Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1905
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Licence: Public Domain Mark

Credit: Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    of cancer of the body of the uterus. It is of interest as showing the first stage of cancer beginning in the glands, when no change except multiplication of the epithelium is recognisable, typical carcinomatous cells not yet being present. The Differential Diagnosis must be made from— Portions of retained placenta, Sloughing submucous-fibroid, Heemorrhagic endometritis, Deciduoma malignum. During the period of sexual activity, differential diagnosis is often difficult, and can be made only by exploring the uterus with the finger, and microscopic examination of the tissue removed. After the meno- pause, the recurrence of haemorrhage is an important diagnostic. The microscope is, when available, the most reliable guide. TREATMENT. As to the treatment of the symptoms, this is the same as in Car- cinoma of the Cervix (v. Chap. XLIL). As to the treatment of the disease, the scraping away of the polypoidal masses with the curette or sharp spoon gives temporary relief from the haemorrhage and discharge. The only hope of cure lies in extirpation of the uterus (v. p. 503). The results of hysterectomy are better, as regards non-recurrence, for cancer of the body than for that of the cervix, 56 p. c. of the former being without recurrence as against 20 p. c. of the latter (Cullen). Adenoma Malignum.—It is doubtful whether malignant adenoma should be considered as an affection distinct from carcinoma of the uterus.1 It usually affects the body of the uterus; being, unlike carcinoma, rare in the cervix.2 Its clinical history closely resembles the latter, and the pathological appearances are not clearly marked off —adenoma passing into carcinoma. There is an atypical hypertrophy, the lumina of the glands becoming enlarged, irregular, and often com- municating with each other. The columnar epithelium loses its cilia and becomes stratified, and the gland may be converted into an epithelial plug. It occurs late in life, begins insidiously, and runs a chronic course. While haemorrhage is present, there is not the foetid discharge so characteristic of cancer. Cases have been described by Matthews Duncan3 and more recently by Landerer,4 Beyea,5 and Sinclair.6 1 At the discussion on this subject before the Berlin Gynecological Society opinions were divided ; while Hofmeier advocated the distinction, Leopold maintained that the term adenoma can mean only a benign glandular formation; as soon as the glandular development is atypical, it ceases to be an adenoma. Cent. f. Gyn., 1891, S. 438-440. 2 Gebhard could collect only 6 cases in which the cervix was affected : Zeits. f. Geb. u. Gyn., Bd. xxxiii., Hft. 3. Other cases have been recorded by Krukenberg (Monats. f. Geb. u. Gyn., 1S97, Bd. 5, S. 13S) and Cullen (Cancer of the Uterus, p. 304). 3 Quoted by Williams, op. cit., p. 100. 4 Eine Adeno-carcinom des Corpus Uteri : Zeits. f. Geb. u. Gyn., Bd. xxv., 1S92. 5 Malignant Adenoma of the Corpus Uteri: Amer. Jour. Obstet., Vol. xxxiii., 1S96, p. 190. ti Loc. cit.