It is probable that fibro-sarcoma usually, if not always, originates in a benign fibroid tumor. In the early stage of the disease the microscopic appearances of fibroid tumor are present, and the transition from the benign to the malignant growth may be studied.
Symptoms.—The symptoms of this form of sarcoma resemble at first those of fibroid tumor; they are—hemorrhage in the form of menorrhagia; a serous, non-odorous discharge; and a moderate degree of pain.
Later, when ulceration and disintegration take place, the hemorrhage becomes more profuse and continuous. The discharge becomes fetid, and contains broken-down sarcomatous tissue. The pain becomes more severe. The uterus is enlarged, and the nodular outline may be determined by palpation.
Before metastasis has taken place the differential diagnosis between sarcoma and benign fibroid tumor can be made only by microscopic examination of the discharge or of curetted or excised portions of tissue. The duration of sarcoma of the uterus is about three years.
Sarcoma may occur at almost any age. Hysterectomy has been performed for this disease in a girl of thirteen. Several cases have been reported under twenty years of age. The most usual period is about the time of the menopause, in the decade from forty to fifty.
The treatment of sarcoma of the uterus is immediate complete hysterectomy. If in the early stage a positive diagnosis cannot be made between benign fibroid and sarcoma, the woman should not be exposed to the dangers of waiting, but the uterus should be immediately removed.
Chorio-epithelioma or syncytioma malignum is a rare and peculiar malignant growth of the uterus which occurs after pregnancy. It originates at the placental site from the epithelial cells covering the chorionic villi. It occurs during the course or after the termination of a uterine or tubal pregnancy. In typical cases the disease immediately follows labor at term, abortion, or a destroyed extra-uterine pregnancy. It may, however, remain latent for weeks or months.
The tumor may be a nodular or pedunculated outgrowth attached to the uterine wall; a fungoid growth from the endometrium; or an intramural growth covered with endometrium. The tumor varies in size from that of a cherry-stone to a mass several inches in diameter. It is composed of soft fragile spongy tissue, light or dark red in color, infiltrated with blood, and containing circumscribed hemorrhages. Histologically the tumor consists of many types of cells irregularly placed; syncytial tissue, cells derived from Langhans’ layer, and sometimes chorionic connective tissue. There are numerous cavities containing blood and connective tissue.
Metastatic growths have a similar structure. Metastasis takes place through the vascular system and may reach distant organs—the lungs, liver, and spleen.
Symptoms.—There is no characteristic symptom of chorio-epithelioma. The chief symptom is irregular or continuous hemorrhage from the uterus following a labor, an abortion, or an extra-uterine pregnancy. The body of the uterus is enlarged, and the cervical canal dilated as in cancer and sarcoma. A positive diagnosis can be made only by microscopic examination of tissue removed by the curet.