Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . ies, theabsence of any syphilis, the presence of giant cells in the ulceration,and the positive signs of an active tubercular lesion in the chest, makethe suspicion of a tubercular factor in the production of the lesionvery strong. Gonorrhea is, probably, never a primary factor, but will oftengreatly increase vulvar irritation and so, secondarily, aids in thegrowth of the vulvar enlargements. In the presence of a profuse 170 FRED J. TAUSSIG leucorrhea the tendency to the papulono
Transactions of the American Association of Obstetricians, Gynecologists, and Abdominal Surgeons for the year ... . ies, theabsence of any syphilis, the presence of giant cells in the ulceration,and the positive signs of an active tubercular lesion in the chest, makethe suspicion of a tubercular factor in the production of the lesionvery strong. Gonorrhea is, probably, never a primary factor, but will oftengreatly increase vulvar irritation and so, secondarily, aids in thegrowth of the vulvar enlargements. In the presence of a profuse 170 FRED J. TAUSSIG leucorrhea the tendency to the papulonodular form of hypertrophyis more pronounced. In two instances of my series tissue was removed and speciallystained for Ducreys chancroid bacillus, but with negative results. Asuppurating bubo will, however, predispose to lymph blocking and so,in the presence of syphilis, may lead to more pronounced enlargements. In general we may distinguish three types of cases according tolocation: (1) An inguinal-labial type involving, usually, only oneside, and leaving the clitoris unaffected. (2) A clitoral type involving. Fig. 3.—(Case 6) Microscopic section of nodular mass removed by operation. Everywhereare areas of lymphocytic infiltration. The epithelium shows increased keratin but less papil-lary extensions with the connective tissue than ordinarily is formed. No superficial ulcerspresent at time of operation. the clitoris and, usually, also both labia minora; but not the labiamajora. (3) A diffuse type in which the hypertrophy is more gen-eral, involving the entire vulva more or less. A further grouping of these cases is also possible according to theprevailing type of pathologic lesion. We can have: (1) A hypertrophicform, in which large pendulous tumors are found, usually with butslight ulcerations. (2) An ulcerative form, in which the ulceratinggranuloma makes up the bulk of the enlargement. (3) A papillary HYPERTROPHIC-ULCERATIVE CHRONIC VULVITIS 171 form, in which the tumor s
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