A Text-book of Diseases of Women

by Charles B. Penrose

The diagnosis of the condition is made by bimanual examination and by observation of the clinical course of the disease. The cystic disease is very often bilateral. The ovarian enlargement is slow in development and is always limited. A moderate maximum size is reached and may persist for years.

Treatment.—The only curative treatment of follicular cystic disease of the ovaries is by operation and removal of the tumor. Operation is required only in those cases in which the suffering is great. The mere presence of the cystic ovary does not demand operation, whether it causes physical suffering or not, as in the case of the cystic tumors hereafter to be considered. It must be remembered, however, that it is often difficult or impossible to make a differential diagnosis between follicular cyst of the ovary and a young glandular or papillomatous cyst, and it is very much safer in all doubtful cases to adopt the operative rather than the expectant plan of treatment. If, after the abdomen is opened, the cyst is found to be follicular, the ovary need not necessarily be removed.

If, at the time of operation, the ovary is found to present but one follicular cystic cavity, this may be opened and evacuated and part of the wall may be excised. If bleeding occurs from the edges of the cyst-wall, it may be controlled by whipping with a fine continuous suture of silk or catgut. Some operators avoid this bleeding by opening the cyst with the cautery-knife. In any case the bleeding is usually slight if a thin portion of the cyst-wall is selected for the incision. If the ovary is filled with a number of cystic cavities, it is safest to remove the whole organ. If the woman be young and anxious for children, the portion of the ovary that contains the cysts may be excised and the wound in the ovary closed by sutures of fine catgut. Simple puncture of the cysts does no good. The conservative operation is especially desirable in case both ovaries are diseased. When but one is affected, the surgeon need not hesitate so much before performing oöphorectomy.

If, as is very often the case in cystic disease of this character, the Fallopian tubes are found closed by inflammatory adhesions, salpingo-oöphorectomy is usually indicated.

Glandular Cysts.—Glandular cysts are also called multilocular ovarian cysts or ovarian adenomata.

It was formerly thought that all ovarian cysts originated in the Graafian follicles. This view has now been given up by most pathologists. The follicular cysts that have just been described never attain a large size, and run a distinctly different course from the glandular cysts now under consideration.

The glandular cysts probably originate from the tubes of Pflüger. It will be remembered that in the embryo the ovary contains many epithelial tubules derived from the germinal epithelium that covers the surface of the ovary. These are the tubes of Pflüger. In the process of development they become converted into Graafian follicles. Abnormally they persist, and have been found in the ovary at an advanced age, as late as the seventy-fifth year. In the newborn infant these tubes have been found cystic—the size of a pea. Such cystic degeneration of persistent tubes of Pflüger is the probable origin of glandular cysts of the ovary. According to this view, all such cysts are due to a congenital defect. Some are perhaps formed congenitally, and remain stationary or develop in later life.

The central cells of the tubes of Pflüger soften and become liquefied, and the tube becomes distended into a small pouch lined with primitive glandular epithelium.

The outer surface of a typical glandular cyst of the ovary presents a smooth, glistening, silvery appearance. This appearance is subject to considerable variation according to the character of the cyst-contents, the thickness of the wall, and the inflammatory and necrotic changes that have taken place. Sometimes there are ocher-colored or brownish spots upon the surface.

The surface of the cyst is often lobulated, from the presence of smaller cysts or a collection of secondary cysts in the wall.