Fig. 169.—Double papillomatous cyst of the ovary. The right cyst has ruptured and is turned inside out, showing a mass of papillomata. Papillomata have penetrated the wall of the left cyst. The peritoneum has been infected, and a papillomatous growth appears on the fundus uteri.
The escape of a small quantity of the cyst-fluid into the abdomen during the removal of the tumor may cause subsequent recurrence in the peritoneum. Secondary development of the growth in the abdominal cicatrix, or its appearance in the site of puncture after tapping, is due to the same cause.
Papillomata of the peritoneum are usually accompanied by ascites. This is a prominent symptom in those cases of papillomatous ovarian cyst in which secondary infection of the peritoneum has taken place. In rare cases ascites is present, though perforation of the cyst and involvement of the peritoneum cannot be detected.
Sometimes perforation of the cyst takes place into adjacent organs, especially if the growth be intra-ligamentous. In such cases the papillomatous masses may protrude into the bladder, the rectum, or the cavity of the uterus.
CHAPTER XXX.
CYSTS OF THE PAROVARIUM.
The parovarium consists of a series of fine tubules lying between the layers of the mesosalpinx. It may be seen in the fresh specimen by holding the mesosalpinx stretched between the eye and the light ([Fig. 145]).
The typical parovarium consists of three parts: a series of vertical tubules; a series of outer tubules free at one extremity; and a larger longitudinal tubule.