Ovarian tumours simulating inflamed ovaries : including a case of ovarian myoma / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: Ovarian tumours simulating inflamed ovaries : including a case of ovarian myoma / by Alban Doran. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The main truth was that the swelling proved to be a true neoplasm, for an ovarian dermoid cannot be looked upon as in any sense a product of an inflammation.1 I spared the opposite ovary, and the disease had not recurred over five years after the operation. Pfannenstiel2 condemns all healthy ovaries, fellows of cysts, and solid tumours, in patients over 40 ; but, at least in the case of dermoids, his principle may be questioned. The next case is an instance of hremorrhage into the ovaries, which may occur both in oophoritis and in cystoma of the ovary.3 Case 3.—Mpf Ii., set. 25; single. For a year she had been under the care of Dr. J. Williams, of Connaught Street, W., on account of pain in the loins and left iliac fossa; dysuria was marked. The catamenia appeared nearly every two weeks, with free show; small clots occasionally passed, with much pain. The temperature rose to 990,S at night on several occasions. Uterus pushed to the left, cavity 3 in. Left appendages tender, swollen, fixed, and lying in Douglas’s pouch; a swelling in right fornix. Operation, 12th Dec. 1895.—The right ovary was converted into a cyst containing 4 oz. of tarry blood; the tube and mesosalpinx were quite healthy. The left ovary was also cystic and full of blood, with a sound tube and sound ligament. It was strongly adherent to the pelvic structures. Both appendages were removed. Nine months later, the patient, who had never menstruated since both her ovaries were removed, was in fair health. There were flushings and insomnia, but though the patient had been neurotic for several years, the premature menopause was not marked by severe symptoms. Here there was marked menorrhagia, and inflammation assur- edly existed, but the uterus was involved,4 and the free discharge of blood from its cavity possibly had little or nothing to do with the cysts. The ovaries, as I found on examination, were primary 1 A follower of Kiister might speculate as to what would have happened had the operation been deferred for a few months. That observer believes that a dermoid tends to rise in front of the uterus, and to lie well in the middle line, so that if displaced sideways or downwards it rapidly slips back to its favourite site. Mandelstamm (Gynecologic, 1896, p. 179) attributes this alleged peculiarity to the lightness of a dermoid. But a heavy fibroma of the ovary may lie in front of the uterus. 2 “Ueber Carcinombildung nach Ovariotomien,” Ztschr. f. Geburtsh. u. Gynak., Stuttgart, 1894, Bd. xxviii. He emphatically repeats the above statement in his treatise on “Die Erkrankungen des Eierstocks und des Nebeneierstocks,” in Veit’s “Handbuch der Gynak.,” 1898, Bd. iii. part 1, S. 486. 3 In Davenport's Case 4, there was hajmorrhage into a cyst; in Case 9, a ha;ma- toma of one ovary, its fellow being cystic. 4 Davenport notes, in relation to his own cases : “ There seems to be a direct causal connection between severe uterine haemorrhage and cystic ovaries which are closely adherent to the uterus.” The left ovary adhered in this case, but the condition of the uterus explained the menorrhagia. In the main, Davenport’s experience agrees with my own.