Gangrene is most liable to occur in the fibroid polyp. During the process of expulsion from the uterus the vascular supply through the pedicle becomes impeded, so that there is not sufficient blood for nutrition. The tumor is exposed to septic infection through the vagina and the cervix, and sloughing and suppuration occur. As a result of such disintegration the tumor may be discharged piecemeal.
Inflammation, and occasionally suppuration, of fibroid tumors remote from the cavity of the uterus may occur from infection through the intestinal tract or other channel.
Necrobiosis occurs if the nutrition of the fibroid is cut off and there is no infection of the dead tissue. The tumor becomes soft, undergoes fatty degeneration, and liquefies. The necrobiotic degeneration may involve only part or all of the tumor. There is always danger of septic infection occurring in this form of degeneration.
Sarcoma may develop in a fibroid tumor of the uterus. As has already been stated, the “circumscribed fibroid sarcoma,” or sarcoma of the uterine parenchyma, is thought by some authorities always to originate from degeneration of a benign fibroid tumor. It seems probable that the fibroid tumor predisposes the woman to the development of sarcoma of the uterus.
Cancer may also occur in the endometrium of a fibroid uterus. This occurrence is by no means an unusual one. We cannot yet say positively that the fibroid favors the development of cancer, but it seems probable that the diseased endometrium that accompanies fibroids furnishes a place of diminished resistance for the development of malignant disease.
Martin has made an interesting analysis of 205 cases of fibroid tumor of the uterus that had been submitted to operation. From this analysis we may form some estimation of the frequency of the various forms of degeneration that have been described.
Fatty degeneration existed in 7 cases. Calcification was present in 3 cases. In 10 cases there was suppuration, and this process was found in the submucous, interstitial, and subperitoneal tumors. In 11 cases there was extensive edema of the fibroid. In 8 cases the tumors had become cystic.
The telangiectatic change was found to a marked degree in 3 cases.
Sarcomatous degeneration had occurred in 6 cases.
In 7 cases the fibroid was complicated with cancer of the fundus uteri, and in 2 cases with cancer of the neck of the womb.