CASE HISTORY

The patient had increasing offensive brownish yellow vaginal discharge for a year; also general weakness, following shooting pains in the lower abdomen for three weeks. Previously healthy. Menstration had ceased 20 years before. No children or miscarriages. On examination, poorly nourished, tongue furred. Slight tenderness across lower abdomen; no rigidity; irregular mass arising out of pelvis nearly to umbilicus. PV offensive brownish discharge ++. Cervix far back, continuous with tumour about size of four months pregnancy. Fibroid or carcinoma of body of uterus was diagnosed. Total hysterectomy was performed. Her condition improved steadily for a time, the wound healing. X-ray treatment was not considered likely to be of advantage. Four months after operation, felt very well, had gained weight, and had no symptoms. Three months later, however, her doctor reported a mass in the abdomen, apparently a recurrence; and she had been showing signs of obstruction.

PATHOLOGY

Uterus 210mmx200mmx55mm. The specimen consists of a hemi-section through the uterus, the whole of which in the fresh state measure about 12x7x7 cm. Two large tumours are evident, - the first an obvious intra-mural fibroid, near the fundus, and the other is a large fleshy growth distending the whole cavity. This latter growth is yellowish, with haemorrhagic and cystic degeneration. It was attached to the uterine wall only by a pedicle near the fundus.