Tumors of the Fallopian Tubes, Benign Growths. — Tumors of the tubes and ovaries may be benign or ma lignant. The benign tumors of the Fal lopian tubes are exceedingly rare, except ing those which are the products of in flammatory changes, and have already been given.
Fibroma, or myoma, of the tube is an infrequent growth, and attains to small size. It arises from the muscular tissue of the tube, and may grow inward or be come subperitoneal; it rarely obstructs the calibre of the tube. Inflammatory and tuberculous changes have some times been mistaken for this growth, particularly the condition known as sal pingitis nodosa.
Recklinghausen has described a form of fibroma characterized by fibroid con stituents and including glandular struct ure. This growth is attributed to some remains of the primordial structure. The fibrocyst of the tube is so rare that but a single case has been described, that of Stinger-Barth, which consists of three tumors, the conglomeration of various large cysts, firm tumors that were in part from the fimbrim of an otherwise healthy tube. Under exam ination the products greatly resemble a teratoma. Encliondromata are small cartilaginous masses found in the ends of the fimbria.
Dermoid cyst of the tube is exceed ingly rare. Ritchie described one which contained a plum-sized bone. Pozzi has also described a dermoid cyst removed from the tubal wall. Cysts of small size are frequent. The large irregular bullet so common in association with fibroid growths are said to be dilated lymph spaces. Cysts which vary in size from a pea to a walnut are found in the walls of the tube, but most frequently beneath the peritoneum. Cysts within the tube are generally the result of adhesions of adjoining folds of the mucous membrane. Polypus is a rarely recognized growth. Lewers reports a case in which the inner surface of the tube was studded with such growths varying in size from a pin's head to a pea. Papillomata of the tube, con sidered as adenoma by Sutton, are allied to the condylomata, or warts, of the vulva.; they consist mainly of epithe lium. These growths are difficult to dif ferentiate from sarcoma and cancer, but are evidently benign.
Malignant Growths. — Carcinoma of the tube may be either primary or sec ondary, though the latter is much the more frequent. The secondary involve
ment may take place from either the ovaries or the uterus. Doran divides primary cancer of the tube into two forms: where the cancer first develops in mucous membrane of a normally formed tube; second, where it forms in a malformed tube, bearing a cyst whose wall becomes infected.
Case of primary carcinoma of the Fal lopian tube. Thirty-one have already been recorded. The ages of the patients varied from forty to sixty years. The menopause does not seem to he an im portant factor in the development of the disease. Salpingitis has a direct bearing upon it. Boursier and Venot (Bevue de Gyn6e. et de Chir. Abdom., No. 2, 1901).
Sarcoma of the ovary is frequent; of the tube very rare. Sarcomatous nodules are sometimes found scattered over the peritoneal surface of the tube, but it more frequently passes from the ovary to the omentum. Deciduoma malignum can occur in a portion of the placenta or chorion of the tube. it forms in the tubal sac as readily as it would in the placenta or chorion of the uterus. The possibility of such an occurrence is urged by as an additional argument for active interference for the extirpation of tubal moles and the appendages after tubal abortion.
Tumors of the Ovaries.
These tumors differ from the other neoplasms in their greater propensity to malignant degeneration, often rendering it difficult to determine whether the indi vidual growth is malignant or benign; consequently we will discuss the two classes of tumors together.
Classification.—Tumors of the ovary are divided clinically into cystic and solid; pathologically into simple, pro liferating, dermoid, and parorarian. By size, into small and large. The cystic comprise the simple, proliferating, and the dermoid. Solid tumors, less frequent, are the sarcomata, and car cinomata. Cysts may originate in any part of the tubo-ovarian structure, as the cortical, medullary, and parenchymatous portions of the ovary, and in the struct ure between the tube and ovary known as the Rosenmiiller organ, or parovarian structure, of which the hydatid of Mor gagni, the extremity of the canal of Muller, is an example. Cysts which de velop in the folds of the broad ligament are known as broad-ligament cysts.