Roentgen Therapy in the Management of Some Non-Malignant Diseases Affecting the Organs of the Female Pelvis

Endometrial hyperplasia, endometriomata, and myofibromata constitute what appears to be a rather closely related group of tissue changes whose origins depend upon a common factor (estrin). Because of the increase in their incidence in recent years, these conditions warrant intensive investigation and consideration from the standpoint of diagnosis and treatment. That the frequency with which they are encountered in gynecological practice is increasing, there can be little doubt. The explanation of this increase is not so clear, but it is claimed that delayed marriages (2) and lack of early and frequent childbearing are factors of great importance, if not the primary cause. The term management, as used in this paper, implies the adoption of a procedure for case handling based upon an understanding of the etiology and the nature of the disease changes as well as the selection of the most desirable method of treatment and its application. Before discussing therapy for these conditions it is logical and appropriate to consider their pathology and diagnosis. Pathogenesis Endometrial Hyperplasia: Cystic glandular hyperplasia, or endometrial hyperplasia, is characterized by disturbances of the menstrual flow and the presence of glandular cystic hyperplasia of the endometrium. These changes appear to be the result of the action of the ovarian follicular hormone—estrone—and the absence of progesterol. The work of outstanding investigators (4) seems to prove conclusively that long-continued estrin stimulation of the endometrium, produced by ovaries with multiple follicular cysts and without a corpus luteum, is the cause of the characteristic cystic glandular hyperplasia of the endometrium, resulting in what is commonly known as the “Swiss cheese pattern.” There is little doubt that the influence of the gonadotropic hormones of the pituitary body is also in some way a factor in this physiological disturbance. Endometriosis: Endometriomata and endometriosis are conditions in which endometrioid tissues are found in ectopic locations. There are two main types of endometriosis. One is characterized by a down-growth of the epithelium into the myometrium, or the occurrence of islands of endometrial epithelium and stroma interspersed among bundles of smooth muscle tissue, entirely separated from the true endometrium. The latter are usually found in women who have been pregnant. This extension may involve almost the entire uterus, and if fibroids are present even these may be invaded. This condition has been designated adenomyosis. In the other type of endometriosis, endometrioid tissue is found in the ovaries, the oviducts, or somewhere on the pelvic or visceral peritoneum, most frequently in the cul-de-sac, on the anterior surface of the uterus, the uterosacral ligaments, etc.