A Text-book of Diseases of Women

by Charles B. Penrose

Carcinomata.—Primary cancer of the ovaries is very rare. Secondary infection of these organs is, however, of not infrequent occurrence. It is found in cases of cancer of the breast and of the uterus. In 29 cases of death from cancer of the breast, both ovaries were found to be involved in 3 cases.

Primary cancer of the ovary appears as a solid or a cystic tumor. The solid carcinomata are diffuse infiltrations of the ovarian tissue, forming pedunculated, rarely intraligamentous, ovoid or globular tumors having a smooth or slightly irregular surface. They are either of the medullary or scirrhous type. The medullary form is of rapid growth, and may reach the size of the adult head. The scirrhous form is of comparatively slow growth and smaller size, and in consistency resembles a fibroma.

The cystic carcinomata are similar in form to the multilocular glandular cysts, but are smaller, rarely reaching a greater size than that of the adult head. They are adeno-carcinomata or papillary adeno-carcinomata. The surface of the tumor, its walls, and the septa contain to a greater or less extent solid nodules or plates of various size composed of carcinomatous tissue. The nodules often have a papillary character.

Ovarian carcinoma is usually a bilateral growth. Unlike carcinoma in other parts of the body, it may, particularly the medullary form, occur in childhood. It is usually found between the ages of thirty and sixty years. Ascites is commonly present in cancer of the ovaries, the fluid being often tinged with blood; as the disease develops, edema of the lower limbs and cachexia appear.

Cancer of the ovary is an extremely malignant growth, quickly extending to surrounding structures as implantations on the peritoneum, and by metastasis to distant organs. In more than 75 per cent. of the cases operated upon the disease has returned and terminated in death within the first year.

When cancer of the ovaries is secondary to cancer elsewhere than in the uterus, operation offers no prospect of cure. If the disease is secondary to cancer of the uterus, it may be possible to remove all of the affected structures.

Ovarian Papillomata.—Superficial papillomata of the ovary are of very rare occurrence. In many of the cases in which the papillomata appear to grow from the surface of the ovary there had previously been a papillomatous cyst of paroöphoritic origin, which had become perforated and perhaps inverted, so that, after the cyst had become destroyed, the growths appeared to spring from the ovarian surface. Careful dissection and search for the remains of the old cyst should always be made in such cases.

In superficial papilloma of the ovary the growths are in all respects similar to those found in the interior of papillomatous cysts. They may be isolated upon the surface of the ovary, or they may cover it so completely that the ovary is hidden from view. A section, however, will reveal the ovary lying in the centre of the growth.

The papillomata may be pedunculated or sessile. They vary in size. In some cases they form a mass larger than the adult fist.

The disease is often bilateral. Secondary involvement of the peritoneum occurs, as in the case of papillomatous cyst. The course of the disease is similar to that of a perforated papillomatous cyst. The treatment is immediate celiotomy and removal. As in the case of papillomatous cysts, involvement of the peritoneum is no contraindication to operation.