Solid growths of the ovary comprise 5 per cent. of the cases presenting them selves for operation. These tumors are innocent or malignant, and may become cystic.
Fibromyoma is a benign form of rare tumor, but the most common species of solid ovarian tumor. The growth is slow and maintains the normal shape of the ovary. Adhesions are rare. Williams described one which weighed seven pounds seven ounces; Doran, one of sev enteen pounds.
Sarcoma of the ovary resembles in form, size, and color a fibroid, excepting that its surface is smoother; its con sistence is softer than a fibroid, though it contains much fibrous tissue, making the diagnosis at times difficult to deter mine. It occurs in the round and spin dle-cell growths. The latter predomi nating, the tumor is more solid and more strongly resembles the fibroid. Spindle and round cells are frequently combined, while myxomatous transformation exists in both kinds, but cartilage- and bone formation rarely occurs. Sarcoma com bined with carcinoma has been observed in the walls of larger cysts.
Fibrosareomata of the ovary are al ways bilateral, occur in young as well as in old subjects, and grow slowly, ascites being usually present. The entire ovary is affected, but maintains its usual form even when much enlarged, although the surface becomes more or less nodular, On section they show a firm, homogene ous structure with myxomatous soften ing in the interior; cysts may result either from the latter cause or from the dilatation of follicles. Histologically they present more or less marked hyper plasia of the ovarian connective tissue, and may be characterized as fibrosareo mata, rich in cell-elements, and with a tendency to mucoid degeneration.
Although these growths may remain stationary for a long period, they have a marked tendency to become dissemi nated through the lymphatics, first within those of the ovary itself, then in the vessels of the tube and corresponding broad ligament, and often in distant parts of the body. Krukenberg (Archly f. Gynak., B. 1, H. 2, '96).
Carcinoma of the ovary is much more rare than sarcoma. The medullary for mation is the most common, and may form a tumor quite as large as a man's head.
Symptoms of Ovarian Tumors.—Early stages of ovarian tumors produce no symptoms. Occasionally an apple-sized tumor, though movable, may cause un pleasant symptoms, as pain in the sacrum, which extends down the leg. Intraliga mentary tumors or those prevented by adhesions from rising out of the pelvis produce severe symptoms as soon as they fill the space, especially by obstruction to stool and micturition. In large tumors distress arises from pressure, and inter ference with the circulation and respi ration. The skin becomes stretched and forms strive, swelling of the navel, hernia, occasionally from pressure upon the great vessels, (edema, varicosities in the legs, in the sexual apparatus, and in the skin of the abdomen. Albuminuria, diminu tion of urine. and compression of the renal veins are observed. Severe com pression symptoms are now rarely seen from large tumors, as they are not per mitted to attain large size. Menstrua tion is usually unaffected. It disappears comparatively early in those cases in which the follicles perish from the devel opment of sarcoma, carcinoma, and the papillary eystadenoma when bilateral. Menstruation decreases, and the tion to menopause is betrayed, not from absent ovulation, but as a result of constitutional conditions. Amenorrhoea may exist for several years and tion return after the removal of an ova rian cyst.
The disappearance of an abdominal cyst following the passage of large quan tities of urine, usually regarded as pathognomonic of intermittent hydro nephrosis, may also occur in connection with ovarian cysts.
The difficulty of distinguishing be tween such cysts and hydronephrosis is greatest when the tumor fills the ab dominal cavity. The relation of the large intestine to the cyst is most im portant, since it is only exceptionally that it lies in front of one of ovarian origin. If the gut is collapsed it may be distended by injections of effervescing salts. Vaginal examination will often throw light on the diagnosis; also cathe terization of the ureter. Wilson (Bir mingham Med. Rev., Aug., '97).