Reprinted from the Occidental Medical Times, June, 1893. 
A Case of Extirpation of the Uterus per Vaginam 
for Epithelioma of the Cervix, Compli- 
cated by Sarcoma of the Body. 
By D. W. Montgomery, M. D., Prof. Pathology and Histology, University of 
California, San Francisco, Cal. 
On August 30th, 1889, Dr. H. Kreutzmann brought me two small 
pieces of tissue, curettings from the uterus of a woman who had applied 
to him for an opinion, and in whom he suspected cancer. One of these 
pieces was from the uterine cavity, and with the exception of a large 
number of blood vessels, appeared to be normal. The other piece was 
from the cervix at the place where the flat epithelium of the cervical 
portion changes into the glandular structure of the mucous membrane 
lining the internal surface of the neck. A large, thick mass of flat 
epithelial cells could be seen driven down into the subjacent tissue, and 
in one specimen there were branches given off from this mass running 
down still deeper; and far down in the tissue of the cervix there were 
alveoli filled with irregularly arranged, flat epithelial cells. Both Dr. 
Kreutzmann and myself looked carefully over the specimens, and came 
to the conclusion that we had to do with a very early, but, microsco- 
pical! v, clearly recognizable case of epithelioma. 
A few days later, Dr. C. Cushing sent me a wedge-shaped piece of 
cervical tissue, which he had cut out for microscopical examination. I 
sent back a report that there was some epithelial infiltration extending 
into the submucous tissue; that it was slight but unequivocal, and that 
it therefore must be regarded as epithelioma at an early stage of its de- 
velopment. 
It transpired in a conversation with Dr. Cushing relative to this case, 
that both examinations had been made for the same patient. Dr. Cush- 2 
ing removed the uterus and its appendages (both tubes and ovaries) 
some time in the begin- 
ning of September, within 
a week of the last exam- 
ination. 
After removal it was 
noticed the anterior wall 
of the uterus bulged for- 
ward decidedly, and on 
cutting the organ open 
anteroposteriorly, a dark- 
red, round, intramural tu- 
mor was exposed in the 
anterior wall. It was so 
imprisoned by the tissues 
composing the muscular 
wall, and so resilient, that 
when cut in two by the 
section which exposed it, 
it sprang forward like a 
compressed sponge, form- 
ing two large projecting 
masses. It was found to 
Shaded portion shows telangiectatic round-celled sar- 
coma in anterior wall. This tracing was taken by placing 
a ground-glass plate over the cut surface of uterus The 
tracing was made after the organ had been in alcohol for 
some time, so that all its dimensions are somewhat smaller 
than life size. 
be a round-celled sarcoma, positively riddled with blood vessels. 
As for the diagnosis, it was easy to see it was not an epithelioma de- 
rived from the neoplasm in the cervix for it was not alveolar in struc- 
ture, and was composed of young, round, connective tissue cells, which 
were not at all epithelioid in character. It was not a lymphoma, for 
there are no lymphatic glands in this situation, and none of the other 
superficial lymphatic glands of the body were affected. Tuberculosis 
and syphiloma (gumma) were excluded, because of the peculiar telean- 
giectatic blood vessels, and the absence of either the giant cells or the 
cheesy degeneration of tubercle, or the coagulation necrosis and low 
connective tissue of syphilis. 
Forty-two months have now gone by without a relapse, a sufficient 
argument for early operation in such cases, and, furthermore, it illus- 
trates the beneficial results of removing the whole diseased organ when 
attacked by malignant growths. 
1124 Sutter Street.