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
Catalogue details

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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    Vagina was filled with downward growing sarcomatous polypi and infiltration of the cervical stump and vault. The growth was continuous with that in the abdomen. Diagnosis. Extensive sarcomatous lesion. Operation. The vault and shell of dilated cervix were cleaned out digitally and radium was placed in situ, 50 mg. for 30 hours, equaling 1500 milligram-hours. Pathologic Report. Microscopic sections show a widespread cellular structure composed of small, round, and spindle cells, showing numerous mitotic figures. There are numerous small blood vessels in the tissue. The growth corresponds to that seen in previous sections, taken in 1929, except that there are no large vessels involved. Corrected Diagnosis. Small round-celled sarcoma; metastatic growth in the vagina. Again the patient would not submit to deep-x-ray treatment owing to some deep-seated prejudice. No one could fathom her dread of it. She disappeared again and re-appeared in May 1932, that is, 13 months later. Her general nutrition was excellent, and her color good. Her functions were normal, except that she now had a mass in the right lower abdomen the size of a small rugby football, insensitive, hard, and fixed. The right leg was three times the size of the left leg about the thigh, and the ankle was as big as her left thigh. She could barely walk, except by dragging the leg along. She was now suffering a great deal of pain, both in the abdomen and down the leg, and she had lost a great deal of weight but not her cheerful disposition. She finally submitted to our combined pressure for the use of x-rays. Frankly it was not expected that it would accomplish much. She wanted to be operated upon, but accepted assur¬ ances that operation could not promise anything but futility and danger. Dr. Howard Pirie began treatment on May 10, 1932, and ended on June 7, 1932, giving 11 treatments in all, a total number of 2.75 hours. Type of treatment: 5 Ma., 200 K.V., 15 inch dis,, time 15 minutes. The change was almost instantaneous. Within two months the growth was barely palpable as a small induration in the right lower quadrant, the vagina and cervix presented nothing abnormal, and on bimanual examination there was some induration in the right fornix which may connect with the induration in the abdomen, though this cannot be definitely determined. But what impressed the patient and her friends most is that her right leg is now the equal of the unaffected side. At this date, 7.5 years after the x-ray treatment, she is in radiant health, and there is no evidence of any recurrence or metastasis. The above was written in 1939. At that time a re-study of the slides of the case showed numerous emboli in the broad ligament, lymphatics,