Fibrous and Sarcomatous Tumors.
Fibrous or fibroid tumors are by no means as common in the vagina as in the uterus. It has been observed that they are frequently but not invariably associated with the latter. They are developed in the muscular or fibrous structure of the vagina in the same manner as similar formations in the muscular tissue of the uterus.
Some authorities assert that they frequently have the point of departure from the uterus, and then descend little by little between the walls of the vagina.
Sarcomatous tumors are developed in the same tissues and similarly to fibrous growths of the vagina. They are, however, of less frequent occurrence. They sometimes appear primarily in the vagina, but more frequently are consecutive to sarcoma of the uterus.
It is a difficult and often impossible task to make out the differential diagnosis of sarcomatous and fibrous growths in the vagina except by means of the microscope. The symptoms of each are similar to those which indicate sarcomatous and fibrous growths of the uterus, it being accompanied by profuse leucorrhoea, more or less sanious, and occasional hemorrhage. If tumors acquire much size, they interfere with the functions of the rectum and bladder, and cause pain and discomfort by their pressure in the pelvis; sexual intercourse is difficult, frequently painful, and followed by a flow of blood.
DIAGNOSIS.—If of a large size, diagnosis is easily made. Uterine tumors and prolapsed uteri have been mistaken for vaginal growths. By using a uterine probe and inserting a finger in the rectum there need be no error in these respects. By careful examination there is little difficulty in diagnosis.
TREATMENT.—This consists of removal by the knife, scissors, écraseur, or galvano- or thermo-cautery. If there are reasons for believing that a tumor is sarcomatous, it is important that every particle be removed. For this purpose scissors or the galvano- or thermo-cautery are preferable to the ordinary écraseur, which by its action crushes and bruises tissues, and is liable to draw into the chain or wire and crush off more than the operator desires. Serious accidents, such as opening into the peritoneal cavity or the bladder, have occurred in this way in the practice of distinguished and experienced surgeons.
Papillary growths and vegetations in the vagina will receive merely a brief allusion, as they are rarely seen even in the practice of gynecologists. They are not commonly limited to the vagina, but are of more frequent occurrence about the vulva and on the cervix uteri. Vegetations of considerable size sometimes develop in consequence of pregnancy or of granular vaginitis. Sometimes papillary growths within the vagina assume a cauliflower shape with well-defined stalks, or about the ostium vaginæ they may take the form of condylomata. These formations may be confounded with epithelioma.
Treatment consists of removal by scissors or with the thermo- or galvano-cautery, and to guard against hemorrhage some styptic and a vaginal tampon will be required.
Cancer of the Vagina.