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Adenomyomas of Vagina, Rectum, Sigmoid Colon, and Ovary

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Abstract

Diagnosis and surgical treatment of adenomyomas of the rectovaginal pouch of Douglas, so-called adenomyomas of the rectovaginal septum, awaited emergence of surgical pathology in the late nineteenth century. The subspecialty of surgical pathology in North America developed in academic departments of surgery at Johns Hopkins (gynecology), Columbia-Presbyterian, and Washington University-Barnes Hospital and in non-university settings at Memorial Hospital, The Mayo Clinic, and the Armed Forces Institute of Pathology.1

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Notes

  1. 1.

    Juan Rosai, ed., Guiding the Surgeon’s Hand: The History of American Surgical Pathology [Washington, DC: Armed Forces Institute of Pathology, 1997], 3.

  2. 2.

    Cullen TS. Adenomyoma of the round-ligament. Johns Hopkins Hospital Bulletin. 1896; VII:112–14.

  3. 3.

    Von Recklinghausen F. Adenomyomas and cystadenomas of the wall of the uterus and tube: Their origin as remnants of the Wolffian body. Wien klin Wschr 1896;8:530.

  4. 4.

    Cullen TS. Adenomyoma of the round-ligament. Johns Hopkins Hospital Bulletin. 1896; VII:112–14:113.

  5. 5.

    Cullen TS. Adeno-myoma of the round-ligament. Johns Hopkins Hospital Bulletin. 1896; VII:112–14.

  6. 6.

    Cullen TS. Further remarks on adeno-myoma of the round ligament. Johns Hopkins Hospital Bulletin 1898; IX:142.

  7. 7.

    Cullen TS. Umbilical tumors containing uterine mucosa or remnants of Mueller’s duct. Transactions Southern Surgical and Gynecological Association, 1911. Cullen TS. Umbilical tumors containing uterine mucosa or remnants of Mueller’s duct. Surg Gynecol Obstet 1912;l4:479–491.

  8. 8.

    Cullen TS. Adenomyoma of the round ligament and incarcerated omentum in an inguinal hernia, together forming one tumor. Surg Gyn and Obstet. 1916;23:258–260.

  9. 9.

    Thomas S. Cullen. Embryology, Anatomy, and Diseases of the Umbilicus [Philadelphia: W. B. Saunders, 1916].

  10. 10.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 301. As Lockyer pointed out, Cullen’s experience between 1894 and 1908 when he wrote his “monumental” work Adenomyomata of the Uterus, published in 1908, was limited to uterine adenomyomata and adenomyomata of the utero-ovarian and round ligaments. Lockyer stated further: “up to that date this well-know author had met with no case of ‘adenomyoma’ in the recto-genital space.”

  11. 11.

    Cullen TS. The distribution of adenomyomata containing uterine mucosa. Am J Obstetrics Diseases Women and Children 1919;180:130–138:134. In 1913 Jessup’s and Lockyer’s “communications set me thinking and I at once felt sure that two of my cases undoubtedly belonged to this category, although the histological examination had given no inkling of such a condition. I had many more sections made and was finally rewarded by finding in each case the typical picture in other portions of the specimen. Since then I have been on the look out for this condition and have had in all 15 cases.”

  12. 12.

    Jessup, DSD. Adenomyoma of the rectovaginal septum. JAMA 1914;LXIII: 383–387.

  13. 13.

    Jessup, DSD. JAMA 1914;LXIII: 383–387:387.

  14. 14.

    Jessup, DSD. JAMA 1914;LXIII: 383–387. Jessup preserved Cullen’s first assessment of adenomyoma of the rectovaginal septum.

  15. 15.

    Cullen TS. Adenomyoma of the rectovaginal septum. Transactions of Southern Surgical & Gynecological Association. 1913;26:106–118. Lockyer, Cuthbert. Adenomyoma of the rectovaginal septum. Proceedings Royal Society Medicine. February 1913; vi, No. 4.

  16. 16.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118. Cullen made reference to his “Address in Gynecology” before the Canadian Medical Association in June 1913, published in the Canadian Medical Association Journal, August 1913.

  17. 17.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1914;62:835–839. See footnote page 835.

  18. 18.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118.

  19. 19.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1914;LXII: 835–839. The only difference, in the 1913 version large full-page illustrations were clustered in mid-article, in 1914 version the illustrations were smaller and integrated within the text.

  20. 20.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118.

  21. 21.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118, Figure 1. Lockyer, Cuthbert. Adenomyoma of the rectovaginal septum. Proceedings Royal Society Medicine. February 1913; vi, No. 4. Denonvilliers, CPD. Bull Soc Anatomy of Paris (Series 3) 1836:20:105.

  22. 22.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118:116–7.

  23. 23.

    Cullen TS. Adenomyoma of the rectovaginal septum. 1913;26:106–118:116–7, Figure 3.

  24. 24.

    Cullen TS. Adenomyoma of the rectovaginal septum. 1913;26:106–118. In 1918, Lockyer remarked, “The term ‘miniature uterine cavities’ for small cystic spaces in adenomyomas has often been employed by Thomas S. Cullen.” Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 401.

  25. 25.

    Denonvilliers, CPD. Bull Soc Anatomy of Paris (Series 3) 1836:20:105. See also: Nichols DH, Milley PS. Surgical significance of the rectovaginal septum. Am J Obstet Gynecol 1970;108:215–220. See also: Nichols DH, Milley PS. “Clinical anatomy of the vulva, vagina, lower pelvis, and perineum. In Gynecology and Obstetrics, Vol. 1. [Hagerstown, MD: Harper & Row Publishers, Inc., 1977], 15. Figure 1–12. “The rectovaginal septum. Sections showing the partly dissected rectovaginal septum. It extends from the pouch of Douglas to the perineal body and forms the anterior surface of the rectovaginal space. Its adherence to the posterior vaginal wall is illustrated along with its posterolateral curve.” (From Nichols DH, Milley PS: Surgical significance of the rectovaginal septum. Am J Obstet Gynecol 108:215, 1970.)”

  26. 26.

    Cullen TS. Adenomyoma of the rectovaginal septum. Transactions of the Southern Surgical & Gynecological Association. 1913;26:106–118:111–112.

  27. 27.

    Cullen TS. Adenomyoma of the rectovaginal septum. 1913;26:106–118:112–114.

  28. 28.

    Cullen TS. Adenomyoma of the rectovaginal septum. 1913;26:106–118:112–114.

  29. 29.

    Shemwell RE, Weed JC. Ovarian remnant syndrome. Obstet Gynecol 1970;36:299. In the ovarian remnant syndrome fragments of ovarian tissue not removed at surgery survive and function by parasitically deriving their blood supply from other organs or tissues. In 1970, Shemwell and Weed demonstrated the existence of the ovarian remnant syndrome in an experimental model. They fixed fragments of ovarian cortex to the pelvic side wall of cats with sutures [creating artificial adhesions]; the isolated ovarian cortical fragments survived as functioning ovarian cortical tissue by acquiring a parasitic blood supply from vessels in the lateral pelvic wall.

  30. 30.

    Cullen TS. Adenomyoma of the rectovaginal septum. Transactions of the Southern Surgical & Gynecological Association. 1913;26:106–118.

  31. 31.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 320. Referring to page 252 of Cullen’s 1908 publication, Adenomyoma of the Uterus, Lockyer pointed out that “Cullen will have nothing to do with the serosal theory.” In 1898, N.S. Iwanoff published his theory that glandular cystic spaces in fibromyomas originated by an ingrowth of overlying serosa. Iwanoff NS. Drusiges cystenhaltiges Uterusfibromyom compliciert durch Sarcom und Carinom. Monatsschr fur Geb und Gynak 1898; Bd. vii: S. 295.

  32. 32.

    Sampson JA. Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol 1925;10:649–664. Cullen TS. Discussion: Symposium on misplaced endometrial tissue. Am J Obstet Gynecol 1925;10:732–33. “We are great debt to Sampson for the careful, painstaking and brilliant work that he has done toward establishing the modes of origin of peritoneal adenomyomata.”

  33. 33.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1914;62:835–839.

  34. 34.

    Jessup, DSD. Adenomyoma of the rectovaginal septum. JAMA 1914;LXIII: 383–387.

  35. 35.

    Jessup, DSD. Adenomyoma of the rectovaginal septum. JAMA 1914;LXIII: 383–387.

  36. 36.

    Cullen, TS. A rapid method of making permanent specimens from frozen sections by the use of formalin

    . Bull Johns Hopkins Hosp 1895;6:67.

  37. 37.

    Lockyer, Cuthbert. Adenomyoma of the rectovaginal septum. Proceedings Royal Society Medicine. February 1913;vi, No. 4. Not realizing the benign nature of the disease, Lockyer had performed a Wertheim radical hysterectomy, a permanent colostomy, and resection of the rectum.

  38. 38.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Assoc 1913;26:106–118:117.

  39. 39.

    Cullen TS. A further case of adenomyoma of the rectovaginal septum. Surg Gynecol Obstet 1915;20:263–265.

  40. 40.

    Cullen TS. A further case of adenomyoma of the rectovaginal septum. 1915;20:263–265.

  41. 41.

    Stickney GL. A case of diffuse adenomyoma of the uterus, with discrete adenomyoma over the left ureter. Johns Hopkins Hospital Bulletin 1915;xxvi:304.

  42. 42.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:405.

  43. 43.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., 1910;iii:57.

  44. 44.

    Nadal, Pierre. Bull. de l’Assn. franc. Pour l’etude du cancer. 1911;iv:338.

  45. 45.

    Lockyer, Cuthbert. Adenomyoma of the rectovaginal septum. Proceedings Royal Society Medicine. February 1913;vi, No. 4.

  46. 46.

    Jessup, DSD. Adenomyoma of the rectovaginal septum. JAMA 1914;LXIII: 383–387:385.

  47. 47.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., 1916;ix: Obst. and Gynec. Section, p. 1.

  48. 48.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:406:406.

  49. 49.

    Cullen TS. JAMA 1916;LXVII:401–406:406:406.

  50. 50.

    Cullen TS. JAMA 1916;LXVII:401–406:406:406.

  51. 51.

    Cullen TS. JAMA 1916;LXVII:401–406:406. See Figure 1 (case 4).

  52. 52.

    Cullen TS. JAMA 1916;LXVII:401–406:401. Figure 2.

  53. 53.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:402.

  54. 54.

    Cullen TS. JAMA 1916;LXVII:401–406:404. See also Figure 3 (Case 4), page 403. “Muscular and fibrous tissue in an adenomyoma of the broad ligament encircling and compressing nerves. This section is from the right broad ligament. It shows the diffuse myomatous and fibrous tissue surrounding nerves. There were definite symptoms of nerve pressure.”

  55. 55.

    Cullen TS. JAMA 1916;LXVII:401–406:402.

  56. 56.

    Cullen TS. JAMA 1916;LXVII:401–406:402:404. Figure 4 (Case 5). “A reference to the description of the specimen shows that the mass was a typical adenomyoma.”

  57. 57.

    Cullen TS. JAMA 1916;LXVII: 401–406:402. The rectovaginal pouch of Douglas in women with and without children often extends caudally below the mid-level of the vagina. See also: Cullen, Thomas S. The distribution of adenomyomas containing uterine mucosa. Archives of Surgery. 1920;1:215–283. “Adenomyoma of the rectovaginal septum usually starts just behind the cervix, and on bimanual examination, one can feel in this region a small, somewhat moveable nodule scarcely more than a centimeter in diameter.”

  58. 58.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406s:403.

  59. 59.

    Cullen TS. JAMA 1916;LXVII:401–406:403.

  60. 60.

    Cullen TS. JAMA 1916;LXVII:401–406:404.

  61. 61.

    Füth. Zentr f Gynak 1912;xxxvi:1356. Cited by Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 333.

  62. 62.

    Cullen TS. Adenomyoma of the rectovaginal septum. Trans Southern Surgical and Gynecological Association 1913;26:106–118:112–114. Cullen was also influenced deeply by the operative mortality of Richardson.

  63. 63.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:405.

  64. 64.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:405–6.

  65. 65.

    Cullen TS. JAMA 1916;LXVII:401–406:406.

  66. 66.

    Cullen TS. JAMA 1916;LXVII:401–406:405.

  67. 67.

    Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different diseases. Fertility Steril 1997;68:585–96. See also: Michelle Nisolle and Jacques Donnez, Peritoneal, Ovarian and Recto-vaginal Endometriosis: The identification of three separate diseases [New York: Parthenon Publishing Group, 1997], and J Donnez, O Donnez, J Squifflet, and M. Nisolle, “The concept of retroperitoneal adenomyotic disease is born.” An Atlas of Operative Laparoscopy and Hysteroscopy, 2nd ed. Ed. J. Donnez and M. Nisolle [New York: Parthenon Publishing Group, 2001], 113–117.

  68. 68.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., Obstet Gynaecol Section 1916;ix:1–17:16–17.

  69. 69.

    Stevens TG. Proc Roy. Soc Med., Obstet Gynaecol Section 1916;ix:1–17:16.

  70. 70.

    Stevens TG. Proc Roy. Soc Med., Obstet Gynaecol Section 1916;ix:1–17:1. In a footnote on page 6, Stevens identified Case I as the same case he had “demonstrated” in 1909 and published in a brief note: Stevens TG. Adenomyoma of the vaginal wall. “Proceedings, 1910, iii, p. 57.” The author has a copy of the 1910 publication.

  71. 71.

    The posterior fornix of the vagina is bounded anteriorly by that portion of the uterine cervix that protrudes into the vagina and posteriorly by the rectovaginal pouch of Douglas. See Illustrated Stedman’s Medical Dictionary. 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 555. The vaginal fornix or fornix uteri is “the recess at the vault of the vagina; it is divided into a pars anterior, pars posterior, and pars lateralis with respect to its relation the cervix of the uterus.”

  72. 72.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., Obstet Gynaecol Section 1916;ix:1–17:6.

  73. 73.

    Stevens TG. Proc Roy. Soc Med., Obstet Gynaecol Section 1916;ix:1–17:6.

  74. 74.

    Stevens italicized the word site for emphasis.

  75. 75.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., Obstet. and Gynecol. 1916;ix:1–17. When the rectovaginal pouch of Douglas [RVPD] becomes obliterated by disease, the adenomyomatous lesion is enclosed superiorly by adhesion of the serosal surface of the posterior cervix or posterior uterus to the serosal surface of the rectum. This creates the false impression that the floor of the RVPD is above the lesion. Actually the floor of the RVPD is below the lesion. The adenomyoma (deeply invasive endometriosis) is situated between the true floor of the RVPD below (caudad), and the false floor above created by cervix or uterus adherent to rectum above (cephalad).

  76. 76.

    Stevens’ insight was an important step in the evolution of the pathogenesis of deeply invasive endometriosis involving the vagina, cervix, and rectum. It would be left to Johns A. Sampson’s implantation theory to place the site of origin of endometriosis on the peritoneum of the rectovaginal pouch of Douglas.

  77. 77.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:401. Cullen’s footnote 5 on page 401 reads: Stevens, T. G.: Adenomyoma of the Rectovaginal Septum, Proc. Roy. Soc. Med., 1916, ix, Obstet. and Gynecol. Section. p. 1.

  78. 78.

    Cullen TS. JAMA 1916;LXVII:401–406:401.

  79. 79.

    Judith Robinson, Tom Cullen of Baltimore [London, Toronto, New York: Oxford University Press, 1949], 176. Whenever in London, Cullen visited Lockyer for casual evenings; the two corresponded for years.

  80. 80.

    Cullen TS. The distribution of adenomyomata containing uterine mucosa. American Journal of Obstetrics and Diseases of Women and Children 1919;180:130–138.

  81. 81.

    Stevens TG. Adenomyoma of the rectovaginal septum. Proc Roy. Soc Med., Obstet. and Gynecol. 1916;ix:1–17.

  82. 82.

    Kellogg, FS. Adenomyoma of the recto-vaginal septum. Boston Medical and Surgical Journal 1917;176–177:22–24.

  83. 83.

    Cullen TS. Adenomyoma of the rectovaginal septum. JAMA 1916;LXVII:401–406:401.

  84. 84.

    Cullen TS. JAMA 1916;LXVII:401–406:406.

  85. 85.

    Kellogg, FS. Boston Medical and Surgical Journal 1917;176–177:22–24:23.

  86. 86.

    Kellogg, FS. Adenomyoma of the recto-vaginal septum. Boston Medical and Surgical Journal 1917;176–177:22–24:24.

  87. 87.

    Kellogg, FS. Boston Medical and Surgical Journal 1917;176–177:22–24:24.

  88. 88.

    Kellogg, FS. Boston Medical and Surgical Journal 1917;176–177:22–24:24.

  89. 89.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–349:343.

  90. 90.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–349:343.

  91. 91.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXV, Figure 1.

  92. 92.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXVI, Figure 2.

  93. 93.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXVII, Figure 3.

  94. 94.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49. See Figure 3, Plate LXVII.

  95. 95.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:347.

  96. 96.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXVIII, Figure 5.

  97. 97.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXX, Figure 7. See also other large histologic sections: Plate LXIX, Figure 6; Plate LXXL, Figure 8 showing a “miniature uterine cavity;” Plate LXXII, Figure 9; Plate LXXIII, Figure 10; Plate LXXIV, Figure 11, depicting an adenomyomatous polyps projecting into the posterior vaginal vault; and Plate LXXV, Figure 12.

  98. 98.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXVII, Inset upper left corner, Figure 3. The orange sized cyst filled with blood that was observed in 1914 possibly represented a hemorrhagic corpus luteum cyst. It is unlikely that an endometrioma of that size would have completely resolved in two years leaving the ovary to appear normal.

  99. 99.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 262.

  100. 100.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–9:347.

  101. 101.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9:347.

  102. 102.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9:348.

  103. 103.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:347, Case 8.

  104. 104.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:348.

  105. 105.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–349:348.

  106. 106.

    Cullen, Thomas S. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–49.

  107. 107.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXXVI, Figure 13.

  108. 108.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXXVII, Figure 14.

  109. 109.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXXVIII, Figure 15.

  110. 110.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9:349.

  111. 111.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–9. Plate LXXIX, Figures 16 and 17. At surgery Cullen removed both ovaries and both pus filled tubes caused by tuberculosis. The patient was to return to surgery later for removal of adenomyomatous disease.

  112. 112.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–49:344.

  113. 113.

    Sampson JA. The importance of early diagnosis in cancer of the uterus. JAMA 1905;xliv:1586–1593.

  114. 114.

    Wertheim E. The radical abdominal operation in carcinoma of the cervix uteri. Surg Gynecol Obstet 1907;4:1–10, discussion:101–13. Sampson referred to both of these papers in a review article on uterine cancer entitled: The clinical manifestations of uterine cancer. International Clinics 1908; (Series 18) (2):176–201:199.

  115. 115.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:344.

  116. 116.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:344.

  117. 117.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:344.

  118. 118.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–9:344.

  119. 119.

    Cullen TS. Johns Hopkins Hospital Bulletin 1917;28:343–49:344.

  120. 120.

    Sampson JA. The clinical manifestations of uterine cancer. International Clinics 1908;(Series 18 (2)):176–201:196–197. Figure 22, page 196 is particularly graphic!

  121. 121.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], vii.

  122. 122.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 419. Lockyer cited Robert Meyer. Uber adenomatose Schleimhautwucherungen in der Uterus- und Tubenwand und ihre pathologisch-anatomische Bedeutung. Virchow’s Arch 1903;l172:394–409.

  123. 123.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 422, 427.

  124. 124.

    Cullen TS. Adenomyoma of the recto-vaginal septum. Johns Hopkins Hospital Bulletin 1917;28:343–9:343. See footnote 4. “For an admirable review of the foreign literature on adenomyomas of the recto-vaginal septum consult Cuthbert Lockyer in Eden & Lockyer’s New System of Gynaecology, Vol. II, p. 350. It is brim-full of interest.” Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918]. The author is deeply indebted to Cuthbert Lockyer’s scholarly scientific monograph of 1918, an indebtedness also acknowledged by Thomas Cullen and John Sampson. Lockyer presented chronologically and in some detail the pertinent German, French, English, and American literature on adenomyomas to the outbreak of World War I.

  125. 125.

    Cuthbert Lockyer, Fibroids and Allied Tumours, viii.

  126. 126.

    Pfannenstiel JH: Uber die Adenomyoma, etc. Verhdlg d. Deutschen Ges f Gynak, Leipzig 1897: S. 195. Cited by Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 333.

  127. 127.

    Von Herff. Uber Cystomyome, etc. Verhdlg d. Deutschen Ges f. Gynak, Leipzig 1897: S. 189.

  128. 128.

    Pick L. Virchow Archiv 1899; Bd clvi: S. 507. Cited by Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 333.

  129. 129.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 334.

  130. 130.

    Schickele G. Weitere Beitrage zur Lehre von den mesonephritischen Tumoren. Beitr z. Geb. Bd. vi. S. 449.

  131. 131.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 275. Lockyer cites: Schickele, Zentr. F. all. Path. und Anat., 1904;xv. S. 275.

  132. 132.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 334.

  133. 133.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 276. Lockyer cites: Firth, Zur Kasuistik der Adenomyome der Uterus. Zentr. F. Gynak 1903, Bd. xxvi: S. 626.

  134. 134.

    Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 335.

  135. 135.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 335. Lockyer C. Proc Roy Soc Med London (Obst and Gyn Sect.), 1913.

  136. 136.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 371.

  137. 137.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 371.

  138. 138.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 361.

  139. 139.

    Cuthbert Lockyer, Fibroids and Allied Tumours, 361.

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    Ronald E. Batt M.D., Ph.D. (Professor of Gynecology)

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Batt, R.E. (2011). Adenomyomas of Vagina, Rectum, Sigmoid Colon, and Ovary. In: A History of Endometriosis. Springer, London. https://doi.org/10.1007/978-0-85729-585-9_6

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