Gynecology . he uterine canal is calledcentrifugal in its growth, while one that develops toward or into the canal iscalled centripetal. The direction of growth is probably determined by the partof the uterine wall which offers the least resistance. Thus, a myoma beginningnear the outer surface would naturally grow toward the peritoneal surface and NEW GROWTHS 259 become subserous. If it begins near the uterine canal its direction of growthwould more likely be toward the endometrium, and thus become submucous. Ifthe origin of the tumor is at the center of the uterine wall, where the resistance
Gynecology . he uterine canal is calledcentrifugal in its growth, while one that develops toward or into the canal iscalled centripetal. The direction of growth is probably determined by the partof the uterine wall which offers the least resistance. Thus, a myoma beginningnear the outer surface would naturally grow toward the peritoneal surface and NEW GROWTHS 259 become subserous. If it begins near the uterine canal its direction of growthwould more likely be toward the endometrium, and thus become submucous. Ifthe origin of the tumor is at the center of the uterine wall, where the resistanceof the tissues in both directions is nearly equalized, the tumor is likely to remainas an intramural or interstitial fibroid. Uterine fibroids may appear as onetumor or they may be multiple, representing all three types of development inthe same uterus. Subserous myomata indicate always centrifugal development. This out-ward tendency of growth may continue until the tumor is joined to the uterine \\\)te*tf\ Fig. 77.—Intramural (or Interstitial) Myoma. wall only by a pedicle through which pass the blood-vessels that give it nourish-ment. The centrifugal growth may continue to such an extent that the tumormay, as it were, fly off at a tangent and be entirely dissociated from the is called a floating or parasitic myoma. The omentum usually attachesitself to such a tumor and gives it feeble sustenance from its blood-vessels. Interstitial fibroids influence most the uterine wall and may greatly distortthe uterus and its canal. These fibroids do not contain a definite capsule, butmay easily be shelled out from the surrounding uterine tissue. They are spheric 260 GYNECOLOGY in form, and are often called ball myomata, to distinguish them from theadenomyomata which infiltrate the tissues of the uterus irregularly and cannotbe shelled out. Submucous fibroids represent always a centripetal growth. They may en-croach on the uterine canal and greatly distort it, or they may
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