_Treatment of the Fibroid Polyp._--When the fibroid tumor is polypoid, and projects into the uterine cavity, or the cervix, or beyond the external os, none of the operations that have just been described are required. The tumor should then be attacked by way of the vagina. If the fibroid polyp projects from the external os, the pedicle may very easily be divided with curved scissors. If the tumor is still within the cavity of the uterus, it will be necessary to dilate the cervix, or to enlarge the canal by lateral incisions, so that the pedicle may be reached. It should always be remembered that the polyp may, by traction, produce partial or complete inversion of the uterus (Fig. 134), and in dividing the pedicle, therefore, the operator should cut close to the tumor, leaving, if necessary, a portion of the surface of the tumor. In case the polyp is so large that the vagina is filled to such an extent that the pedicle is not accessible, it is advisable to remove the tumor piecemeal, grasping portions with a tenaculum and cutting away with scissors until the pedicle is reached. The fibroid polyp is not vascular, and hemorrhage is not alarming. The pedicle usually contains no large vessel. It retracts after the tumor has been cut away, and spontaneous hemostasis is secured. It was formerly the custom to ligate the pedicle or to remove the polyp with the écraseur, but these methods are unnecessary. If any hemorrhage should follow the operation, the cavity of the uterus should be packed with sterile gauze. =Adenomyoma= is a rare form of myoma of the uterus, which contains epithelial canals of the glandular type. Unlike the common fibromyoma, this tumor has no connective-tissue capsule and its structure cannot be well differentiated from the tissue of the surrounding uterine wall. Adenomyomata are of two varieties: in one variety the epithelial canals seem to be derived from the utricular glands; in the other from the embryonal remains of the Wolffian body. In the first variety the tumor is situated in the posterior, anterior, or lateral uterine wall, and has the usual characteristics of a fibromyoma, except for the presence of glandular structures and the absence of a capsule. Adenomyomata, which are derived from the Wolffian body, develop in the posterior portion of a uterine horn, or less often in the tube, and when small, in the peripheral layers of the muscular wall. The tumor may afterward become interstitial or submucous. These tumors are of various degrees of hardness. They may be dense in consistence, in case the muscular tissue is in excess of the glandular, or they may be soft cystic tumors containing numerous distinct macroscopic cavities. Telangiectatic adenomyomata also occur. The _treatment_ of adenomyoma of the uterus is hysterectomy. CHAPTER XXI. HEMATOMETRA; HYDROMETRA; PYOMETRA.