Uterine Adeno-Sarcoma With Pyometra.* 
T. W. KAY, M. D., SCRANTON, PA. 
The co-existence of adeno-sarcoma and pyometa in 
the same uterus is so rare that I am induced to bring 
the following case to your notice. 
Pyometra, of itself, is not common, as may be seen 
from the small space devoted to it in books on gyne- 
cology. Out of some sixteen consulted, I find it men- 
tioned in only two, viz. : Billroth and Fritsch. 
It usually occurs in old people where atresia of the 
os exists and is due to a retention of the secretions. 
In this case it was due to closure of the internal os by 
the suppurating growth. 
Adenomata of the cervix are quite common in the 
form of small polypi composed of retention cysts with 
hypertrophied walls. In this form they also exist in 
the uterine cavity, where a much rarer form is some- 
times found. This has a broad base, and is not com- 
posed simply of hypertrophied glands, but contains 
new glandular formations. These growths are difiuse, 
rich in blood-vessels, and, according to Winckel 
(Lehrbuch cler Frauenkrankheiten, p. 385), infiltrated 
with round sarcomatous cells. Cases of this kind 
have been reported by Duncan, Gusserow, Schroder, 
Thomas and others. 
The growth in the following case probably began as 
this, and afterwards became sarcomatous. May tells 
us (Diseases of Women, p. 221), that uterine adenoma 
is frequently admixed with sarcoma, in the form of 
adeno-sarcoma. Billroth remarks that "pure adeno- 
mata (which are very rare), may be difficult to distin- 
guish from sarcomata which have developed in glands 
(adeno-sarcomata). "-Surgical Pathology, p. 223. 
Thomas (Diseases of Women, p. 571), reports a case 
which seems to have been the same kind of growth as 
in the following. It was examined by Dr. W. H. 
Welch and pronounced to be a mixture of sarcoma 
and adenoma. 
•Read before the Baltimore Medical Association December. 1889. 2 
Case:-Lateefy, a multipara, 52 years of age, was 
sent to me by Dr. Yusuf Abu-Suleiman, of Zahley, to 
enter the Johanniter Hospital, of Beyrout, Syria. She 
complained of an offensive discharge at times, from 
the vagina, accompanied by colicky pains. The men- 
strual flow ceased ten years before, and since that time 
she had suffered, more or less, from leucorrhcea. The 
offensive discharge was of eight months' duration, and 
the pain had lasted nearly as long. Emaciation was 
great and cachexia was marked. 
Bimanual examination showed the uterus much en- 
larged and extending well up into the abdominal 
cavity. The external os would admit the end of the 
finger with difficulty, and a soft, friable mass could 
be felt in the cervical canal. The uterine probe was 
introduced with difficulty in front of this and gave a 
depth of eight inches. 
Assisted by Dr. J. Mutter, the woman was put in 
the left lateral position, a speculum introduced, and 
the anterior lip seized with vulsellum forceps and well 
drawn down. 
The cervical canal was then rapidly dilated with 
steel urethral sounds until the index finger could be 
introduced. While this was being done, a constant 
flow of most offensive pus took place until some 
eighteen to twenty ounces of pus had been evacuated. 
On introducing the index finger, the growth was 
found to cover much of the posterior wall and it was 
attached nearly down to the internal os. Its base 
was broad and its surface irregular, soft and slough- 
ing. 
A large part of this was removed by the blunt 
curette, the uterine cavity washed out with bichloride 
solution, and the woman put to bed. Antiseptic in- 
jections were used daily and iron and ergot given 
internally. All went -well and in eight days I again 
dilated the uterine cavity, and with a sharp spoon 
removed all roughened elevations from the posterior 
walls. There was free hemorrhage, but this was con- 
trolled by the application of liq. ferri. subsulph. 
Dr. W. T. VanDyck kindly examined the growth 
microscopically for me and pronounced it an adeno- 
sarcoma. 
In three weeks the discharge had entirely ceased and 
the uterine cavity was reduced to three and one-half 
inches, so the woman was permitted to go home, with 
the prognosis of a probable return of the growth.- 
Maryland Medical Journal.