Fibroids and allied tumours (myoma and adenomyoma) : their pathology, clinical features and surgical treatment . g. 213.—Situation of adenomyoma in CuUens case shown diagrammatically.(After Cullen, by permission, Journ. Amer. Med. Assoc, March 14, 1914, Fig. 3, page 837.) Hopkins Hospital, Cullen found a thickening behind thecervix and induration in both broad ligaments. Haemor-rhage continued whilst in hospital. When the abdomenwas opened it was found that the folds of the left broadligament were separated by a cystic mass 6 cm. in diameter(see Fig. 214). This was shelled out from its attachm
Fibroids and allied tumours (myoma and adenomyoma) : their pathology, clinical features and surgical treatment . g. 213.—Situation of adenomyoma in CuUens case shown diagrammatically.(After Cullen, by permission, Journ. Amer. Med. Assoc, March 14, 1914, Fig. 3, page 837.) Hopkins Hospital, Cullen found a thickening behind thecervix and induration in both broad ligaments. Haemor-rhage continued whilst in hospital. When the abdomenwas opened it was found that the folds of the left broadligament were separated by a cystic mass 6 cm. in diameter(see Fig. 214). This was shelled out from its attachment tothe pelvic wall, but a portion was left adherent to therectum, as the patients condition was serious. The right 360 EXTRAUTERINE ADENOMYOMA chap. broad ligament was not explored. The cyst containedchocolate-coloured fluid. The more solid parts weremade up of smooth muscle-fibres and quantities of uterineglands embedded in their characteristic stroma. Cullen says : In my group of adenomyomas of theuterus there were several of cervical origin. If these grow Tumour in nglit broadligament below bladder-. Cystic Adenomyomaadherent to Rectum. Fig. 214.—Cullens cystic adenomyoma adherent to the rectum. The uterus had beenpreviously removed. (After Cullen, by permission, Journ. Amer. Med. Assoc, March 14,1914, Fig. 5, page 838.) posteriorly, owing to their inherent tendency to becomeattached, they will spread out into the recto-vaginal septumand become adherent to the rectum, or xh^ peritoneal surfaceof the cervix (sic) may grow fast to the peritoneal surfaceof the rectum. In either case the rectum becomes fixed tothe cervix. This authors practical observations were asfollows : When the growth has invaded the rectum to a II OF THE RECTO-GENITAL SPACE 361 limited extent, it is necessaj-y to remove only a small portionof the anterior wall of the rectum. On the aetiology of adenomyoma of the recto-genitalspace Cullen is dogmatic ; he states that the glands inthese growths undoub
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