These tumors are the most common of those of the uterus. Although spoken of as fibroma, they nearly always contain a large amount of involuntary muscle, so the term fibromyoma is the more correct. They occur very frequently in negroes. They are classified according to their situation into: mural, intramural, or interstitial, when occurring within the muscular body of the uterus; submucous, when beneath the endometrium; and subperitoneal, when beneath the peritoneal covering. The tumors may be single or multiple, and their size varies from a pea to one weighing fifty pounds. The largest are the subperitoneal, as their growth is practically unlimited.

The density of the tumors depends upon the amount of fibrous tissue present. They are generally encapsulated.

The blood-supply is poor, so degenerations are common. These usually begin in the center of the tumor, and the most frequent form is calcification. If the tumor has been a pedunculated one, the pedicle may become twisted and necrosis set in. Fibromata may be associated with lipoma, myxoma, or sarcoma.

Fibroid tumors, although of the benign type, may give rise to severe symptoms on account of exerting pressure upon neighboring structures. The submucous type is often associated with hyperemia and hemorrhage from the endometrium or from a degenerated growth. Infection with necrosis and gangrene may take place. Labor may also be interfered with by the presence of such tumors.

Sarcoma of the uterus usually originates within the connective tissue between the muscle-fibers and about the vessels or occasionally from the muscle cells - myoma sarcomatodes. It may also arise within the submucous tissue. The myome-trial sarcoma is generally spindle-cell in character; is grayish-white and soft; the endometrial is commonly round celled. Angiosarcoma is rare, and the so-called adenosarcoma is probably nothing more than an inclusion of the pre-existing endometrial glands.

A peculiar tumor occurring in early life is the edematous papillary sarcoma of the cervix. It is composed of a mass of soft, grayish, grape-like structures, that microscopically are made up of myxomatous round and spindle cells. There are also found epithelial tubules, areas of cartilage, and both smooth and striated muscle-fibers. Is quite malignant.

Papilloma appear on the cervix as rather small, cauliflower-like growths, composed of connective-tissue villi covered by many layers of squamous epithelium. Venereal warts are sometimes found upon the cervix.

Adenoma as such occur as polypoid projections from the mucous membrane, or as a glandular hyperplasia of the endometrium. They are benign.

Malignant adenoma, or adenocarcinoma, usually arises in the fundus of the uterus, upon the posterior wall. It is characterized by the tendency of the glands to invade the uterine 32 muscle and by the epithelium breaking through the basement membrane. Quite frequently the epithelium proliferates so rapidly that the acini become completely filled with cells, the glandular character is lost, and the tumor assumes a typical carcinomatous structure. Metastasis is unusual; the destruction is mainly local. The invasion and destruction of the muscle progresses until the bladder and the rectum may become involved (see Fig. 65).

Carcinoma is usually an adenocarcinoma and the progress is practically similar. There is rapid infiltration with extensive ulceration. The vaginal walls and the tissues in the neighborhood of the cervix become involved. The neighboring lymphatic nodes are frequently the seat of metastases.

Squamous epithelioma of the cervix is the commonest type of malignant tumor. In many cases it probably begins as a papilloma. There is soon developed a tendency of the cells to infiltrate the surrounding tissues and to grow superficially as a cauliflower mass. The growth extends downward, involving the vagina; extensive ulceration, accompanied at times by severe hemorrhage, occurs, and there is an extremely foul discharge. The tumor extends in all directions, and may perforate into the bladder or rectum or into the peritoneal cavity, giving rise to fatal peritonitis. In consequence of the loss of blood and absorption of harmful substances resulting from the breaking down of the tissues, there may develop a well-marked anemia and cachexia.

In old people squamous epithelioma may occur in the body of the uterus when metaplasia of the columnar epithelium has taken place.

Syncytioma malignum, or chorio-epithelioma, is a peculiar malignant tumor developing from embryonal tissue. The greater part of the cells are supposed to be derived from the syncytium. Is a rare form of growth (see p. 165).

Cysts of the uterus may result from a liquefaction necrosis of a fibromyoma, or from the obstruction of the Nabothian follicles. Dermoid cysts are occasionally found. Parasitic cysts due to the cysticercus and echinococcus have been described.