A Text-book of Diseases of Women

by Charles B. Penrose

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 gland-spaces 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, however, never infiltrate the interstitial tissue, as in cancer. The muscular wall of the uterus appears to be destroyed by atrophy or by fatty degeneration.

The disease is malignant, it extends to the neighboring structures, and it destroys life. It presents, in the later stages, all the gross appearances and phenomena of cancer.

The symptoms of cancer of the fundus are hemorrhage, leucorrheal discharge, and pain.

Fig. 129.—Advanced malignant adenoma of the body of the uterus. A fibroid tumor (F) is in the fundus.

In women before the time of the menopause the hemorrhage may appear as a menorrhagia or a metrorrhagia, as an increase of the normal menstrual bleeding, or as a bleeding occurring at some other time than the normal menstrual period. Such irregular bleeding may be caused by any unusual effort.

After the menopause the hemorrhage may appear as a return of menstruation, occurring with more or less periodicity, and, as in cancer of the cervix, often contemplated with satisfaction by the woman. It may appear as a slight occasional discharge of blood, as a bloody streak in the leucorrheal discharge, as a spot upon the clothing, or as continuous hemorrhage. In the late stages of the disease there is a continuous discharge of blood.

The leucorrheal discharge at first resembles that of a non-malignant endometritis. It often begins as a gradual increase of a leucorrhea which the woman may have had for several years. It may be streaked with blood. In the early stages there is nothing at all characteristic about the discharge; later, however, it usually becomes very offensive, on account of the breaking down of necrotic tissue. It becomes more purulent in character, and brown in color from the presence of blood. In some cases of cancer of the fundus, however, the leucorrheal discharge remains light-colored and practically odorless throughout the whole course of the disease. It is sometimes thin and watery and exceedingly profuse, saturating many napkins during the day.

The pain of cancer of the fundus is not a marked symptom. It may be absent even though the whole body of the uterus be involved by the disease. When the peritoneum is affected, and extension takes place to other pelvic structures, the pain is much more pronounced. In other cases the pain may be present in the early stages, before the disease has extended beyond the endometrium.