CHAPTER XV. CERVICAL POLYPI; HYPERTROPHIC ELONGATION OF THE CERVIX; CHANCRE OF THE CERVIX; TUBERCULOSIS OF THE CERVIX.

Cervical Polypi.—Polypoid tumors are found growing from the mucous membrane of the cervical canal, projecting into the canal or protruding from the external os. The mucous polypus is the most usual form, and is caused by cystic degeneration of the Nabothian glands of the cervical mucous membrane. Sometimes such polypi protrude from the ostium vaginÆ. Less often a papillary or warty growth is found on the mucous membrane of the cervical canal, in the neighborhood of the external os. There is usually present dilatation of the external os and cervical canal. The symptoms of cervical polypi are not characteristic. Inflammation of the cervical mucous membrane and cervical catarrh may result. There may be slight, and rarely profuse, bleeding from the external os. The bleeding may follow efforts at straining, sexual connection, long standing, or exercise. Occurring at the time of the menopause or later, this symptom would excite the suspicion of beginning cancer of the cervix.

Pediculated polypi should be twisted or cut away. Bleeding is usually very slight. The sessile growths, like the papillomata, should be excised, the incision being carried well below the base of the tumor into the healthy tissue of the cervix. The wound may then be closed with an interrupted suture. In every case of such tumor a careful microscopical examination should be made to determine its benign or malignant character.

Hypertrophic Elongation of the Vaginal Cervix.—In this condition there is a marked increase in the length of the vaginal portion of the cervix uteri, though the thickness of the cervix may be but little, if any, greater than normal. The vaginal cervix may be so long that the external os may lie outside the ostium vaginÆ.

The condition is a true hypertrophic growth, the cause of which is unknown. It is probably congenital, as it is found in the virgin.

The diagnosis between elongation of the vaginal cervix and the various forms of prolapse of the uterus and the vagina may be readily made. In elongation of the vaginal cervix the fundus uteri is at the normal level; there is no inversion of the vagina; the vaginal fornices are in the normal position.

Elongation of the vaginal cervix to a degree sufficient to be considered pathological is very rare.

The treatment consists in amputation of the cervix.

Chancre of the Cervix.—Chancre of the cervix is a rare lesion. One observer, Rassennone, found 117 uterine chancres in a series of 1375 cases of venereal sores on the female genitals. The sore may occur on either lip of the cervix and may extend into the cervical canal. The appearance is that characteristic of similar sores in other parts of the body.

The diagnosis may be made from a history of coitus with a man having active syphilis, by microscopic examination if necessary, and by the later appearance of secondary syphilitic symptoms.

Tuberculosis of the Cervix.—Tuberculosis of the cervix is a very rare condition. The appearance of the cervix in such cases resembles that of cancer. In fact, hysterectomy has been performed for this condition under the mistaken diagnosis of malignant disease.

The diagnosis may be made by the microscopic examination of the discharge and of excised tissue.

Complete hysterectomy should be performed for tuberculosis of the cervix.

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