A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The operator should not be content with the removal of a few strips
or portions of the endometrium. He should remember that in the early
stages the disease may be confined to a small area, and, unless the
whole interior of the uterus is gone over, this area may be missed
by the curette, and only healthy endometrium may be removed for
examination. Such thorough curetting is of especial importance in case
the tissue removed should at first present no suspicious features upon
gross examination. All portions of the endometrium should be saved and
preserved as directed in cancer of the cervix.
The tissue should be submitted for examination to a person trained in
gynecological pathology. The recognition of the early stages of cancer
of the endometrium, and especially of malignant adenoma, requires the
training of the expert. If a positive diagnosis cannot be given from
the microscopic examination, the case should be carefully watched,
and if the symptoms continue, subsequent curetting and microscopic
examination should be made.
The =treatment= of cancer of the fundus is immediate complete
hysterectomy, with removal of the tubes and ovaries. Cancer has
recurred in an ovary after removal of the uterus. The hysterectomy may
be performed by the vaginal, the abdominal, or the combined method.
The ultimate results of hysterectomy for cancer of the body of the
uterus are exceedingly good. Statistics show about 75 per cent. of
permanent cures. Recurrence may be considered exceptional. In this
respect they are in marked contrast to the results after operation for
cancer of the cervix.
SARCOMA OF THE UTERUS.
Sarcoma of the uterus is a very rare disease. There have been but
few properly authenticated cases of this disease reported in medical
literature. All cases of this disease should be put on record.
There are two varieties of sarcoma of the uterus: diffuse sarcoma of
the mucous membrane, and sarcoma of the uterine parenchyma.
In =diffuse sarcoma of the mucous membrane= the endometrium is
infiltrated by round or spindle cells. Soft projections or tumors,
which may be villous, lobulated, or polypoid in shape, are formed upon
the mucous membrane.
The polypoid sarcoma may present at the cervix uteri. The disease
extends to the muscular coat of the uterus.
[Illustration: FIG. 130.--Diffuse sarcoma of the mucous membrane of the
uterus.]
In the later stages ulceration and disintegration of tissue occur.
The cervix is not involved by the disease.
The _symptoms_ of this form of sarcoma resemble those of cancer of the
fundus. There are hemorrhage, discharge, and pain.
The discharge is serous, and is less fetid than in cancer, as
ulceration takes place later in the course of the disease.
The cervical canal is patulous, and in the polypoid form the tumor may
be felt projecting into the cavity of the uterus or protruding from the
external os.
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