ment. All of them were lined with a typical cylindrical epithelium, the cells of which were opaque, fatty or in process of degeneration, and filled the cavity like a mass of mucus. In the smallest of the cavities the distension caused by the growth of the tumor had flattened the cells until they resembled those of the uterine glands during pregnancy; or they were in a con

dition of excessive proliferation and contained two or three nuclei. The stroma of the tumor consisted of very delicate fusiform cells, or plaques of cells resembling those of the normal uterine mucous membrane. There were a few large vessels in the tumor. The wavy, uneven surface was apparently covered with cylindrical epithelium.

FIG. 60.

I recently requested my assistant, Dr. Overlach, to make another careful examination of the tumor, which revealed the

following interesting facts. First, it was found that the surface was not covered by simple cylindrical cells, but by cells which were identical with the so-called metatypical epithelium of ovarian cysts, described by Malassez and Sinéty. This circumstance increased the similarity of the tumor to an ovarian cyst. The cells are characterized by their marked globular or pear-shaped body, which terminates in a thin pedicle, and contains a very large round nucleus. They all seem to be distended, are placed in layers, one above the other, but, instead of forming a smooth uniform superficial stratum, some of the round bodies project. Pro

FIG. 61.

fessor Ackermann found such cells in a glandular polypus of the anterior lip of the uterus, which I had previously extirpated.*

In the diverticuli between the vesicles as well as in the larger and smaller cysts themselves, there was very large, elevated, ciliated, cylindrical epithelium 0.003 millimeter in diameter (fig. 61). These cells are identical with the striking club- and flaskshaped epithelium of the inner surface of the cervix (see page 348), and of the large, irregular, acinous cervical glands. The nuclei were arranged in a row but situated in various parts of the cells. Many were ruptured at the ciliated end, and discharged a

* Virchow's Archiv, Bd. xviii.

tenacious, transparent secretion which formed the contents of the small cysts.

The proper tissue of the tumor was likewise of two kinds: While the inter-tices of the cells and the diverticuli consisted of compact, round and fusiform cells, with a clear intercellular substance and a few broad strands of fibrillated connective tissue (fig. 62), nearer to the surface, and under the metatypical epithelium there were large and small cells which showed a reticulated structure, in that innumerable delicate, branched threads anastomosed and crossed each other in every direction, thus forming numerous cavities bounded by the filaments. These cells were most abundant in the papillary excrescences of the surface. This

extremely fine and delicate network of minute filaments was traversed by a few coarser, wavy strands. In the direction of the coarser strands and at their intersections there were isolated, large round cells, which seemed to be the only nucleated formations of this tissue (fig. 63).

If the tumor be named from this, we must first assert that it is an adenoma, and, indeed, of the acinous cervical glands. The proof is in the fact that the real cysts are lined with the characteristic large, club-shaped, ciliated cells, and also in the peculiar clear, cellular contents and the anastomotic connections of the cells with one another.

In this respect the tumor is very different

from those described by Thiede, Rein and Spiegelberg. It is, however, closely related to Spiegelberg's by the sarcomatous degeneration of its stroma, while in other respects it is similar to the myxoma described by Rein, though it contained no cartilage. The most appropriate name is doubtless adeno-myxo-sarcoma cervicis, the adenoma being the primary condition, which later passes into myxomatous degeneration. It is certainly a rare combination of malignant elements. It represents a transition from epithelioma to sarcoma, and conclusively proves that our knowledge of malignant diseases of the vaginal portion is by no means complete.

2. SARCOMA OF THE UTERUS.

Pathological Anatomy.-Sarcomata of the uterus which are classified as mucous, muscular and peritoneal, originate in

Diffuse Sarcoma of the Mucous Membrane. Section of anterior wall.
Lig. rot., round ligament; Blase, bladder.

the interglandular tissue of the uterine mucous membrane, from the inter-muscular and subserous tissue, and finally, from the peritoneal coat of the uterus. The mucous form may begin in the cer

vical walls. Winckler has collected the statistics of all the known cases of this class. In addition to the adeno-sarcoma of the cervix described in the foregoing chapter, I have extirpated a similar tumor of the anterior lip. It was as large as a walnut and was composed of small cells. Sarcoma may appear on the cervix in a form similar to a cancroid papillary tumor.

It is more common in the mucous membrane above the cervix. Here it forms knotty, villous prominences which grow towards

the cavity and protrude through the internal os. They may also penetrate the uterine walls, pass to adjacent organs and even perforate the abdominal walls and appear at the surface.

Sarcoma of the uterus which does not originate in the mucous membrane may come from an existing myoma, the most common condition, whether the tumor be interstitial or submucous. As a rule, the round or fusiform cells do not lie upon the periphery, but either near, or exactly in the centre of a mass of muscular tissue which forms a capsule about them; this fact is of significance with respect to the extension of the growth. When it has grown through its envelope, metastases occur through the agency of the