There is an interesting variety of ovarian cysts which is characterized by the presence of papillomata, or warts, upon the inner surface. These cysts arise from the paroöphoron or from the hilum of the ovary. Many theories have been advanced to explain the origin of these tumors. Pathologists are far from agreeing upon this subject. Perhaps the most popular view among English and American pathologists is that the papillomatous cysts originate from the remains of the Wolffian body which may persist in the paroöphoron in various stages of degeneration.
As paroöphoritic cysts spring from the hilum or the attached portion of the ovary, and develop in the direction of least resistance, they very often separate the lamellæ of the mesovarium and invade the loose connective tissue between the layers of the broad ligament. These cysts are thus very often extra-peritoneal or intra-ligamentous in their development.
Some writers of experience state that three-fourths of all papillomatous tumors of the ovary are of intra-ligamentous growth. This has not been the experience of the author. The majority of the papillomatous ovarian cysts that he has seen have been intra-peritoneal in development, and have had as well-defined pedicles as the ordinary multilocular ovarian cyst.
Fig. 168.—Papillomatous cyst of the paroöphoron. The section shows the papillomatous growths in the interior and the relation of the oöphoron.
Cyst-wall.—If the papillomatous cyst be intra-peritoneal in development, two layers of tissue may be distinguished in its wall: an outer dense layer, composed of laminated connective tissue which sometimes contains unstriped muscle-fibers; and an inner loose layer of fibrous tissue. Both layers contain numerous blood-vessels.
If the cyst be extra-peritoneal or intra-ligamentous in its development, we find, in addition to the two layers just described, an outer coat of peritoneum which is derived from the broad ligament.
The internal surface of the cyst—the walls and the papillæ—is covered by a single layer of cylindrical epithelial cells, which may become flattened by pressure in the large cysts. The epithelium is often ciliated.
Upon the interior of the papillomatous cyst are found warts or papillary growths. These growths vary in size from that of a grain of sand to that of the fetal head. They may be scattered over the cyst-wall or collected in groups. The larger growths often form arborescent, cauliflower-like masses, which may be so numerous and luxuriant that rupture of the cyst results.
In color the papillomata vary from whitish to dark red or black, according to the vascular supply. They are sometimes yellow as the result of fatty degeneration. They are usually very vascular, and bleed freely when manipulated.