Sarcoma of the uterus: With report of case of sarcoma botryoides

Abstract

S ARCOMA of the uterus is much Iess frequent than carcinoma. According to ZacherI,’ carcinoma outnumbers sarcoma by 40 to I, and Evans2 reported 22 sarcomata and 873 carcinomata in studies of the statistics of the Mayo Clinic from 1910 to 1919. Norris3 concluded that carcinomata are from 20 to 50 times as frequent as sarcomata of the uterus. Uterine sarcomata are reIativeIy more frequent in earIy Iife than carcinomata. Sarcoma botryoides is occasionaIIy seen in infants and young girIs. However, most sarcomata deveIop at from thirty-five to fifty years of age. Lynch reported a case of sarcoma of’ the uterus in a woman -seventy years of ag<. Sarcomata may be cIassified into those originating from the’endometrium and the myometrium. The most frequent variety is that originating in’ fibroids, aIthough occasionaIIy they originate primariIy in the muscufature-of the uterus and cervix. Some authorities fee1 that this transition from fibroids to sarcoma is rare, whiIe others think that sarcoma deveIops in IO per cent of fibroids. The frequency with which sarcomata are found in fibroids is in proportion to the care with which they are sectioned. If every fibroid tumor was carefully sectioned, a much Iarger percentage of sarcomata wouId be found than if the examination was made more superficiaIly. Winter4 reported 4.3 per cent sarcomatous change in 352 fibroid tumors which were systematicaIIy examined. Sarcoma aIso arises from the mucosa of the uterine body and from the mucosa of the cervix. The former is usuaIIy a large, soft tumor which extends into the uterine muscIe and sometimes into the peritoneum. At other times it is a Iarge poIypoid tumor which fiIIs the uterine cavity and extends through the cervica1 OS, as a Iarge sloughing, bIeeding mass. The more common form of sarcoma arises from the cervicaI mucosa and is named sarcoma botryoides, first described by Spiegelberg. It is a growth occurring in infants and smaI1 chiIdren and Iess commonly in aduIts, is extremeIy malignant, and grows very rapidIy. It begins as a group of smaI1 poIypoid tumors which rapidIy muItipIy unti1 the growth protrudes from the cervix, fiIIs the vagina, and may protrude from the vuIvar orifice. As a resuIt of erosion and infection, hemorrhage and necrosis are common comphcations.