A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall.

  • Goodall, James Robert, 1877-1947.
Date:
1943
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Licence: In copyright

Credit: A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall. Source: Wellcome Collection.

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    Cervical and uterine endometrioses, owing to the absence of character¬ istic symptoms, are also usually found only when examination is under¬ taken. Cervical endometriosis is, of course, secondary to uterine endo¬ metriosis by extension into the fibromuscular tissues of the cervix. There are no symptoms arising out of this extension, but the cervical dimensions may be increased, though this is due rarely to the invasion but rather to the concomitant enlargement of the cervix under the stimulus that engenders the endometriosis. Leukorrhea, cervical mucous polypi, endo- cervicitis with ectropion, and precancerous overgrowths are common results of endometriotic stimulation, and symptoms may arise as results of these pathologic changes. Uterine parietal endometriosis is a very insidious disease for two reasons: (1) because the uterus is insensitive, and (2) because this infiltration of its wall by basal endometrium does not respond to the hormones of the menstrual cycle. The disease is seldom diagnosed before operation, and can be confirmed only by biopsy. There are all grades of infiltration. In the major types there is enlargement of the uterus either symmetrically or asymmetrically, but enlargement, of itself, is insufficient evidence to diagnose endometriosis, because so many other causes may produce a like condition. Mobility of the uterus is not inter¬ fered with except in the advanced cases where the disease has spread beyond the confines of the uterus into the parametrium. Endometrial endometriosis may reach large dimensions, on palpation simulating an early pregnancy. Recently I operated upon a case of single fibroid with old endometriosis of both ovaries, and an endometrial intra-uteri ne polyp measuring two inches long, one-half inch thick and one and one-half inches broad. The uterine wall was, in places, two inches thick, vascular and soft, closely simulating a complicated pregnancy. The polyp was composed almost exclusively of active stroma cells. Hemorrhage was the dominant symp¬ tom. Usually the menstrual flow is more abundant than normal, but any derangement of the rhythm is due, not to the endometriosis, but to the endocrine imbalance. In ovarian endometriosis we come upon grounds of frequent involve¬ ment with more definite diagnostic signs. The symptoms of ovarian endometriosis are circumscribed. As a rule there is no disturbance of either the rhythm or the duration of the menstrual flow. When these occur it has been almost invariably possible to trace them to complica¬ tions or to extrapelvic causes. The outstanding symptom of this type of disease is pain. This is of two types: premenstrual and menstrual. They require some elucidation. Premenstrual pain, as the term implies, is pain before the onset of the flow. It may antedate menstruation for a week and is nearly always