OVARY (ABNORMAL ANATOMY). 



579 



To this coat, which appears to retain or in- 

 crease its thickness by a perpetual new for- 

 mation of fibrous tissue, is clue that support 

 and resistance to the pressure of the in- 

 creasing contents of the sac, which prevents 

 the more frequent rupture of these cysts. And 

 it is probable that when the latter phenome- 

 non occurs, without the formation of previous 

 adhesions, followed by tilceration, the lacera- 

 tion is clue to the gradual attenuation of the 

 middle wall of the sac. 



Occasionally portions of these walls are 

 found to be of nearly cartilaginous hardness, 

 so that they can with difficulty be broken up 

 into fragments for minute examination. Such 

 portions are seen under the microscope to be 

 composed almost entirely of close-lying fibres 

 of white fibrous tissue, with scarcely a trace 

 of the embryonic fibres and granules, which 

 are found abundantly in the walls of the softer 

 cysts, and of the normal ovisac. Other por- 

 tions of these cyst walls, still more dense, 

 present to the naked eye, as well as under the 

 microscope, all the characters of the simpler 

 forms of cartilage ; whilst in the walls of 

 other cysts again are found patches of ossific 

 matter, in which the earthy elements of bone 

 are aggregated together, (calcification) but 

 without the definite arrangement characteris- 

 tic of true osseous structures. 



Upon and in the substance of this middle 

 coat ramify numerous arteries and veins, some- 

 times of considerable magnitude. These dis- 

 tribute their minute branches upon the inner 

 surface of the cyst, where they occasionally 

 present a peculiar straight or rectangular ar- 

 rangement. Doubtless these vessels are the 

 carriers of those enormous collections of fluids 

 which accumulate within the cysts, and upon 

 their arrangement, as well as upon the nature 

 of the epithelial lining of the sac, depends 

 probably the character of the fluids secreted 

 or effused. 



Most variable is the condition of the lining 

 membrane which bounds the inner surface of 

 the cyst. In the smaller cysts it is often com- 

 posed of one or more layers of simple flat- 

 tened epithelial cells ; the remains, perhaps, 

 of the membranagranulosa. This surface may 

 be free, or to it may adhere fragments of blood 

 clot, degenerating or undergoing fibrillation, by 

 which the sac, when small, is partly filled. 

 This lining of epithelial cells is often seen in 

 a state of fatty degeneration*, and similar 

 cells are found abundantly scattered among 

 the contents of the sac. 



In the larger and older cysts the membrane 

 lining the sac is nearly as smooth as that which 

 covers it externally. In these the lining 

 membrane often exhibits but little vasctilarity, 

 and shows small traces of an epithelial cover- 

 ing in its smoother parts, where it is usually 

 so intimately adherent to the middle walls, as 

 to be separable from the latter only with diffi- 

 culty. Fragments so obtained are easily 

 split up, and are seen to be composed of deve- 

 loped fibres of connective tissue, intermixed 



* Wedl, Tatholog. Ilistol. p. 4G1. Syd. Soc. 



with fine granules 



and a few embryonic 

 fibres. 



After the simple cyst has arrived at a cer- 

 tain period of its growth, and generally when 

 it equals the size of a large orange, it begins 

 to exhibit upon its inner surface patches, more 

 or less extensive, of rough projections, gra- 

 nulations, or vesicles, which will be described 

 more fully under another section. 



Multiple Ci/rfs. I have employed this term 

 to designate a variety of the single cyst which 

 might be confounded with the compound or 

 proliferous kind, and which consists merely in 

 an aggregation of two or more simple cysts 

 that have been contemporaneous in their 

 growth. The distinction between a mere ag- 

 gregation of simple cysts and the growth of 

 a compound one has been carefully drawn by 

 Rokitansky*, and has been also illustrated by 

 Paget.f 



If such cysts are observed at an early 

 period of their growth, they may be seen to 

 occupy different portions of the ovary in which 

 they arise independently of each other, and 

 having distinct portions of ovarian stroma 

 interposed between each. They have at first 

 a round or oval form, but " as they all enlarge 

 together, and sometimes by the wasting of their 

 partition walls come into communication, they 

 are flattened by reciprocal pressure, and " may 

 at length look like a single many-chambered 

 cyst, having its one proper wall formed by the 

 extended fibrous covering of the ovary. Many 

 multilocular cysts, as they are named, are only 

 groups of close-packed single cysts ; though 

 when examined in late periods of their growth, 

 and especially when one of the group of cysts 

 enlarges much more than the rest, it may be 

 difficult to distinguish them from some of the 

 proliferous cysts. 



Figs. 392. and 393. serve to illustrate the 

 simple and the multiple cyst respectively. 

 Fig. 392. has been described at p. 575, where 

 this example is given as an instance of hyper- 

 trophy of a Graafian follicle in an early stage, 

 forming a simple or unilocular cyst, still 

 hardly contained within the substance of the 

 ovary. It will be seen that at one part of this 

 preparation the wall of the cyst has become 

 blended with the general investments of the 

 ovary ; and it will be easily understood how, 

 by the gradual enlargement of the cyst in this 

 direction, where there will be the least amount 

 of resistance to its growth, the sac may at 

 length become so greatly expanded that the 

 remaining healthy portion of the ovary will 

 appear only as an appendage to it, or may 

 become by pressure and extension altogether 

 obliterated. Fig. 393., taken from Dr.IIooper's 

 collection |, offers a good example of the mul- 

 tiple cyst. It is composed of a mure aggre- 

 gation of simple or unilocular cysts, which, 

 by coincident enlargement, have come at length 

 to fill the entire ovary, causing considerable 

 increase in bulk of that organ. From the 

 right ovary () a portion has been removed 



* Loo. cit. p. 33-2. 



f Lectures on Surgical Patlinl. Vol. ii. p. 50. 

 J Morbid Anatomy of the Human Uterus. 

 p i> 2 



