Retention Cysts.—It is certainly possible that through occlusion of the main duct retention may occur, and an ever-increasing distension of the canals of the gland. For the formation of retention cysts, however, the chief cause must be occlusion of the separate lobules, since inflamma tion of the efferent duct is more likely to result in rupture and discharge of the accumulated secretion.
Certain retention cysts, according to Blob, are at the outset generally spindle-shaped, and later round. They are superficial, smooth-walled, uni locular cysts, in general containing clear mucoid matter. They occur also as dilatations of the efferent duct, and seldom are larger than a wal nut. Huguier describes further a species of conglomerate cyst, which results from the occlusion of the common duct and dilatation of the near est lobule.
Another form of retention cyst is also round, and developes from cys tic degeneration of one or more of the acini. The contents are either serous, or colloid, varying in color from a clear yellow to a brown. The cysts which develop from the gland or its duct enlarge during menstrua tion, and may merge into abscesses. (Blob and Kobner.) It is ques tionable if where, as in KObner's case, the contents of the cyst is fatty, and with chalky deposits in the walls, it is not more correct to consider it a dermoid rather than a cyst formed from Cowper's gland.
Honing has described a peculiarly interesting case, of which there is only one other instance to be found in literature. At the outset the patient had an imperforate hymen which was opened for the relief of retention of the menses. She then became chlorotic and ceased to men struate. At twenty-three years of age the menses returned with dys menorrhea. At thirty-six years of age the patient again sought advice on account of a tumor of a labium which was found to spread up the va gina, and pushing up the cervix. It could be felt through the abdomi nal wall. The diagnosis of vagina duplex with retention of blood was made. Incision, however, gave exit to a thick, gray-white, fatty mate rial, and the tumor was proved to be a retention cyst of Bartholin's gland which had extended up the vagina. It appeared then as if the atresia of the hymen and the occlusion of the duct of the gland had occurred at the same time in early childhood. The only other similar case which has
been recorded is that of Boys de Lourq. (Sur les cystes et tes absces des grandee limes. Revue Medicate, IV. 1840.) The differential diagnosis between hiematokolpos and a dissecting cyst of this nature may be made by the fact that pressure on the cyst in the vagina will not result in its appearing beyond the dividing line between the vagina and the vestibule in case it is a hcematokolpos, whilst in case of cyst of the gland pressure will force the contents down into the labium majus.
Huguier stated that such cysts might develop upwards in the space between the pelvis, vagina, and rectum, but an instance of this nature has never been recorded. As regards the symptoms, it is noteworthy that in Honing's case the incision and excision of a portion of the cyst wall caused the disappearance of dysmenorrhoea which had lasted for years: He thence claimed that the menstrual hyperaemia caused each time an increased tension of the cyst.
The treatment of these cysts is only radical when they are entirely extirpated. In the case of other retention cysts, we know how frequent recurrence is after excision, unless adhesive union is obtained. We should remember, however, that in instances like those of Honing and Boys de Lourq, extirpation has its risks from the liability of wounding neighboring organs. In case of small cysts, however, extirpation is in dicated, and is not difficult even where union has occurred with the sur rounding cellular tissue. When I refer to abscess of Cowper's glands. the result of interstitial inflammation, I will speak further of the method of extirpation.
When from some cause or other the entire gland cannot be removed, then after incision we must endeavor to pass a probe from outwards through the duct, since otherwise recurrence will unquestionably obtain if we cannot cause union of the walls of the cyst. To cause such adhesion the best plan is to fill the cavity with cotton dipped in tincture of iodine or covered with iodoform.
The Bartholinian gland may also inflame, aside from retention of its secretion and without extension of the inflammation through the duct.