The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1903]
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Licence: In copyright

Credit: The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran. Source: Wellcome Collection.

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    lectures, has recently turned my attention to an example of “malignant fibroid” which he intends to report in full. Most unfortunately the patient died after the operation, which was performed by an experienced surgeon. Two points of interest must be noted in respect to this case. Firstly, the tumour consists of large well-circumscribed growths, purely sarcomatous in the midst of a pure myoma, so that it is not certain that it corresponds with Ulesko- Stroganowa’s cases. Secondly, what is yet more important for our purpose, I cannot see how the operator could have taken the fibroid for a malignant growth. Had the patient lived of course malignancy would soon have been manifest in the remains of the cervix. But then the case would have been an argument, 1 admit, in favour of panhysterectomy, but not an example of malignant disease developing in a stump of which the tissues were healthy at the date of the hysterec- tomy. I turned attention to this source of fallacy in relating Menge and Stone’s case. The same must be said of Dr. Herbert Spencer’s cases read at the Manchester meeting of the British Medical Association last August.21 In two cases of retro-peritoneal hysterectomy the tumours were indis- tinguishable from fibroids and were not known to be sarcomata until some months after removal ; the patients ultimately died with secondary masses in the pelvis. This experience is no doubt a plea in favour of panhysterectomy, but there was no sarcomatous degeneration of the stump of a previously healthy cervix. It is remarkable that one operator should have had two cases of so rare a disease as sarcoma of the uterus with full clinical proof of malignancy within a very few years. Thus there is such a thing as malignant fibroid and it must be taken into account in association with degenera- tion of the stump. We must further grant that a malignant fibroid is a sarcoma. Cancer of the fibroid uterus means carcinoma of the uterus coincident with a myoma, a grave complication to be duly borne in mind in association with the carcinoma of the stump which we must now consider, but a “cancerous fibroid” is not clinically any more than patho- logically the same thing as a true sarcoma of the uterus developed from muscle cells or their elements. Having duly weighed all these considerations about sarcoma, we are at length free to discuss cancer of the stump of the cervix, true carcinoma, which has undoubtedly been observed after retro-peritoneal hysterectomy. The most interesting summaries of clinical evidence which have recently appeared are to be found in Thumim’s monograph on the operative surgery of the gravid uterus22 and in a discussion held this year at the annual meeting of the American Gyntecological 21 Total Abdominal Hysterectomy (especially by Doyen’s Method) for Fibro-Myoma Uteri, Brit. Med. Jour., Oct. lith, 1902, p. 1131. 22 Chirurgisehe Eingriffe bei Myomen der Gebarmutter und Schwan- gerschaft und Geburt, Archiv fiir Gyniikologie, vol. lxiv., p. 457. F