Papillary proliferous cysts present marked proliferation of the connective tissue, which forms tufts upon the inner surface of the tumor. These branching projections may distend the sac to burst ing, the tuft project upon the outside, and lead to rapid infection of the general peritoneum. Vegetations spring up lux uriously over the surface of the ovary, and are carried to every part of the peri toneal cavity, and not infrequently by aspiration arc made to penetrate the dia phragm into the thorax. The contact of the peritoneum with the infection pro duces extensive ascites. Similar vegeta tions may arise spontaneously upon the surface of the ovary, and are then known as superficial papillary. These are eases in which a small cyst is opened and in fects the external surfaces. Papillary tumors rarely attain a large size, but are generally bilateral. The dendritic growths project in every direction. The projections are reddish or pearly white and glistening, often three or four inches long, and have the appearance of stems of coral. Masses occasionally undergo partial calcification; so they break easily and without bleeding.
Migrated ovarian and parovarian tu mors: i.e., growths that have by torsion and tension of the pedicle become en tirely detached from their former con nection with the broad ligament, and either lie free in the abdominal cavity or have formed new attachments to other organs or tissues. Four eases reported. Recovery followed operation in all these cases. Forty-three cases found in litera tune. The migrating organs consisted of free ovaries, 3; parovarian cysts, 3; ovarian cysts, 21; ovarian dermoids, 15; eystosarcoma of the ovary, 1. G. M. Edebohls (Med. Record, Aug. 18, 1900).
Dermoid Cysts.—These are growths in which are found skin and mucous brane, with all the structures generally associated with such tissues. The tissues most frequently found are teeth, hair, nails, and sebaceous and sweat- glands.
Other structures occasionally seen are mamma;, horn, bone, unstriped muscu lar fibre, and very rarely tissue resem bling brain. Fat or sebaceous material at the temperature of the body is gener ally in the liquid state. Occasionally they are found in solid balls. Sutton reports finding three hundred of these in one sac. Hair is frequently present in great abundance, and varies in color, length, and quantity. It may be blond, brown, or black, but bears no relation to the color of the individual. Teeth are found in about one-half the cases, and may be loose, fixed, or buried in the wall. All varieties of teeth are found. Schnabel describes a case which had three pieces of bone and one hundred teeth. Plouquet found three hundred teeth. Various bones have been described, as the jaw, petrous portion of the temple, ribs, and pelvic bones, a finger with articulated phalanges, nail and or entire skeleton has been recognized.
Dermoids do not always occur alone, but in conjunction with large glandular cysts, the dermoid forming a small part of the mass.
Ovarian dermoids believed to be due to simultaneous irritation of histolog ically different portions of the paren chyma, each portion responding to this irritation in its peculiar way. Dermoids are usually found in combination with pseudomucin cysts, which, in all prob ability develop from the follicular epi the combination with cysts lined with ciliated epithelium. Nan nenstiel (Amer. Jour. Med. Sci., Oct., '97).
Dermoid and teratoid tumors of the ovary are ovulogenous, since they al ways present evidences of the three em bryonic layers. It may be assured that their manner of development is not one of pathogenesis, since the latter is a physiological process. The cleavage of the ovum from which a dermoid de velops is pathological. Only the earliest portions of the embryo develop, hence the prominence of the ectoderm and cephalic end, while the remaining por tions either do not develop at all or are deformed. The differentiation is one sided, and is sometimes confined to a single organ, such as a breast. In con nection with this subject the question of the differentiation of sex in the ovum presents a suggestive field for future study, though the expectation of affect ing this result, as claimed by Schenck, may be dismissed as vain. Kroemer (Archie f. Gynak., B. 57, II. 2, '99).
Teratoma is a more complete form of growth of tumor which is usually classed with the dermoid. It often attains to an enormous size, contains the various structures of the dermoids, cartilage, and a large amount of connective tissue. Der moid growths can appear at any age, have been found in children at birth, and in women of ninety years. The contents of the dermoid sac are exceedingly ing, and every precaution should be prac ticed to prevent their escape into the peri toneal cavity.
Parovarian Cysts. — The parovarium, or epoophoron, is situated in the lateral part of the mesosalpinx and is a rem nant of the IV°lfflan body. Parovarian tumors are almost always cystic and sub serous, and consequently have a double wall. The external peritoneal is easily separable. The pellicle consists of the tube, median ovarian ligament, and the suspensory ligament. Paroophoron and broad-ligament cysts form about 11 per cent. of abdominal tumors of pelvic origin, and both proliferating and der moid growths have been found in this situation. They arc distinguished from ovarian, first, by the ease with which the peritoneum can be stripped off; sec ond, by the ovary being generally found attached to the side of the cyst; third, by the cyst being unilocular; fourth, by the Fallopian tube stretching over the cyst, never communicating with it; lastly, the gradual thickening of the mesosalpinx.