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vagina, origin, wall, vaginal, tumor, cyst and posterior

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CYSTS. — Symptoms and Etiology. Cysts of the vagina are not of frequent occurrence. They may occur singly or there may be several on one or both vaginal walls. They may be retention cysts containing lymph or litmus, to which blood may have been added by rupture of contiguous vessels. Purulent degeneration may be a subsequent stage. An abscess forming a cystic tumor of the vagina may also result from a hm/iatoma. or from a tumor within the pelvis (pelvic abscess, cyst of the broad ligament, etc.) which communicates with the vagina by means of a sinus or fistula.

Histological examinations have shown that cysts of the vagina may be classified as follows: (a) inclusion cysts; (b) cysts of embryonic-tissue origin; (c) cysts of glandular origin.

(a) Inclusion cysts, due to the epithe lium being included within the raw sur face, follow a traumatic lesion of the vagina. This is the most probable origin of cysts found on the posterior wall of the vagina, though a cyst of such origin may occur in any portion of the vagina.

(b) Cysts of embryonic-tissue origin are most probably due to either the fcetal remains of a portion of the lining epithe lium of a WoMan duct or to a dilatation of the duct itself, the most likely position for cysts of such an origin being upon either lateral wall.

(c) Cysts of glandular origin are due to the dilatation of one or more gland, of the vagina. If von Preuschen's theory of glands be accepted, then the dilatation may be considered to have taken place in the branching portion of the glands. J. E. Stokes (Johns Hopkins Hosp. Re ports, vol.,vii, '98).

These cysts seldom attain any great size, and they are not usually painful except when connected with severe le sions of the pelvic organs.

The size of cysts of the vagina varies from that of a pea to a small orange. Those cysts which are larger are gen erally found to have arisen without the vaginal tissue. The most common loca tions are the posterior wall, about the median line; the lateral wall, upon either side; in the sulcus formed by the junction of the posterior and lateral walls; and the anterior wall, in the sub urethral area. The appearance of the

cyst in situ is of importance, as it not only aids in showing the etiology of the cyst,—cysts without the vaginal tissue being more apt to be conical in shape,— but aids in making the differential diag nosis. The vaginal mucosa may be smooth or thrown into ridges. The smaller cysts generally resemble a white grape, but may be of a dark-brown color, the larger ones being generally of a dark, opaque color. The walls may be thin or markedly thickened.

The smaller cysts of the vagina sel dom, if ever, give rise to any symptoms. The larger cysts may produce painful and frequent urination, painful defecation, dysmenorrhcca, dragging pains in the back, difficult locomotion, or dyspareu nia. If decidedly large they may ob struct labor. A diagnosis is generally made without difficulty. The possibility of connection with the bladder or rectum or the presence of a hernia should always be borne in mind. J. E. Stokes (Johns Hopkins Hosp. Reports, vol. vii, '9S).

The positive diagnosis of cysts can always be corroborated without the least danger (if the ordinary necessary aseptic precautions are taken) by the use of the hypodermic syringe. With cysts simulat ing cystocele (if the hypodermic is used for differential diagnosis), due care must be observed to avoid aspirating the blad der by passing directly through the cyst into the cavity. This may be avoided by introducing a sound into the bladder to determine the relative thickness of the suspected tissue. When the tumor is on the posterior wall, the index finger is in troduced per rectum and the thumb per raginam; and all the structures between can be easily distinguished. Herman L. Collyer (Amer. Medico-Surg. Bull., Apr. 25, '99).

uncomplicated cysts may be ligated at their base and excised, or if too deep seated for ligation, they may be exposed by incision in the vagina and dissected out, the wound being then carefully closed. If connected with a tumor of the pelvis, of course this must be removed as a preliminary to their re moval.

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