OVARY (ABNORMAL ANATOMY). 



581 



The growth of these secondary cysts with 

 broad bases, of which a good example is ex- 

 hibited in _/?-. 39-k, is often very irregular, so 

 that one or more of them enlarging with 

 greater rapidity than the rest, encroach upon 

 the cavity of the containing cyst, and fill it 

 more or less completely. This rapid enlarge- 

 ment of the secondary cysts also occasionally 

 causes rupture of their walls and the escape of 

 their contained fluids into the parent cyst, 

 followed by the unrepressed growth of the 

 secondary or tertiary cysts which arise from 

 its surface. 



After the appearance of a tertiary order of 

 cyst within the secondary ones, their growth 

 occasions so much disturbance of the even 

 outlines of the walls in which they originate, 

 that it is often difficult to trace the order and 

 manner of enlargement of the different series. 

 Nevertheless, with care, these may be often 

 made out even in the complex forms, of which 

 jig. 395. furnishes an example. Here is re- 

 presented a small portion only of an enor- 

 mously enlarged ovarv, consisting of a primary 

 or principal sac, the greater part of which has 

 been cut away, so as to leave a part of its walls 

 visible at a, it, a , and of a more solid basis 

 which was made up of numerous secondary 



Fie: 395. 



Compound or proliferus ovarian cyst. (Ad Nat.) 



a, a, , divided walls of the principal single cyst ; 

 b, small simple cyst ; c, c, two masses of compound 

 secondary cysts, containing many of a tertiary 

 order. 



and tertiary cysts. Both of these orders may 

 be traced in this example. At a, a, a are seen 

 the divided walls of the original parent cyst, 



whilst springing from these walls at b is a single 

 secondary cyst, and at c, c are two groups of 

 similar cysts aggregated in masses. The lat- 

 ter are, however, examples of compound se- 

 condary cysts, for in the interior of each is 

 contained a series of a tertiary order, which 

 are so numerous as to fill completely the 

 secondary sacculi. By Lebert it is deemed 

 to be still an open question whether these 

 cysts, which apparently spring from the in- 

 terior of the main sac, as represented in figs. 

 39-i. and 395., are altogether new formations, 

 or whether they were not originally in part 

 developed, and by force of pressure, arising 

 from contiguity of situation, have penetrated 

 and at length grown within the principal 

 cyst, into the interior of which, in this view, 

 therefore, they would form a species of hernia. 

 Dr. Hodgkin *, whose elaborate descrip- 

 tions of ovarian cysts has made known all the 

 principal varieties of form which they assume, 

 distinguishes from the broad-based cysts, al- 

 ready noticed, those which arise by narrow 

 or slender peduncles. These sometimes grow 

 from the walls of the principal cyst, and, in- 

 deed, in almost all cases which I have exa- 

 mined, after the sac has attained a certain size, 

 patches of these pedunculated sacculi may be 

 observed scattered over the interior in various 

 places, but they are more constantly observed 

 growing from the interior of the secondary 

 cyst. These little sacculi appear at first in 

 scattered patches, under the form of little 

 round grains, thickly covering the lining mem- 

 brane which they raise above them, and so 

 closely set that two or three hundred may 

 sometimes be counted in the space of a square 

 inch. When these elongate, mutual pressure 

 causes them to assume a filamentous condition ; 

 but when greater freedom of growth is enjoyed, 

 their extremities commonly dilate into little 

 pouches, or buds of another order sprout from 

 the sides and extremities of the original 

 growths, and convert them into a multitude of 

 little dendritic processes which roughen the 

 inner surface of the larger cysts, or fill more 

 or less completely the cavities of the smaller 

 ones. 



If a section be made of these dendritic 

 processes, they are seen usually to be solid at 

 their base, the white fibrous tissue of the 

 parent cyst wall, from which they spring, being 

 easily traced into their stems and branches. 

 But at their extremities they become dilated 

 into little pouches filled with fluid, similar to 

 the little pediculated cysts, with which they 

 are abundantly intermixed. These little cysts 

 and processes are covered by epithelium, and 

 it is probable that they are the active agents 

 in the elimination of the various fluids by which 

 the ovarian cysts, of whatever order, are com- 

 monly filled. These minute processes and 

 vesicles, so abundantly found on the walls of 

 endogenous cysts, are represented in fig. 396., 

 which exhibits a portion of a proliferous cyst 

 of the natural size, covered by them on its 

 inner surface. 



* Loc. citat. and Med. Chir. Trans. Vol. xv. pt. ii. 

 p p 3 



