The branched arborescent, fibrous villi covered with cylindrical epithelium constituting the stroma may be recognized by isolating portions with needles and a brush. Ovarian tumors, especially cystomata, are very frequently bilateral, and are usually further advanced on one side than upon the other. When they are of equal size upon the two sides, and of a malignant nature, it may always be suspected that they are secondary (for instance, in cancer of the stomach). Finally, the ovary is the place of origin for the so-called organoid and teratoid tumors, i.e., those tumors in which whole organs or parts of a skeleton are produced. The most frequent appearance is skin in dermoid tumors or cysts, with an outer wall consisting of connective tissue and inner epidermis; glandular and horny formations (hair) originate from the latter. The cavity of the cyst is filled with greasy yellow pulp mixed with hair, containing sebum, epidermis, Cholesterine, etc., discovered by microscopic examination. In other cases, reproduction of normal organs or groups of tissue may be extensive, including bones, teeth, muscles, nerves, etc.
The changes taking place upon the outer surface of the uterus, Fallopian tubes, and ovaries still remain to be considered, as well as those which the peritoneum in the rectovesical fossa undergo. The most frequent are caused by chronic adhesive inflammation (perimetritis, perioophoritis chron. adhesiva). False membranes extend from the posterior surface of the uterus to the anterior portion of the rectum or lateral walls of the true pelvis. Others connect Fallopian tubes and ovaries with the rectum and pelvic walls; tubes are often curved, closed, ovaries displaced, packed in pseudomembranes.
Chronic inflammation resembling pachymeningitis hemorrhagica occurs frequently in the true pelvis. Hemorrhages occur in newly formed connective tissue layers, giving rise to retro-uterine hematocele or hematoma retro-uterinum of Virchow. The hemorrhage may cause purulent inflammation leading to rupture into vagina, rectum, etc.
Tuberculous and carcinomatous inflammations affect this portion in peculiar ways. Frequently, when few tuberculous and carcinomatous nodules exist elsewhere, their number is large in the excavatio recto-uterina, suggesting germs falling here from abdominal cavity depths.
Extra-uterine foetation must not be omitted from pelvic affections. Its effects vary according to duration, ovum size, extent of secondary changes produced by growth. As extra-uterine pregnancy usually terminates in rupture and internal hemorrhage, post-mortem examination reveals varying quantities of coagulated blood either free or confined by peritoneal adhesions.
The rectum is laid open from the anus through the posterior wall after pelvic organs are turned over so that bladder lies underneath and rectum on top. Among variations in size, there is found narrowing (stricture) from cicatrices or tumors; it may be dilated by fecal masses or prolapsed intestine portions resulting from invagination higher up.
Changes affect the mucous membrane primarily but muscular layer takes a secondary part in many affections, becoming thickened in chronic ulcerative processes. The color is usually gray but red or bluish-red toward anus due to numerous dilated veins. In acute inflammation it becomes brighter or darker red; after chronic inflammation, slaty.
Dilatation of hemorrhoidal veins at lowest part above and at the anus appears as thick blue varicose projections in mucous membrane; when more developed they are nodules containing little else than blood. They may attain pea, cherry, or even plum size and project beyond external skin.
Simple inflammation (proctitis) is characterized by swelling and marked reddening of mucous membrane covered with mucous secretion or puriform mass. Syphilitic affections are very characteristic; condylomata situated at and about anus produced by female genital secretions similarly affected. Recent syphilitic ulcers rarely occur but resulting cicatrices usually found.
Diphtheritic ulcers which have healed resemble the syphilitic in changes produced in intestine but differ materially in seat, almost always situated at commencement of rectum (junction with sigmoid flexure), increasing extent and severity from anus upwards. According to Virchow, diphtheritic cicatrices are ragged and irregular both on surface and circumference.
Recent diphtheritis attacks first prominent points as tops of folds appearing much reddened and sprinkled with bran later appearing as infiltrations of gray or brown color beginning to involve portions between folds. Then there occurs a loss of substance extending wider and deeper till large portion of thickened muscular coat is laid bare, only very small islets of mucous membrane remaining.
Tumors of the mucous membrane include polypi of varied size sometimes multiple when condition may be termed proctitis polyposa vel prolifera; at other times solitary and considerable size. Carcinomatous tumors are more important with two principal varieties, cylindrical-cell and gelatinous or colloid cancer (carcinoma colloides vel mucosum); latter occurs here frequently except stomach.
Atresia ani is an important congenital affection in which intestine does not open externally but terminates in a blind extremity at greater or less distance from integument. Point indicated by little depression in skin; occurs not only in prematurely born children but those otherwise perfectly formed.
Key Takeaways
- Identify and differentiate between various types of ovarian tumors, including cystomata and teratoid tumors.
- Recognize the symptoms and complications associated with extra-uterine pregnancies.
- Understand the significance of chronic inflammatory conditions in pelvic organs and their potential to cause severe health issues.
Practical Tips
- Use needles and brushes for isolating and examining ovarian tissues during pathological analysis.
- Be cautious when dealing with hemorrhoidal veins, as thrombi can form leading to complications.
- Recognize the importance of distinguishing between syphilitic and diphtheritic ulcers based on their location and appearance.
Warnings & Risks
- Failure to properly diagnose extra-uterine pregnancies can lead to severe internal bleeding and death.
- Chronic inflammatory conditions in pelvic organs can cause significant adhesions leading to complications such as peritonitis.
- Improper handling of hemorrhoidal veins may result in thrombosis or other serious vascular issues.
Modern Application
While the diagnostic methods described here are outdated, understanding these historical perspectives provides valuable context for modern medical practitioners. The detailed descriptions of pathological conditions and their symptoms remain relevant today, aiding in accurate diagnosis and treatment planning.
Frequently Asked Questions
Q: What is the significance of recognizing bilateral ovarian tumors?
Recognizing that ovarian tumors are often bilateral helps in diagnosing secondary malignancies or determining if a tumor is primary. For instance, equal-sized malignant tumors on both sides may indicate they are secondary to another cancer site like stomach cancer.
Q: How can one distinguish between syphilitic and diphtheritic ulcers?
Syphilitic ulcers typically leave a uniform tough fibrous cicatricial tissue, while diphtheritic ulcers are ragged and irregular both on the surface and at the circumference. Additionally, diphtheritic ulcers usually start near the junction of rectum with sigmoid flexure.
Q: What is the importance of identifying extra-uterine pregnancy?
Identifying extra-uterine pregnancy is crucial because it often leads to rupture and internal hemorrhage, which can be fatal. Proper diagnosis allows for timely intervention and treatment.