Gynaecology for students and practitioners . culties of removal, they are not of great moment. MALIGNANT CHANGES IN FIBROID Myomata being exclusively mesenchymal growths, the only typeof malignant metaplasia which they can possibly undergo, must bemesoblastic likewise. We may thus have (1) malignant leiomyomata,which are very cellular and capable of producing metastases, althoughthey are not histologically malignant; (2) sarcomata, formed bymalignant metaplasia from the muscle-cells (see Figs. 227 and 228)and from the connective-tissue cells of a myoma ; (3) peri- and endo-theliomata, which ar
Gynaecology for students and practitioners . culties of removal, they are not of great moment. MALIGNANT CHANGES IN FIBROID Myomata being exclusively mesenchymal growths, the only typeof malignant metaplasia which they can possibly undergo, must bemesoblastic likewise. We may thus have (1) malignant leiomyomata,which are very cellular and capable of producing metastases, althoughthey are not histologically malignant; (2) sarcomata, formed bymalignant metaplasia from the muscle-cells (see Figs. 227 and 228)and from the connective-tissue cells of a myoma ; (3) peri- and endo-theliomata, which are types of sarcoma of low malignancy arisingfrom the blood-vessels and lymphatics of a myoma. Epiblastic tissuebeing absent, it is impossible for epitheliomata and carcinomata todevelop from within a myomatous tumour. A myoma may, however,be invaded by a co-existing carcinoma or sarcoma. MALIGNANT CHANGES IN FIBROIDS 455 Sarcomatous Metaplasia. The possibility of sarcomatous changeoccurring in a fibro-myoma was once held to be doubtful, but. jHORrlToH Fig. 226. Sarcojiatous Metaplasia ik a Fibroid Tumour. The lowerand larger growth shows areas of smooth homogeneous sarcoma. The largecystic space was an abscess-cavity. The smaller ones were capsule of this growth was calcareous. Compare the n horled appearanceof the fibroid seen above with the smooth section of the sarcoma seen below it is now generally admitted. The natural history of a fibro-myoma, the type-cell of which is the embryonic fibroblast, would not 456 GYNECOLOGY be complete without this faculty of demonstrating malignant meta-plasia. Frequency. Fehling and also Martin found sarcomatous metaplasiain fibroids in about 2 per cent, of cases. Cullen found this change in1-21 per cent., Noble in l-8percent.,andTraceyin 1-5 per cent, of cases. It is a well-known clinical fact that fibroid polypi, pedunculatedsubmucous myomata, which on section have appeared innocent, mayrecur again and again, and have
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