A case of primary adeno-carcinoma of the Fallopian tube / by Elizabeth Hurdon.

  • Hurdon, Elizabeth, 1868-1941.
Date:
1901
Catalogue details

Licence: In copyright

Credit: A case of primary adeno-carcinoma of the Fallopian tube / by Elizabeth Hurdon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    LIPO-MYOMA OF THE UTERUS/ By J. H. Mason Knox, Jr., Ph. D., M. D. Clinical Assistant in Gynecology, The Johns Hopkins Hospital Dispensary. Although fatty tumors are frequently found in many parts of the body, the presence in the uterus of a new growth, con- sisting in large part of adipose tissue is so rare as to lend some interest to the report of the following case: The patient was a woman, aged 62, married, and the mother of thirteen children, the youngest 24 years of age. The labors had all been natural. She had had three miscar- riages, the last twenty-six years before. Her menstrual his- tory had been perfectly regular and normal. The menopause occurred twelve years previously. The family and personal history was excellent. She had always been in good health. The first indication of any abnormality occurred nine years ago, when the patient noticed a slight serous vaginal dis- charge. This passed away after some weeks and did not affect her general health. The discharge returned after an interval of over eight years, but, again lasted but a short time, and was accompanied by no untoward symptoms. For two weeks before examination she had been bleeding moderately, but continuously. The discharge has never been offensive. On only one occasion did the patient suffer when she complained of a sharp pain like that during labor. Her appetite was good and the bowels were regular. There was slight in- creased frequency of micturition. The patient thought that eke had gradually lost in weight. Tim heart and lungs were, normal. On abdominal and vaginal examination a large firm tumor was found connected with the uterus, filling the pelvis and extending almost to the umbilicus. Operation was advised and performed by Dr. H. A. Kelly and a large mass, includ- ing the uterus and appendages, was removed by the supra- vaginal route. The tumor was not densely adherent, and the operation presented no unusual difficulties, except for rather free haemorrhage, which was finally perfectly controlled. The patient made a slow but satisfactory recovery and is at present, eighteen months after the operation, in fair health. During the operation and indeed for some time afterward there was no suspicion that the mass did not consist of a simple large myomatous uterus. It was only in the routine examination of the specimen in the laboratory that its un- usual structure was discovered. Hence it is to the patho- logical description that most interest attaches. Pathological description (Gyn. Path. No. 3703).—The speci- men consists of a uUrus involved in a large tumor, both Fallopian tubes, a portion of the left ovary, and a cystic right ovary. The uterine mass is globular in form, regular in outline and approximately 15 cm. in length, 14 cm. in breadth and 18 cm. in its antero-posterior diameter. The surfaces are generally smoothly covered by peritoneum. On the left side, however, above the attachment of the tube, the surface is roughened by numerous tags of adhesions. The *Read before the Johns Hopkins Hospital Medical Society, March 18, 1901. tumor is firm and resilient in consistency. The uterine cavity is about 14 cm. in length. The mucosa of the anterior wall is glistening and is hardly 1 mm. in thickness. It is everywhere intact. That covering the posterior wall is much altered on account of the tumor which projects into it from behind. In some places many minute cysts are scattered throughout the mucous membrane, some of them being 2 mm. in diameter. In the uper part of the cavity is an area 4 x4 cm., irregular in outline, sharply defined and very pale in color. At this point the mucosa is excessively thin and the tumor in the posterior wall almost comes in direct contact with the uterine cavity. In the lower part of the cavity is another pale area 9x9 cm. Here the mucosa is also thinned out but at numerous points it is still preserved, as witnessed by the small cyst-like spaces—dilated uterine glands. Sit- uated in the upper part of the cavity is a sessile polypoid thickening 5 x 2 J cm. Here the mucosa varies from 1-7 mm. in thickness; some of the glands here are 1.5 mm. in diameter. The anterior uterine wall varies from .8 to 1 cm. in thickness and presents no abnormality. Occupying the posterior wall is a tumor mass somewhat globular in form (Fig. 1). It is approximately 10 x 13 x 10 cm. in size. On section the tumor to casual examination presents the appearance of mvoma. but on more careful scrutiny is found tu be markedly different. Traversing it in all directions are glistening bands between which are yellow soft looking areas. On scraping the cut surface distinct oil globrdes can be brought away, a thing that is never possible when an ordinary myoma is exam- ined. The tumor itself presents no areas of breaking down. It is sharply defined from the surrounding uterine muscle, which varies from 3-5 mm. in thickness. At the point where the mucosa is pale-staining the tumor encroaches upon the uterine cavity to a marked extent and the mucosa here shows much atrophy. Appendages.—On the right side the Fallopian tube is ap- proximately 12 cm. in length, normal in consistency, and presents a uniform diameter of about 4 mm. Its surface is everywhere roughened and the fimbriated extremity is densely adherent to and occluded by the large ovary about to be described. The ovary is converted into a tabulated mass, partly cystic, partly firm. The mass is somewhat bean shaped in outline and measures 8x5x4 cm. The inner pole is quite hard in consistency and on section is seen to be made up of dense fibrous tissue. The harder portion merges into a small multilocular cyst which has a smooth, glistening surface with thin walls, and contains an iridescent yellowish fluid. The cystic portion is divided into loculae of various shapes and sizes by firm trabeculae. The several small pedunculated masses project into the cavity of the cyst.