Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: was an abscess, which idea was confirmed by the large quantity of cheesy, bloodstained debris which escaped with clots. The first suggestion of the carcinomatous nature did not present until her return four months later. Age.—The carcinoma usually appears after the menopause. Spencer and Wittkopf each have reported a case of the disease in women under thirty, both of whom had had a gonorrheal infection of the gland. Our case was forty-eight years. Fig. 14.—Carcinoma Bartholin Gland (Kelly, Operative Gynecology). Gross appearance.—The tumor varies in size from a small pea-sized nodule to a cauliflower mass even larger than a goose egg (Fig. 14). It is usually firm and nodular but may be soft and suggest an abscess, probably as a result of bacterial invasion. The smaller growths are usually red (from inflammatory reaction), but have been described as blue with large skin veins surmounting the tumor. Ulceration usually occurs early, and the growth presents the typical appearance of a carcinomatous ulcer, with its punched-out edges and a necrotic sloughing base. The edges are firm, and the tumor bleeds readily. With the coming of ulceration, the surrounding tissues become infiltrated, and the mass becomes firmly attached to the underlying pubic bones. The glands are early involved, and enlarge not only from carcinomatous invasion but especially from the inflammatory reaction. Either side is attacked with equal frequency. The growth may be primary in both sides, or, as shown by the case of Schluter, both sides may be involved secondarily from extensions from a cancer of the uterine body. Symptoms.—Subjective symptoms may be absent when the growth is small, especially if the skin is intact. Occasionally there is dull pain. With the advent of ulceration, the pain may be acute...