STRUCTURE. — The internal structure of glandular cysts justifies their division into the areolar, unilocular, and multi locular. The glandular cysts, Yirchow says, originate in the invagination or proliferation of the epithelium in the stroma. Continuation of these processes causes the formation of a bered, glandular, or adenomatous cyst.
An areolar cyst is a conglomeration of small cysts, with thick, well-developed and vascular stroma. A number of cysts may have ruptured to form a able-sized one or the entire tumor may be made up of a large number of small masses, none of which will exceed the size of a plum. Ynilocular cysts often attain an enormous size, but examination will disclose evidence of a previous di vision into numerous smaller cysts; so it may be asserted that all unilocular cysts originate from multilocular ones. A careful investigation will usually dis close small cysts in the wall, not infre quently the remains of septa in its cavity. Multilocular cysts contain a number of cysts of varying size, so arranged as to present the appearance of a single tumor. By the increase of the individual sacs, their intervening walls gradually become thinned until one after another they rupture, and the sacs coalesce to form larger single chambers. These remains of septa become still more stretched as the tumor increases in size, until they present only a cord-like surface on the inner margin of the tumor. Occasionally the vascular structure alone remains to indicate the former septum. In sudden rupture vessels of the septa are torn and extensive hcemorrhage may follow, changing the character of the sac-con tents. Upon examination of a large cyst we usually find a wall with three layers, the outside consisting of pure connective tissue like the albuginea of the ovary, the middle of loose connective tissue with numerous large vessels, while the inner is rich with cells and contains numerous small vessels. The external surface of the cyst is covered with columnar epithe lium, and it is lined with one layer of cylinder epithelium, which presents dif ferent forms in different tumors, and by its structure governs the character of the secretion in the various sacs. In the larger cyst the epithelium undergoes de generative changes, through thinning of the septal wall. Fatty or albuminous changes cause the epithelium to disap pear entirely from the wall of one or more of the larger cysts. Pfannensteil
has directed attention to the possibility of the formation of papillary growths in the glandular cysts. These growths may be sparsely distributed from the inner surface of a large cyst; in others they appear as circumscribed tufts in one side of the cyst, while the remaining portion is smooth, or, again, the entire cavity may be filled with strong, branching growths, while the quantity of fluid is very scant. The larger the cyst, the greater the probability that a large por tion of the wall is smooth. Cyst-con tents often present a very great contrast in color and consistence, as almost color less, a straw color, green, purple or black, thin or thick, viscid or gelatinous. The contents of the various cysts in the small tumor differ in color and consistence, in some the fluid will be thin and in others so viscid that it will not flow. The con tents of smaller cysts are more consistent, and become thinner as the cysts increase in size. The specific gravity of the fluid varies from 1002 to 1020, with an average of 1012. The fluid, however viscid it is, is absolutely structureless. It contains blood-corpuscles, epithelial cells, and crystals of cholesterin, while its reaction is neutral or alkaline. analysis. various forms of albumin, metalbumin. paralbumin, and albumin peptone arc found.
Contrary to the opinion now almost universally accepted, that in simple ovarian cysts, especially in cases of hy drops folliculi, we have to do with re tention cysts of Graefe's follicles, the writer, on the basis of careful investiga tions (always of both ovaries) in a series of cases points out that it is rather an adenomatous new growth developing from a sinking in of germinal epithelium. The observation is one of great impor tance in regard to the histogenesis of papillary and glandular cystoma. The question whether the complex formation of papillary cystoma may be developed from insinkings of ciliated epithelium the author does not consider ripe for dis cussion. The ova found in such cysts by earlier authors, which were the essen tial basis of the views hitherto prevailing, are also, according to the writer's investi gations, partly the products of degenera tion of epithelial cells, partly egg-like forms due to transformatory or new growth processes in the epithelia of the cyst. V. Kalihien (Brit. Gymec. Jour., from Ziegler's Beitr. z. Path. Anat., B. 27, H. 1, 1900).