the tumor.
In large solid tumors the color is darker than in the large
fibro-cystic variety; indeed, in some of the latter the pearly color
strongly reminds one of an ovarian cyst. We cannot therefore depend on
the color or shape of surface for a diagnosis. Even after the abdominal
cavity is opened the contour of the uterus is usually not regular. If
we make an incision into the tumor, we find that it is surrounded by a
distinct capsule, which limits and defines its boundaries and separates
it from the adjacent substance. This envelope is not a cyst or other
form of membrane: it is continuous with, and inseparable from, the
muscular structure of the uterine walls. It, in fact, is a condensed
layer of the fibrous substance of the uterus. In cases of true encysted
tumors the cyst-wall is the generating portion of the growth. In
fibrous tumors of the uterus the growth produces the capsule by
displacing the surrounding substance in every direction, pressing it
strongly against the unaffected fibrous tissue and condensing it into
the smooth capsule. It is thus engendered in, and enveloped by, the
muscular walls of the uterus. These latter of course grow to dimensions
sufficient to keep pace with the increasing tumor. The growth may, as a
consequence of such a connection, be hulled out or enucleated, and will
not be reproduced. Inflammation or other degenerating processes may
occasionally cause adhesion of the capsule and tumor, but this is an
accident of uncommon occurrence. To understand this mode of
encapsulation we must remember that the uterine muscles are irregularly
stratified, {246} and that the tumors are developed between the strata
as between the leaves of a book, separating them sufficiently to gain
lodgment and room.
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