Cysts of the corpus lute= are uni locular cysts the size of a pigeon's egg, occasionally that of an apple. They were described by Rokitansky, and it was sup posed they could only occur in the cor pus luteum of pregnancy, but they have been found in the nullipara.
Tubo-ovarian cysts arise from contact with the distended tube adherent to a cyst of the ovary. The increasing press ure of the accumulating fluid gradually absorbs the thin septum, and the two sacs form one cavity, the smaller portion of which is usually formed by the tube. The uterine end of the tube can remain permeable and, as the fluid increases. permit the overflow to drain through the uterus. Such a condition is known as a profluent tubo-ovarian hydrops, which resembles ovarian hydrops tuba? pro fluens. The open tube acts as a safety valve and prevents increase from disten sion of the cyst.
Large Cysts. — Proliferating cysts comprise the great majority of ovarian tumors and vary in size from an egg to that of a tumor weighing over one hun dred pounds, which fills up the abdo men and encroaches upon the thoracic viscera. The surface of the cyst presents a pearly-white, glistening appearance, the thinner portions of which are purple, or black, according to the color of their individual contents. The external surface may be smooth or covered with papillary growths or mucous vegetations. . The glandular proliferous are highly or ganized and richly supplied with blood vessels. The glandular proliferous have the faculty of budding or generating new cysts from within the original growth. They may be spherical in shape and regular in outline, simulating a sin gle cyst, or be irregular from numerous nodules, which indicate a multilocular tumor. These growths generally have a distinct pedicle, which is the attachment of the tumor. The pedicle may be long or short, thin and band-like or broad and thick. Occasionally the tumor is
sessile. The latter are frequently intra ligamentary. The pedicle is developed by the traction of the tumor and the re sulting hyperplasia of the ovarian liga ment and stretching of the meso-ova rium. The tube generally remains sepa rated by its mesosalpinx from the tumor, while the ampulla is often fastened to or approaches the sac. The tube is usually elongated. In ovariotomy the tube is generally removed with the pedicle. The pedicle varies in length from four to twenty centimetres; in breadth, from two to twelve centimetres, and may be entirely absent. The tendency to absence of the pedicle depends somewhat upon the variety of the cyst. In glandular, the tendency is to a long pedicle; in papil lary, to short or absent pedicle; and in dermoid, it is short and strong.
Summary of 23 ovarian tumors weigh ing over 100 pounds collected from litera ture, and history of a personal case in which the weight of the tumor, sac, and contents was 245 pounds: 43 pounds more than any cyst yet recorded. In 24 cases, 15 recoveries followed operation. The average weight of the tumors was 129 pounds, while in G cases followed by death the average weight was 1S1 pounds. The fatality from operation in such cases thus appears to be directly proportional to the size of the tumor. Extensive adhesions also militate against successful operation. Primary aspiration is appar ently no safer than immediate opera tion. Marsupialization is contra-indi cated. Successful tappings are sometimes tolerated, but usually lead to exhaustion and death in a few hours. Death is apt to occur within a few hours as the result of shock, but, if this danger is passed, the fatal issue is likely to be the result of intestinal obstruction following ad hesions. BuHitt (Annals of Surg., Jan., 1900).