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ough curetting. Sometimes the change in the body of the uterus is so marked after amputation of the cervix, or even after trachelorrhaphy, that a condition of superinvolution, or uterine atrophy, results.

SUPERINVOLUTION OF THE UTERUS.

Superinvolution of the uterus is a disease the reverse of subinvolution. In this condition the uterus, after childbirth or abortion, not only undergoes the normal involution, but continues to atrophy until the length of the uterine cavity may measure but one and a half inches. The atrophy involves the neck as well as the body of the organ, the Fallopian tubes, and sometimes the ovaries.

Superinvolution of the uterus is a rare condition. The cause is difficult to determine. It has been attributed to great loss of blood at confinement, to prolonged lactation, and to pelvic peritonitis occurring during the puerperium.

Amenorrhea is the most marked symptom of superinvolution. Nervous disturbances and hysterical symptoms. may also be present.

The diagnosis is easily made from the history of the case and by means of bimanual examination and the use of the sound. Congenital malformation may be excluded from the fact that a pregnancy has occurred, and senile atrophy from a consideration of the age and history of the woman. The treatment should be directed to restoring and maintaining the general health of the woman. Iron and the remedies useful in other forms of amenorrhea may be of advantage.

CHAPTER XIX.

CANCER AND SARCOMA OF THE UTERUS.

CANCER OF THE BODY OF THE UTERUS.

CANCER of the body of the uterus is a rare disease in comparison with cancer of the cervix. The older statistics-those of Schroeder-appear to show that the disease begins in the body of the uterus in about 2 per cent. of

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This percentage, how

all cases of cancer of this organ. ever, is probably much too small. Cancer of the body of the uterus is by no means an infrequent disease; it is a disease for which the physician should always be on the watch.

Cancer of the body of the uterus originates in the epithelial structures of the endometrium. It may first appear on the surface of the endometrium or deeply in the utricular glands.

The gross appearance of the disease varies as does cancer of the cervix or of any other part of the body.

Cancer of the uterus may begin upon the surface of the endometrium as a superficial ulceration, as a uniform swelling of the mucous membrane, as a polypoid or papillary projection, or as a large cauliflower-like mass projecting into the uterine cavity.

When the disease begins in the utricular glands, it may form nodules throughout the body of the uterus.

These

[graphic]

FIG. 126.-Nodular form of cancer of the body of the uterus.

nodules are of various sizes, from that of a pea to that of a hen's egg. They grow rapidly. They may be submucous and project into the uterine cavity, or they may project beneath the peritoneal covering, giving the uterus an irregular nodular appearance (Fig. 126).

In the later stages of the disease the whole body of the uterus becomes infiltrated. The endometrium is destroyed. The cancerous masses ulcerate and break down. The peritoneal covering is for a certain time a barrier to the extension of the disease. In many cases

the whole of the body of the uterus may be infiltrated with cancer, and yet the peritoneum will remain intact. The accompanying illustration (Fig. 127) shows this: the infiltration extends to, but does not involve, the peri

toneum.

Later, however, the peritoneum, the Fallopian tubes, and the ovaries become involved. Intestinal adhesions

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FIG. 127. Cancer of the body of the uterus: a large single cancerous nodule (c) in the anterior wall has been divided.

are formed, and the disease may extend throughout the abdominal cavity. The cervix and the vagina may be attacked by extension from above, though, on the other hand, the disease may progress sufficiently to destroy life, and yet the cervix may remain unaffected.

Metastasis may take place by way of the lymphatics. Extension by metastasis, however, is unusual.

Cancer of the body of the uterus occurs at a somewhat later age than cancer of the cervix. The average age is between fifty and sixty. The disease attacks both the parous and nulliparous woman, the latter perhaps more often than the former.

The causes of cancer of the body of the uterus are unknown. It is probable that the various forms of endometritis, by diminishing the resistance of the endometrium, predispose to the development of cancer. It has been maintained that fibroid tumors of the uterus, as a result of the accompanying alterations in the endometrium, predispose to cancer. Cancer of the endometrium is certainly not infrequently found in uteri containing fibroid tumors.

[graphic]

FIG. 128.-Malignant adenoma of the body of the uterus (Beyea).

Malignant adenoma is a disease of the utricular glands which has been classed by some writers as a distinct disease, by others as a form of carcinoma. In it the glandspaces are much enlarged, irregular, and joined to other gland-spaces. The columnar epithelial cells often fill the whole of the gland-space (Fig. 128). The cells,

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