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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![fearing the possibililj- of sarcoma, tlie oi)erativc plan was changed from anterior hysterotomy to dilation of the canal and morcellation and removal of the ovum. The interna! os easily admitted the passage of a No. 8 Ilegar dilator, and the vascular cervi.x was stretched to permit the passage of No. 26, which facilitated examination with the eye and linger. 'I'he polyps were most abundant as a ring in the lower canal, yet were present for 3 cm. above the os. 'I'hey appeared to decrease in size in the higher levels. The membrane, however, presented folds to the internal os, cm. above its lower fellow. Indeed the feel above was as of numerous projec- tions extending as papillsc down from the maternal side of the fcetal sac, which but loosely covered the internal os. The lower uterine segment ap- peared more funnel-shaped than usual, as if there had been no widening of the lower jiole of an infantile type of uterus. The upper edge of the cervix formed a very obtuse angle with the uterine body. The placenta was found in the right upper lateral pole of the uterus, and the 4X-month foetus with the membranes was crushed and removed with ovum forceps. No pack was applied, but scrapings were taken from the posterior wall of the lower half of the canal for microscopic examination as a guide for subsequent treatment. Twenty-four hours later these were found to present no evidence of malignancy. The sections showed masses of irregular polyps together with considerable free blood. The mar- gins of the ])olyps were covered with high columnar epithelium, the protoplasm of which contained many granules. There were glands with crenated edges, some being full of mucus. There was marked mdema of the stroma and the cells were widely separated, showing stellate branches with vesicular oval and round shaped nuclei. There were many dilated blood-vessels, for the most part with thin wall vessels. Many lymirhocytcs and a few leucocytes were seen scattered Ihrough the sec- tion. In contrast with the areas just described, the tissue presenting decidual change showed an even and rounded edge. 'I'he surface epithelium was lower than in the other areas, and in certain sections presented the typical llattened surface epithelium of uterine decidua. 'I'he cell margins were distinct and the nuclei round. 'I'here were comparatively few granules noted in the protoplasm. 'I'he stroma was also verj' (rdematous, and its cells bore no resemblance to the areas first described save that they were also of irregular and stellate shape. 'I'he cells i)rcsenled the typical decidual type (bigs, i and 2). 'I'he nuclei were rounded. Many cells contained two nuclei. 'I’licre were areas of vesiculation scattered through the sections, as if some cells had fallen from the reticulum, 'riierc were many lymphocytes in the tissues and the blood-vessels were markedly dilated. In favorable sections it will be seen that the large decidual cells Fig. I. 'I'he tissue on the bottom of the illustration has not undergone tire decidual process. are groujicd about the blood-vessels as if beginning in the perithelia! coat (Fig. 3). Five days later, under gas, the cervix was again inspected, when the site of the former excrescences was found to be occupied by an irregular and sloughing base with no evidence of the former pic- ture. 'I'he examination of scrapings taken from the lower and upper halves of the cervical canal merely confirmed the clinical [liclure. C'crvical ])olyps have long been recognized as a source of bleeding (hiring pregnancy, yet I can lind no case on record presenting the ]n‘cture given in our case. As a rule the jtolyps are single and of fairly large size. d'hree of tlie cases noted in this review show that bleeding may result from trauma of the decidual patches. \’olk's case bled from con- tact of the numerous placpies. while Stroganoff clearly shows that the bleeding in his case came from the decidual proliferations. Blum-](https://iiif.wellcomecollection.org/image/b22466678_0010.jp2/full/800%2C/0/default.jpg)
