Lesions. The enlarged ovary may be uniformly rounded and smooth, or it may be marked by irregular bosses, giving it a lobulated appearance. It is very vascular, and is often covered by a thickening of peritoneum. When multiple they are usually closely adherent and may even be included one within another. The individual cysts may be of the most varied sizes. The cystic ovary has at times reached enormous dimensions: in the mare 46 lbs. (Bouley, Rivolta, Thiernesse): in the cow 250 lbs. (Reynolds, Meyer): in the ewe 7 lbs. (Willis): in the sow 7 lbs. (Reyer): in the bitch 15 lbs. (Bovett). The walls of the cyst are formed of connective tissue more or less perfectly organized, arranged it may be in several superposed layers (Galtier) and lined or not by epithelial cells (cylindroid, nucleated, or of various forms). They may be reddened by hæmorrhages or pigmented from former blood extravasations. The liquid contents may be clear and watery, white, straw yellow, or of a deeper yellow, brown or red. Among other constituents there are alkaline chlorides and sulphates, albumen in solution or flakes, mucin, fibrine, fatty granules and cholesterine crystals. In some instances they contain pus cells (chronic abscess).
Symptoms. Small, tardily growing cysts may cause no appreciable symptoms. The larger ones or those that increase rapidly are liable to cause disorders of circulation, innervation and digestion. The mere pressure of a considerable cystic ovary may interfere with portal circulation so as to entail muco-enteritis, rectal congestion, piles, or intestinal torpor or impaction. Adhesions of the diseased ovary to adjacent intestinal viscera, tend to produce constrictions, obstructions and local congestions or inflammation. In adhesions to the womb or bladder, ureter or kidney, the symptoms will indicate disorder of these respective parts. The weight of the enlarged ovary causing extension of its ligamentous connections will allow of its winding around a loop of intestine and producing strangulation. In those unusual cases in which pregnancy occurs it may interfere with its completion, causing abortion or, failing in this, with parturition, by becoming imbedded in the pelvis. In the line of innervation, disorder is especially common in the digestive organs, anorexia, nausea, impaired rumination, and colicy pains resulting. Again, in many subjects the genesic instinct is stimulated, the patient is more or less constantly in heat, cows become bullers, and mares switchers, they cannot be impregnated, and under the continuous excitement undergo rapid emaciation. There is often urinary disturbance, frequent straining with the passage of a small quantity only of turbid or glairy liquid, colored, it may be, by blood, or fœtid. The colics are liable to be dull and slight, the patient moving uneasily, switching the tail, moving the weight from one hind foot to the other, pawing, looking at the flank, but seldom lying down or rolling. In other cases, with adhesions, impactions, obstructions, and congestions, all the violent motions of the most intense spasmodic colic may be shown. Where there has been rupture of the obstructed bowel, these symptoms may merge into those of peritonitis, septic infection, or collapse. When with these symptoms of intestinal disorder, there are tender loins and flank, abdominal plenitude and tension, genital excitement, frequent straining to pass urine, the discharge of a glairy or fœtid liquid, and when all these symptoms have increased slowly for weeks or months in a female, the ovaries may be suspected and a rectal examination should be made. Usually the outline of the womb can be made out with the enlarged and irregularly shaped ovary anteriorly and adherent to it through one of the broad ligaments; it may be sensitive to touch, tense, or even fluctuating. Difficulty may be encountered when the enlarged ovary is so great as to fill the whole region, or when adherent to or wound round the rectum, thus hindering the advance of the hand or the movement of the gut, or when it has become pediculated and displaced to a distant part of the abdomen. Even the obstructed and distended intestine, may prevent a satisfactory diagnosis. Yet in the great majority of cases rectal examination gives conclusive results.
Treatment. Medicinal measures are useless: surgical alone are of any avail. Castration is the natural resort, and in all recent cases, uncomplicated by adhesions, is to be preferred. In the large females it may often be performed through the vagina, but if the ovary is very large the flank operation becomes imperative. Sometimes the evacuation through a cannula of the contents of one or more large cysts will so reduce the mass as to allow of the safer vaginal operation.
A less radical measure is the evacuation of the cyst with cannula and trochar and the injection of tincture of iodine. With a hand in the rectum the ovary may be held against the abdominal wall to facilitate the operation. The results, however, are not satisfactory, for, although re-accumulation of the liquid is delayed, it is not entirely prevented. Moreover, when the cysts are multiple, the punctures also must be numerous, or remain ineffective. Nor is the operation unattended by danger as deaths often occur from resulting inflammation, infection, or iodine poisoning.
Zannger, in 1860, introduced the method of rupturing the cyst without incision, and met with considerable success. With the hand in the rectum the cystic ovary is pressed against the wall of the pelvis or abdomen, until the attenuated wall of the cyst gives way, the fluid is left in the abdominal cavity, to be absorbed and many animals will afterward become pregnant. In a large proportion of cases in which the symptoms are marked, the walls of the cyst are sufficiently attenuated to allow of rupture by pressure, and, if the escaping contents are free from infecting microbes, no immediate harm comes to the peritoneum. It should be avoided in case of abscess, following perhaps on a shivering fit and constitutional febrile reaction, and when there is a fœtid discharge from the vulva, suggesting microbian infection likely to dangerously infect the serosa. In appropriate cases it is a resort of very great value, in restoring to use animals that are especially valuable for their progeny and which become utterly useless when rendered barren. According to different observers an average of 70 per cent. can be restored to usefulness in this way. Friedberger and Fröhner claim 90 per cent. Some febrile reaction may be noted for twenty-four hours, demanding rest, restricted, cooling, laxative food and sometimes laxatives and anodynes.
DERMOID CYSTS OF THE OVARY. PILOUS CYSTS.
Closed cutaneous sacs, with hair and sebum. Causes: enclosure of dermoid tissue in embryo: aborted ovum: virgin gestation. Symptoms. Treatment: Castration.
These are much less common than are simple cysts. They are closed sacs, lined by a tissue essentially representing skin, and containing sebaceous matter and hairs, some growing from the dermoid surface, and others detached and formed into a loose mass.
Causes. These cysts have been attributed to the enclosure, in the forming embryo, of the formative elements of dermoid tissue, which may or may not remain latent and inactive until maturity, or until the ovary becomes physiologically active.
Another theory is that an impregnated ovum has remained imperfect, developing only the elements of the skin, instead of the whole fœtal body. Many cases cannot by any possibility be included under this head, seeing that the cyst is found at much too early an age, and its bearer has never had sexual intercourse.