A Text-book of Diseases of Women

by Charles B. Penrose

The papillomata may be sessile or pedunculated. The pedicle is sometimes very long and thin. Calcification of the papillomata often takes place.

Papillary cysts are usually unilocular. In any case the number of secondary loculi is much smaller than in the glandular cyst.

Fluid Contents.—The fluid contents of the papillomatous cyst differ considerably from those of the glandular cyst of the ovary.

In the papillomatous tumor the contents are usually clear and of a watery consistency, with a specific gravity of from 1005 to 1040. They are not often thick, mucous, or gelatinous in consistency, as in the glandular cyst. The color varies from light yellow to dark brown from admixture of blood. As in all cystic tumors, the character of the contents depends upon the accidents that have happened during the growth of the cyst.

Papillomatous cysts are more often bilateral than any other cystic tumors of the ovary. They affect both ovaries in from 50 to 75 per cent. of the cases. For this reason the operator should always carefully examine the second ovary after removing an ovarian cyst, for beginning cystic degeneration may be found in it also.

Papillary cysts are usually of smaller size and of slower growth than glandular cysts. The papillomata usually perforate the cyst and invade the peritoneum before large size has been attained. These tumors, therefore, are not often seen of larger size than the adult head.

Though papillomatous cysts of the ovary are not as common as the glandular cystomata, yet they are by no means unusual. The statistics of operators vary a great deal. In 600 ovariotomies Schroeder found 50 papillomatous cysts—somewhat over 8 per cent. In the experience of the writer they have been very much more frequent than this.

The papillomatous cyst is the most dangerous cyst affecting the ovary. The danger lies in metastasis of the papillomatous growths to the general peritoneum. Metastasis occurs from the perforation of the cyst-wall and the escape into the peritoneum of the papillomatous masses.

The tendency to rupture of the cyst-wall is one of the characteristics of this form of tumor. The wall becomes weakened by atrophy or fatty degeneration, or by direct pressure of the luxuriant papillary growths. These growths make their way to the outer surface of the cyst, and extend thence throughout the peritoneum; or, if rupture takes place, the cyst may become so inverted that the site of each ovary is occupied by a mass of papillomata; the formerly enclosing cyst has disappeared, and its remains can be discovered only by careful dissection ([Fig. 169]). Such a condition has undoubtedly often been mistaken for primary papilloma of the ovary, the real origin in a papillomatous cyst not having been detected.

The secondary affection of the peritoneum is due not only to continuity of tissue, but to implantation and growth of portions of papillomata that have become broken off and carried to different parts of the peritoneal cavity. Such secondary growths may extend throughout the whole abdomen from the pelvis to the diaphragm, covering any of the viscera. They resemble in all respects the original papillomata found in the interior of the ovarian cyst. They sometimes form cauliflower-like masses as large as the fist, and may be palpated through the abdominal wall. They are very vascular, and bleed profusely on being handled. The smallest particles of papillomata are capable of infecting the peritoneum or other tissues in this way.