Malformations

The ovaries may be hypoplastic or occasionally one may be absent, seldom both. An ovary may be much displaced, sometimes being found in the inguinal canal or in the labium majus. It may also be displaced as a result of a change of position in the uterus or from pressure or adhesions.

Circulatory Disturbances

Active hyperemia may be either pathologic or physiologic; in the first as a beginning inflammation or in the latter during the menstrual period.

Chronic hyperemia is found in chronic heart disease or as a result of some localized obstruction.

Hemorrhage takes place when a follicle is ruptured. The blood escapes into the follicle after the ovum has been cast off and at the same time the cells lining the follicle proliferate. They soon undergo fatty degeneration, forming the corpus lu-teum of menstruation. The blood is finally absorbed, the cells break down, and organization takes place, leaving a small scar. When impregnation has occurred the corpus luteum is considerably larger than the above, and there is a more marked proliferation of the follicular cells. Instead of rapidly organizing it may persist even to the end of pregnancy. It contains a translucent gelatinous substance and little blood. The luteal cells are arranged in peculiar fan-like folds.

Oophoritis, or inflammation of the ovaries, is generally secondary to an inflammatory condition of the Fallopian tubes or of the peritoneum. Is generally due to the presence of pyogenic organisms which may infect the ovary by direct contact, as in peritonitis, or be carried in the blood- or lymph-vessels.

The ovary is much enlarged and congested and round-cell infiltration is common. Small abscesses may appear as minute yellowish points. Occasionally larger collections of pus form and these may rupture into the peritoneal cavity or into a loop of intestine. Generally the inflammation quiets down with absorption or inspissation of the abscesses and terminates in connective-tissue formation, chronic oophoritis. As a gradual transformation of the ovary into fibrous tissue is a normal process as the person advances in age, the change cannot always be attributed to inflammatory processes. The walls of the blood-vessels are usually much thickened and may show hyaline changes.

Adhesions frequently follow oophoritis and may cause serious trouble by their presence.

Tumors of the ovary are, as a rule, cystic in character.

Small follicular cysts may occur singly or multiple, as a result of the failure to discharge the ovum, with subsequent enlargement of the follicle. They may become as large as a man's fist and contain a thin or jelly-like fluid that is usually clear but which may be discolored by the presence of blood.

Such cysts are lined by a single layer of flattened epithelium, and are formed within the ovarian tissue.

The neoplastic cysts differ from the follicular in that the dilated spaces are surrounded by fibrous tissue that supports a vascular basement membrane upon which the cells rest. The epithelium is usually columnar and rarely is ciliated. These cysts are probably developed from Pflüger's tubes, and represent a cystic adenoma.

Instead of being single they are multilocular, and may be divided into two groups - the simple cystoma and the papillary cystoma. The material contained within the cysts is usually clear and gelatinous, if there has not been an admixture of blood. Although this substance closely resembles mucin it is not precipitated by acetic acid, consequently it is known as pseudomucin.

The simple cystoma is a benign growth and retains to some extent a glandular arrangement, in that there are formed acini lined by epithelium. It is usually multilocular, although in many instances the septa between the acini have been broken. The contents are usually thick and viscid on account of the pseudomucin present and vary from transparent to a reddish or even chocolate color. This substance is less frequently found in the papillary cystoma.

At times the proliferation of the epithelium may take on a malignant tendency and give rise to a carcinomatous degeneration. This is more frequent in the papillary variety.

The papillary cystoma are generally bilateral and probably originate from the paroophoron. From the inner surface of the cyst there extend papillary outgrowths covered by a stratified layer of ciliated columnar epithelial cells, many of which are of the goblet type. The fibrous framework is less marked, and concentric calcareous bodies (psammoma bodies) may be found within it. The substance in these cysts resembles that found in the simple form, except that there is a less amount of pseudomucin.

This form is much more inclined to undergo a secondary malignant degeneration than is the simple cystoma. The growth may be so rapid as to cause the wall of the cyst to rupture and the papillary structures project on the surface, giving rise to a cauliflower-like mass.

Dermoid cysts are more commonly found in the ovaries than in any other part of the body. They may be very small or large, and though generally unilateral may occur in both ovaries. Their structure and origin has already been described.

Fig. 176. - Papillary Cystoma of the Ovary. X 150 (Ziegler).

Their origin has been explained as a foetus infetu, or as a result of parthenogenesis of an unfertilized ovum.

Carcinoma of the ovary is nearly always a primary growth. It is glandular in character and generally undergoes a mucous degeneration. It usually gives a widespread metastasis along the peritoneum. Is not infrequent in childhood, and is rapidly fatal.

Fibroma may be found singly or multiple. They probably originate from the scars formed in the organization of the corpora luteii. Combination with sarcoma, fibrosarcoma, sometimes occurs. Myofibroma are also met with. Chondroma is rare. Sarcoma is rare, but may occur as a spindle cell or, more rarely, as a round-cell variety. Myxomatous degeneration is common. Metastasis is unusual, and the malignancy of these growths is slight. If there are many glandular structures present the neoplasm is called an adeno-sarcoma. Angiosarcoma occasionally occurs. Endothelioma is unusual.