Cervical decidua / by Frank W. Lynch.
- Lynch, Frank W. (Frank Worthington), 1871-1945
- Date:
- [1913]
Licence: In copyright
Credit: Cervical decidua / by Frank W. Lynch. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![operated in the Munich clinic for carcinoma. Her periods had been irregular for the past two years and there had been bleeding at irregular intervals. On this account the missing of two months’ menstruation had not aroused the suspicion of pregnancy, and the enlargement of the uterus had been attributed to metritis. The organ, when removed by vaginal hysterectomy, suggested pregnancy, and was preserved in toto in formalin, after some of the preservative had been injected into the specimen. Before the operation the cervix had been seen to be gaping, yet no membrane was visible in the canal. The lowxr cervix was considerably torn by bullet forceps. On opening the uterus several weeks later a seven weeks’ pregnancy was seen, with the chorion embedded on the upper lateral wall. The sac of the foetus contained clear fluid. Between the decidua vera and reflexa was a fresh, unorganized blood clot extending down to the internal os. The cervix presents an early carcinoma. The internal os is nearly as wide as the dilated external orifice, and projecting down throughout the length of the entire cervical canal is a fold of decidua con- tinuous with that of the uterine body, thus extending the circumference of the decidua vera to the external os. Histologically the membrane is identical with that of the uterine body, although it is attached to the cervical tissue more loosely than that in the cavity of the corpus. The membrane is also thinner. The microscopical picture of the underlying tissue is confused, because of poor fixing of tissues and changes incidental to the develop- ing carcinoma. Yet the author concludes that the cervix proper shows no decidual change and that the decidual membrane was forced through the somewhat dilated os by a combination of trauma during the operation and the injection of fixing Iluid into the uterine cavity in the ])reservation of the sj^eci- men. Kermauner in the same year (1906) men- tions the presence of cervical decidua in the upper cervix of his specimen of a i)ost-partum uterus which had presented a ])lacenta i)i7evia. Bondi in 1907 describes the uterus of a 37- >ear-old multipara which was removed in the second month of pregnancy for a carcinoma- tous polyp. Larger and smaller areas of decidual reaction were found in the region of the external os, some of which were covered , with stratified epithelium. Decidual changes could not be demonstrated in the upper cervix. Stroganoff (1908) records a case of polypoid proliferation on the anterior cervical lip of a three months’ pregnancy. This bled freely on contact and was removed for microscopic examination. It proved to be well-developed decidua. The upper layer was here and there covered with stratified epithelium. The pa- tient remained under observation for several months without a return of the growth and without bleeding. Gaifami (1909) and Ballerini (1910) also describe cases in which they have demon- strated cervical tissue. Excluding the case of Seitz as not proven, and the observations of Gaifami and Ballerini, which are recorded in the Italian journals, and of which I have seen only reviews, we find in the literature 22 reports of decidual change in the cervix in our search. Thirteen of these were observed in connection with placenta prjevia, 8 with normally situated placentae, and one in tubal pregnancies. Yet the more recent articles indicate the feeling that the condition is more common than hitherto believed. Indeed Ballerini’s article is quoted in review as stat- ing that such reaction occurs in 25 per cent of cases. It is of interest to recall that, of the 8 cases reported in normally implanted placen- ta, the decidual areas were noted on the lower cervix in 7 instances. On the contrary, in connection with placenta prcTvia the findings are reversed, since the upper cervix is the usual site. That this portion of the uterus is the site of decidual changes more commonly than hitherto supposed may be inferred from Hohmeier’s observations (not mentioned above) that decidua was present in the upper third of the cervix in all of his 7 cases. All cases thus far reported show that the decidual formation occurs only in localized areas with- out the production of a continuous membrane. My interest in this subject was recently revived l)y the observation of an unusual case of pregnancy in which bleeding from the cer- \ix followecl trauma and in which a watery, bran-colored leucorrhoeal discharge was a](https://iiif.wellcomecollection.org/image/b22466678_0008.jp2/full/800%2C/0/default.jpg)
