A Case of Sarcomatous Degeneration of Uterine Leiomyoma with Metastases to Lungs and Heart

Abstract

As compared with carcinoma, sarcoma of the uterus is rare (about 1:50). It does not occur so rarely, however, that it may be disregarded. The following case is presented because of the unusual metastases to the heart. G. W., colored, aged sixty-four, was admitted to the hospital Dee. 21, 1930, complaining of indefinite abdominal pains and vaginal bleeding. The family and past history was irrelevant. The patient began to menstruate at twelve years, and up to the present illness had always been normal as to cycle and duration. She was married at the age of forty, and her husband had died ten years later. There had been no pregnancies. About ten years before admission the patient first noticed that her menstruation had become irregular. The irregularity had manifested itself first as menorrhagia and later as metrorrhagia. Four weeks before admission there had been rather profuse bleeding for twelve days, accompanied by slight abdominal pain. After several days the patient had again begun to bleed and had been bleeding intermittently until admitted to the hospital. There was a foul odor to the discharge. The patient complained, also, of weakness and loss of appetite. Physical examination showed a rather obese colored woman with short, gray, kinky hair. She had only two teeth; otherwise, eyes, ears, nose, and throat were negative. The chest was well formed, the heart showed no enlargement; there was a loud systolic murmur at the apex, which was transmitted to the left axilla, and there was a pre-systolic murmur in the second left interspace. Examination of lungs showed no dullness; the percussion note was good throughout. There were moist râles over both bases. The blood pressure was 174/80. An irregular, hard, nodular mass filled the lower abdomen. Vaginal examination was unsatisfactory because of a nulliparous outlet. There was slight edema of both ankles. The deep and superficial reflexes were present and equal. Examination of the urine showed albumen, one plus; no sugar; pus, one plus. The blood count showed red blood cells, 2,321,000; hemoglobin 35 per cent; color index .76; white blood cells, 9,200; polymorphonuclears 70 per cent; large lymphocytes 10 per cent; small lymphocytes 20 per cent. The red cells showed moderate achromia, marked anisocytosis, and poikilocytosis, and polychromasia. The Wassermann reaction was negative. Blood typing showed group 4. The provisional diagnosis was papillary cystadenoma of the ovary or multiple fibroids. An operation was thought advisable, but because of the poor condition of the patient, it was deemed wise to build her up before operating. On Feb. 2, 1931, she was given 500 c.c. of blood. She was given a second transfusion on Feb. 26, 1931, receiving 400 c.c. of blood. Many blood counts were done in the meantime, but these showed no appreciable differences. The patient continued bleeding and her general condition did not change much. On April 12 she had a profuse hemorrhage, following which she died rather suddenly.