CASE HISTORY

Patient was admitted on 3.1.36 complaining of a blood-stained watery vaginal discharge, which had been present for 2 1/2 years and was at times offensive. This discharge gradually became extremely severe. Menstruation was slight 6/28, until 2 1/2 years ago when it slowly increased, but the loss was never excessive. Her general condition became impaired during the last few months. She had 6 full term pregnancies, 2 children were alive (aged 15 and 7) and there was one miscarriage, 7 years before admission at 5/12. Last menstrual period on 19.12.35. On examination she was pale and lethargic. She had follicular tonsillitis. In the abdomen a tumour was felt, rising from the pelvis in the midline, about the size of a 20/52 pregnancy. PV the cortex was firm, the fundus the size of a 20 weeks pregnancy, not hard, mobile. The fornices were clear. A provisional diagnosis of Fibromyoma uteri and uterine polyp was made. Iron was given to improve her Hb, which was 50% only, and on 27.1.36 a subtotal hysterectomy and bilateral salpingo-oophorectomy was performed. At operation the uterus was found soft and symmetrically enlarged, the right ovary contained small cysts and there was a left sided ovarian cyst, the size of a foetal head. Recovery was uneventful and patient was still in very satisfactory condition when last seen in April 1936.

PATHOLOGY

The specimen consists of the uterus and both tubes and ovaries. The uterus, amputated at the junction of cervix and body, and opened by removing the posterior wall, shows a uniform thickening and some fibroids of its wall. The cavity is somewhat enlarged and completely filled by a lobulated ovoid polypoidal growth, about 5 1/2cms in its longer diameter. The right ovary (right) is a little enlarged and shows a number of small cysts. The left ovary (left) is greatly enlarged and converted into a thin-walled cyst and arising from its left pole there is a large pedunculated multilocular cyst about 4" in diameter, one par of which is firm and represents a thickened part of the outer wall, where several septa, dividing the large cyst into smaller ones, join. The left Fallopian tube is stretched out over the anterior aspect of this cyst.