Adenomyoma involving the Vermiform Appendix. *

EXTRA-UTERINE adenomyomata are by no means rare, but have generally been observed in connexion with the rectum; there do not appear to be a great number of cases on record in which the vermiform appendix has been involved. The work of Sampson on ovarian adenomata of endometrial type has added further interest to these cases, and in a paper published last year he hns dealt especially with the subject of intestinal adenomata and their relation to the ovarian tumours. H e mentions the sigmoid, rectum, appendix and terminal loop of the ileum as the usual sites and gives the histories of twelve cases. The lesions may be surface implantations, implantations developing between adherent folds of peritoneum or deep invasions of underlying structures, and are present in more than half the cases of ovarian adenomata of endometrial type. The case which I have to describe belongs to the class dealt with by Sampson in the paper referred to, typical adenomyomatous tissue being present in the vermiform appendix. The patient was a married woman, 35 years of age, who had never been pregnant. The menstrual flow was regular but excessive. She complained of severe pain in the left lower abdomen, constantly present but worse at her periods. On examination the uterus was found enlarged and nodular and the left appendage cystic and adherent. She was thought to h a w uterine fibroids and an adherent appendage and was admitted to hospital for operation. On opening the abdomen the uterus was found to contain several fibroids and the bladder was adherent high u p on its anterior surface. The left ovary was cystic, closely fixed to the sigmoid and contained a quantity of brown treacly material vhich escaped during removal. The adjacent part of the sigmoid was nxrch thickened. The right ovary was not enlarged but was firmly adherent to the back of the broad ligament. The vermiform appendix was long, dipped down into the pelvic brim and its