A Case of Sarcomatous Degeneration O F Uterine Leiomyoma with Metastases to Lungs and Heart

.G. W., colored, aged sixty-four, was admitted to the hospital Dee. 21, 1930, complaining of indeflnite abdominal pains and vaginal bleeding. The family and past history was irrelevant. The patient began to menstruate a t twelve years, and up to the present illness had always been normal as to cycle and duration. She was married at the age of forty, and her husband had died ten years later. There had been no pregnancies. About ten years before admission the patient first noticed that her menstruation had become irregular. The irregularity had manifested itself flrst as menorrhagia and later as metrorrhagia. Four weeks before admission there had been rather profuse bleeding for twelve days, accompanied by slight abdominal pain. After several days the patient had again begun to bleed and had been bleeding intermittently until admitted to the hospital. There was a foul odor to the discharge. The patient complained, also, of weakness and loss of appetite. Physical examination showed a rather obese colored woman with short, gray, kinky hair. She had only two teeth; otherwise, eyes, ears, nose, and throat were negative. The chest was well formed, the heart showed no enlargement; there was a loud systolic murmur at the apex, which was transmitted to the left axilla, and there was a pre-systolic murmur in the second left interspace. Examination of lungs showed no dullness; the percussion note was good throughout. There were moist riiles over both bases. The blood pressure was 174/80. An irregular, hai*d, nodular mass filled the lower abdomen. Vaginal examination was unsatisfactory because of a nulliparous outlet. There was slight edema of both ankles. The deep and superfleial reflexes were present and equal. Examination of the urine showed albumen, one plus; no sugar; pus, one plus. The blood count showed red blood cells, 2,321,000; hemoglobin 35 per cent; color index .76; white blood cells, 9,200; polymorphonuclears 70 per cent; large lymphocytes 10 per cent; small lymphocytes 20 per cent. The red cells showed moderate achmmia, marked anisocytosis, and poikilocytosis, and polychromasia. The Wassermann reaction was negative. Blood typing showed group 4. The provisional diagnosis was papillary cystadenoma of the ovary or multiple flbroids. An operation was thought advisable, but because of the poor condition of the patient, it was deemed wise to build her up before operating. On Feb. 2, 1931, she was given 500 C.C. of blood. She was given a second transfusion on Feb. 26, 1931, rewiving 400 C.C. of blood. Many blood counts were done in the meantime, but these showed no appreciable differences. The patient continued bleeding and her