+

F. Wash antisepticelly daily.

G. In a few weeks, cystitis is cured and opening

can be closed.

Fibroid Tumors of the Uterus.

CAUSES: Not known positively.

PATHOLOGY:

I. Develop during actual menstrual life, usually about the age of 30.

2.

3.

4.

5.

Always grow from parenchyma, no matter what variety.

If fibrous tissue predominates, it is a fibromaand hard. If muscular tissue predominates, it is a myoma and softer.

If fibrous and muscular tissues are about equal, it is a myo-fibroma.

6. Non-malignant.

7.

Often have malignant disease associated. 8. Grow front any part of uterus.

VARIETIES:

I.

I.

A. Fundus and body more frequently.

B. Cervix less often.

Interstitial or mural, occupies body; all forms originate from this.

2. Sub-mucous, under lining mucous membrane, impinges on canal.

3. Sub-serous, under serous coat pushes, outward. 4. Intraligamentous, begins low down and separates folds of broad ligament as it grows from the side. INTERSTITIAL:

I.

Surrounded by loose cellular tissue, not closely connected with parenchyma; if adherent, due to inflammation and adhesions.

2. Easily shelled out.

3.

4.

Size varies from small nodules to involvement of entire uterus.

As they grow, are easily pushed to one or other surface, and may become sub-mucous or sub-serous, or remain as a simple bulging of walls. Fibroid enlargement, when whole uterus is involved. II. SUB-MUCOUS:

5.

Arises from the interstitial by growth inward.

I.

A simple bulging into canal.

2. Large and fills entire cavity.

3. Fibroid polyp, when situated in canal and attached to wall by a pedicle.

III. SUB-SEROUS:

Arises from interstitial by growth outward.

1.

Broad base.

2. Sessile base.

Predunculated, tumor external and attached by peduncle to uterus.

IV. INTRALIGAMENTOUS:

I. Grow most frequently in the folds of the broad liga

ment.

A. May grow to great size and lift up ureters

with it.

B. Be very careful in excising not to cut ureters.

2. May grow in vesico-uterine fold.

A. Often large size, which pulls up bladder with it and spreads it over its surface.

B. Be careful in opening to guard bladder.

3. Retro-peritoneal tumor, when grows from posterior wall of cervix and dissects under cul de sac of Douglas.

SIZE: Varies from small seed to 200 lbs. in weight.

GROWTH:

1.

Usually very slow:

2

May become very rapid, after years of slow growth.
A. Due to pregnancy.

B. Due to degenerative change, as cystic.

HARDNESS: varies.

1. Fibroma, hard.

3. Myo-fibroma has a tendency to bulge.

4. Deep red or pale color depends on distribution of blood.

STUDY OF EFFECTS:

I. On neighboring organs.

2. Changes in themselves.

A. NEIGHORING ORGANS:

I. Fallopian tubes.

I.

Inflamed, due to extension of endometritis, associat

ed with fibroid.

2. Occlusion, due to inflamation.

A. Exudate poured out and tube swells.

B. Swelling continues until fimbria turn in and agglutinate.

II.

3. Hydrosalpinx; tubes filled with water.
Hematosalpinx; tubes filled with blood.

5. Pyosalpinx; tubes filled with pus.

6. Dislocation may occur, adherence to other structures follow, may become lost and only recognized when tumor removed and tubes dissected off.

3. Flattened out by pressure against abdominal wall. III. Peritoneum.

I.

2.

Inflammation from friction, producing chronic peritonitis.

Adhesions of uterus to viscera, due to peritonitis. 3. Intestines adherent, due to peritonitis.

IV. Bladder, from pressure.

V.

I.

Retention of urine.

2. Tenesmus, especially with large fibroid in vesicouterine fold, which pulls up and spreads out bladder on its anterior surface.

3. Incontinence.

Rectum. Especially affected by retro-peritoneal fibroids.
Hemorrhoids from pressure on circulation.

I.

2. Mucous discharge.

Constipation, loss of sensitiveness.

4. Toxemia from absorption of toxines. VI. Ureters.

I. Fibroid nipping ureter between itself and bony pelvis.

2. Fibroid raising ureters on its anterior and upper surface.

VII. Kidneys.

VIII.

I.

2.

Structural changes.

Changes in pelvis of kidney due to obstructed flow. Heart. Small fibroids don't affect, large ones do.

1. Hypertrophy.

2. Degeneration, in advanced cases.

IX. Liver. Fatty degeneration, due to obstructed circula

tion.

Hypertrophic in character.

2. Danger of epithelioma from degeneration.

3.

Danger of sarcoma from irritation.

II. Inflammation of tumor.

I.

May cease; may effect whole mass, form pus and become gangrenous.

2. Probably due to cutting off blood supply, especially in large tumors.

A. A knuckle of gut adheres to tumor. Circulation interfered with, mucous membrane degenerates. Germ passes through intestinal wall into tumor and infects it.

B. Intrauterine interference, dirty sound or hand. III. Cystic degeneration.

IV.

V.

VI.

I.

Due usually to dilatation of lymph spaces. 2. Due occasionally to myxomatous change.

Cavernous fibroid, a variety of cystic, due to dilatation of blood spaces and formation of lakes of blood.

Fatty degeneration.

Myxomatous degeneration.

Calcareous degeneration-a deposit of lime salts in the tissues, especially in old women.

VII. Edematous.

Condition, same as in other parts of body.

2. Grow rapidly.

3. Large size.

PROGNOSIS.

I. As to effects on near and distant organs.

Interferes with circulation, heart hypertrophies.

2. May produce abortion.

3. May cause difficult or impossible labor.

4.

May cause sterility by changes in endometrium and

glands.

II. As to changes in tumor itself.

I.

2.

At menopause some change.

B. May atrophy.

A. May grow rapidly.
Menopause may be delayed by fibroid.

3. Usually no tendency to improve before menopause.

1. Menorrhagia is often first symptom of a fibroid.
A. This may progress into a metrorrhagia.

3.

It occurs with the different fibroids in frequency as follows:

I.

2.

3.

4.

5.

Due to pressure on vessels, viscera and nerves. Submucous occupies all or part of cavity of uterus and causes contraction.

General fibroid enlargement, densely hard, constantly presses on nerve endings.

Local peritonitis.

Adhesion of uterus to intestines or near organs causes pain on every movement.

6. Intraligamentous put everying on stretch and cause great pain.

7.

Increases at menses, the parts congested, inactive and more sensitive.

8. Headache, vertical or occipital shows pelvic trouble, but not distinctive of fibroid.

III. Results of mechanical pressure.

I.

The situation and not size of tumor does the damage; as a small one in true pelvis more injurious than one three times as large in abdomen.

Rectum.

A. Constipation from toxemia by absorption.
B. Hemorrhoids from obstructed circulation.
C. Feeling of fullness and weight.

Incontinence; carried up on tumor and capacity lessened.

C.

Tenesmus.

D.

3.

Ureters.

A. Nipped and hydronephrosis may follow, or degenerative changes in the kidney.

4. Lower extremities.

A.

Dropsy may result from obstructed circulation.

DEATH may arise from

3. Changes in remote organs, as heart, liver, etc. Changes in tumor itself, as inflammation, suppuration or gangrene.