SOLID TUMORS OF THE OVARY.
Solid tumors of the ovary are of rare occurrence. They are said to be
found in about 5 per cent. of all the cases of ovarian tumors that are
submitted to operation.
The solid tumors of the ovary are fibromata, myomata, sarcomata,
carcinomata, and papillomata.
=Fibromata.=--Ovarian fibromata are very rare; they are histologically
similar to fibroid tumors of other parts of the body. They do not
form circumscribed new growths, but affect the whole organ, which
becomes uniformly hypertrophied, preserving its general shape and
anatomical relations. The tumor may contain, between the bundles of
fibrous tissue, small cavities filled with fluid. The growth is usually
intra-peritoneal and has a well-formed pedicle; it may, however, in
exceptional cases be extra-peritoneal and develop between the layers of
the broad ligament. In such a case there is difficulty in determining
whether the fibroid originated in the uterus or in the ovary. Ovarian
fibromata are usually of small size and slow growth. A case has been
reported in which the tumor weighed over 7 pounds.
_Corpora Fibrosa._--A variety of the ovarian fibromata are the corpora
fibrosa, which are due to fibroid degeneration of the corpus luteum.
They are tough, fibrous bodies, about the size of a pea, which are
occasionally found upon the surface of the ovary. It is said that they
may attain the size of a child’s head. They are usually, however, very
small, and have no clinical significance.
=Myomata.=--Ovarian myomata are composed chiefly of unstriped muscular
fiber. They are somewhat more frequent than the pure fibromata. The two
growths may be mixed, forming a fibro-myomatous tumor. The myomatous
tumor may attain the weight of fifteen pounds.
=Sarcomata.=--The majority of solid tumors of the ovary are sarcomatous
in character, and it seems probable that many tumors that are classed
as fibroids or fibro-myomata are in reality ovarian sarcomata. The
growth may be either of the spindle-cell or the round-cell variety.
Occasionally it is an endothelioma, a form of sarcoma developing from
the endothelial cells of the blood- and lymph-vessels.
Sarcoma of the ovary differs from sarcoma in other parts of the body
in the fact that it is very often bilateral. Sutton states that
both ovaries are affected in about 20 per cent. of the cases. Other
observers state that ovarian sarcomata are usually bilateral.
The surface of the tumor is smooth, and the general form and anatomical
relations of the ovary are unaltered. Ovarian sarcomata are usually of
median size, though they may attain enormous proportions and fill the
abdominal cavity.
The tumor is usually of rapid growth; in one case it attained a weight
of ten pounds within a period of six months. The growth is accelerated
by pregnancy. Ascites is commonly present with ovarian sarcoma, and
cachexia may appear rapidly.
Ascites caused by peritoneal irritation may accompany any of the solid
tumors of the ovary, as other kinds of freely movable abdominal tumor.
It is, however, especially characteristic of the ovarian sarcomata, and
is a point of diagnostic importance.
Ovarian sarcomata differ from the fibroid and the myomatous tumors in
rapidity of growth, involvement of both ovaries, and the presence of
ascites. Ovarian sarcomata may occur at any age. They are relatively
very frequent in children. An analysis of 60 cases of ovarian tumors in
children collected by Sutton shows that sarcomata occurred 16 times.
The symptoms caused by ovarian fibromata, myomata, and sarcoma are
those referable to pressure and peritoneal irritation. These tumors,
on account of their moderate size and great mobility, seem to be
especially liable to torsion of the pedicle. They should be removed by
celiotomy as soon as recognized.
Both ovaries should always be carefully examined, for in sarcoma the
disease is often bilateral.
=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.
=Tuberculosis of the Ovary.=--Tuberculosis of the ovary is usually
secondary to tuberculosis of the Fallopian tubes. In tuberculosis of
the peritoneum the ovaries are often found to be involved, in some
cases without accompanying disease of the tube. In phthisical women
the ovaries have been found, in rare instances, to be the only portion
of the genital apparatus in which secondary deposit of tubercles took
place.
Williams states that primary tuberculosis of the ovaries has not yet
been described.
The surface of the ovary may be covered with miliary tubercles, or they
may be scattered through the substance of the gland. In other cases the
ovary contains cavities filled with cheesy material or pus, forming a
tuberculous abscess.
There are no characteristic symptoms of tuberculosis of the ovaries.
The condition is usually found at operation or at autopsy, associated
with tuberculosis of the peritoneum or of some other part of the
genital organs, as the Fallopian tubes and the uterus.
The treatment consists in oöphorectomy, unless operation is
contraindicated on account of extensive involvement of other structures.
=Tumors of the Ovarian ligament.=--Fibroid and sarcomatous tumors have
occasionally been found in the ovarian ligament. Doran has reported a
fibroid of the ovarian ligament that weighed 17 pounds. The writer has
removed a sarcoma of the ovarian ligament that weighed 5 pounds.
It is impossible to distinguish these tumors from similar growths of
the ovary. They demand like treatment.