Cysts.—Cystic growths attain almost unlimited size, larger than any other growth, and occasionally the body seems but an appendage to the tumor. They rapidly reach the weight of one hundred pounds. Maritan recently reported an ovarian cyst weighing two hundred pounds, removed from a woman who had previously weighed two hundred and ninety pounds. Her girth measure was ninety inches. Solid tumors closely re tain the shape of the ovary; cystic are irregularly spherical,—the larger they become, the more spherical. The surface of the cyst is a bluish white, greenish, brownish, yellow, or a glistening white. Secondary developments in the cyst-wall may give it an irregular shape. Cysts are still further divided into unilocular, or single cysts, and multilocular, where the cysts are divided into a number of cavi ties or smaller cysts within its walls.
The contents of the various tumors greatly differ. Indeed, the different cysts in the same tumors show radically different contents. In the unilocular tumors the contents are usually clear and limpid; in the multilocular, thick, viscid, and glne-like. In some chambers it may be clear and limpid, in others thick and viscid, or, again, mixed with pus, blood, or fat. Cysts of the broad ligament are generally unilocular and contain clear fluid. Those which orig inate in the hilum are papillary, and those from the parenchymatous structure of the ovary glandular. The small cysts are described as: first, small residual cysts which develop from the horizontal canals of the parovarium, with which may be included the hydatid of Mor gagni; second, follicular cysts; third, cysts of the corpus lutcum; fourth, tubo ovarian cysts.
The large cysts are: first, the gland ular proliferous; second, the papillary proliferous; third, the dermoid, simple and mixed; fourth, parovarian, includ ing several varieties, as hyaline, papillary, and dermoid.
of cystic degeneration of the ovary are divisible into three groups, viz.: 1. Those in which the ovary is filled with small cysts, showing various stages of degeneration, where it is diffi cult to decide macroscopically whether the condition is normal or pathological.
It seems to represent essentially an in crease in physiological processes. 2. In this group the changes are more evident, as some of the dropsical follicles attain a considerable size and others atrophy. Hyperremia is more marked, with result ing hemorrhages; so that some follicles lose their lining epithelium and are filled with coagula. 3. In the third group the cystic formation is general, though ova can still be found in some of the fol licles, even when they are denuded of epithelium. Degeneration of the ovum
is often preceded by changes in the membrana granulosa.
Microscopically, in the majority of the cases, so-called hydrops follicull are due to glandular formations following in growth of the germinal epithelium, and not to simple dilatation of a pre-existing follicle. Moreover, this mode of origin can be inferred in some cases of ordinary cystic degeneration. Kahlden (Beitrfige zur path. Anat. u. zur AlIgem. Path., Bd. xxxi, 1902).
Small residual cysts develop in the structure between the tube and ovary, known as the parovarian structure, or organ of Rosenmilller. Those originat ing in the vertical tubes have ciliated epithelium, and may subsequently de velop into papillary growths. They are detached from the ligament and hang from the peritoneal surface by a slender pedicle. Attached to the fimbriated end of the tube is generally found a small cyst varying in size from a pea to a cherry, known as the hydatid of Morgagni, which from its almost constant presence is re garded as a physiological cyst.
Follicular cysts, or hydrops lorum, are small cysts which are unilocu lar, dilated follicles, generally multiple and small. In an ovary which has not attained twice its size, fifteen or twenty of these cysts are often found. They were long considered as the sole source of large ovarian cysts, but it is in rare instances only when they attain the size of a fist, occasionally that of a man's bead. The contents of the cyst are gen erally clear, may be blood-stained, and have a specific gravity of 1005 to 1020. The cyst-wall is a transparent, thin mem brane of light-gray color, covered with columnar epithelium. The ovarian stroma may be excessive or the reverse. In the latter condition the ovary is fre quently converted into a mass of delicate cysts. The disease is generally bilateral. These cysts are unruptured and dilated Graafian follicles. In the smaller ones ovuli may be detected. Failure to rupt ure and increase of fluid contents increase the atrophy of the follicle. Rupture may be prevented by undue thickness, or toughness, of the ovarian wall, which re sults from inflammation, or deposits of exudation upon the surface of the ovary. It also is caused by a deep situation of the developing follicle, or a very slight congestion, insufficient to furnish proper secretion to produce rupture. These cysts have been found in an ovary prior to menstruation; indeed, in the foetal ovary. They rarely give rise to syrup MUM^.