Treatise on gynaecology : medical and surgical . is caused by hyperplasia ofthe skin and subcutaneous cellular tis-sue. It is most common on the lower ex-tremity (96^) and takes its name from theresulting resemblance to the foot of theelephant. It is also seen in men involv-ing the penis and scrotum, and in womenupon the labia and clitoris. It is a rareaffection in our climate. Pathology.—The largely hypertrophiedlabia majora form voluminous masseswhich may exceed the dimensions of theadult head and the weight of ten kilo-grams (4i lb.). Their base is often broad,but at other times there is a
Treatise on gynaecology : medical and surgical . is caused by hyperplasia ofthe skin and subcutaneous cellular tis-sue. It is most common on the lower ex-tremity (96^) and takes its name from theresulting resemblance to the foot of theelephant. It is also seen in men involv-ing the penis and scrotum, and in womenupon the labia and clitoris. It is a rareaffection in our climate. Pathology.—The largely hypertrophiedlabia majora form voluminous masseswhich may exceed the dimensions of theadult head and the weight of ten kilo-grams (4i lb.). Their base is often broad,but at other times there is a pedicleand the tumor takes on the apppearance which the older writers de-scribed as molluscum pendulosum—a clinical term which compre-hends all forms of tumor of the integument, whether elephantiasis,lipoma, fibroma, or myxoma. Many of the cases published as elephan-tiasis with a normal skin seem to me explicable by this confusion. According to Cornil and Ranvier, there are histologically threeprincipal forms of elephantiasis of the vulva:. Fig. 133.—Elephantiasis of the Vulva. 404 CLIlSriCAL AND OPERATIVE GYNECOLOGY. 1. In the first the entire derma is hypertrojjhied and returns to theembryonic condition. In the midst of this transformed tissue thereare vast dilatations of the lymph spaces, comparable to those whichare found in lymphangioma. 2. In the second form, which often succeeds to repeated cedema,the engorgement of the tissues extends over a large area, there is astagnation of the lymi:)h in the capillaries, larger trunks, and lacunaeof the lymph system; and particularly in this variety, the ganglia be-come the seat of fibrous alteration. 3. The third variety is chiefly remarkable for the enormous in-crease in the thickness of the derma. There is an abundant prolifera-tion of all the elements of the derma, involving the connective tissue,the elastic fibres, and tlie smooth muscular cells, and, as in the othertwo forms, the lymph spaces are notably dilated. The obl
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