112 DISEASES OF THE OVAKIES. 



indisposition to burst is not the sole cause of their formation, and 

 that a morbid state of the secretion within the follicle may be the 

 real cause. Sometimes these cysts are solitary ; sometimes they 

 exist in great numbers. They are generally small, and hence often 

 remain undetected until after death. Exceptionally, a cyst or a 

 cluster of cysts makes a tumor of the size of a fist, very rarely of 

 the size of the head. Such a cyst has thick walls, is smooth within^ 

 and contains a yellow, serous liquid. In young cysts traces of fresh 

 or altered blood can be perceived. Communication between several 

 cysts due to atrophy of the intervening tissues is rarely seen. 



2. The so-called cystomata, or cystoids that is to say, prolif er- > 

 ating cysts are by far the most common and important form of 

 ovarian tumor. By most new authors the histogenesis of a cystoma 

 is sought in the epithelial components of the ovary. According to 

 Waldeyer's graphic account, a cystoma does not originate from the 

 ordinary egg containing a Graafian follicle, but rather from the 

 more rudimentary forms of the epithelial portion of the ovary, 

 from the rounded balls of epithelium, and from the tubular struc- 

 tures, the so-called "Pflttger's tubes" which have probably origi- 

 nated at the embryonal period of the organ. Instead, however, of 

 normally developing into Graafian follicles, from the very commence- 

 ment they have developed into cystomata ; or else the follicle is 

 converted into a cystoma by repeated proliferation of the epithelium 

 of its inner surface. As in all mixed tumors in their later periods, 

 there is in a cystoma an intergrowth of epithelial, dermoid, and 

 vesicular structures, out of which the various types of tumor are 

 built. This growth by proliferation of the interior of the cyst the 

 author classifies in two groups, glandular and papillary. In the 

 glandular form sections through the cyst-wall everywhere exhibit 

 small, simple, tubular epithelial pits (almost always cylinder-epithe- 

 lium) in the substance of the wall, which present the character of a 

 glandular formation. The mouths of these tubes soon become 

 stopped up by tough secretion, and then, almost exactly as other 

 " retention-cysts " form, they become first distended pouches and 

 then small sacs. Upon the interior of the walls of these sacs new 

 depressions form, which in their turn deepen and form pouches and 

 cysts, and so on ; thus a honeycomb appearance is produced. In 

 the papillary cystoma the proliferation of the connective tissue of 

 the cyst-wall is the main feature. From their inner surface numer- 

 ous ramifying, shaggy, highly-vascular vegetations sprout. Some- 

 times these are circumscribed, growing only within a certain limit ; 

 sometimes they increase incredibly, filling the whole sac. There 

 are many intermediate forms. 



