Reflex disturbances in the breast may occur with ovarian cysts, as in any form of ovarian disease. The areola may become pigmented, the breasts swell, and a milky secretion may be produced even in young girls.
Malignant degeneration may occur in any form of ovarian cyst. It seems to be most frequent in the papillomatous tumors, next in the dermoids, and less frequent in the glandular cysts.
The rapidity of growth of ovarian cysts varies a great deal. The glandular tumors are of the most rapid development. They sometimes attain a very large size within a few months. The rate of accumulation of the fluid depends upon the intracystic pressure, and is consequently greatest immediately after rupture or tapping. Some remarkable cases of great rapidity of accumulation after tapping have been reported. In one case 90 pints of fluid reaccumulated in seven weeks—a rate of about 2 pints a day. In another case 3½ pints of fluid were accumulated every day.
The enormous size attained by ovarian cysts, and the tremendous amount of fluid drawn off from them, are shown by the old records of the days when tapping the cyst was the only treatment. A few references will illustrate this. In one case 1920 pints of fluid were drawn off by 66 tappings in a period of sixty-seven months. In another case 2787 pints were withdrawn by 49 tappings. In another case 9867 pounds were withdrawn by 299 tappings. The fluid in these remarkable cases must have been of low specific gravity, containing but little solid matter, or the women would have sooner succumbed from the drain on the system.
The misery of the women who were slowly crowded out of existence by these enormous tumors, or who, though with life prolonged by tapping, were exhausted by the continuous drain, was depicted in their countenances. The expression was called the facies ovariana. We do not often see it at the present day. Wells describes it thus: “The emaciation, the prominent or almost uncovered muscles and bones, the expression of anxiety and suffering, the furrowed forehead, the sunken eyes, the open, sharply defined nostrils, the long, compressed lips, the depressed angles of the mouth, and the deep wrinkles curving around these angles, form together a face which is strikingly characteristic.”
The natural duration of life depends upon the character of the ovarian tumor. A dermoid may exist from childhood and give no trouble—in fact, may not be recognized until some accident starts it into rapid development. Even then it is of comparatively slow and limited growth, and danger from it is due to the accidents, such as inflammation and suppuration, to which it is especially liable.
Though the papillomatous cyst is also of slow growth when compared with the glandular cyst, yet the danger here is due to peritoneal infection, which very often takes place before the tumor has, by its size, begun to annoy the woman.
The glandular cyst, however, is of rapid, continuous, unlimited growth, and usually destroys the woman within a period of three years. Life has been prolonged for a much longer period in some cases by palliative treatment and tapping. On the other hand, life may at any time be cut short by the occurrence of some accident, such as rupture or torsion of the pedicle.
Symptoms of the Accidents that occur in Ovarian Cysts.—The symptoms of inflammation are pain and tenderness over the surface of the tumor. The tenderness is often limited to a local area which marks the position of an intestinal adhesion.
When suppuration takes place, the symptoms indicative of the presence of pus appear—elevated temperature, rapid and feeble pulse, exhaustion, and emaciation.