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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    innermost part of the cyst, at the point of junction with the second and solid tumour, the two tumours touching over a circular area f- in. in diameter, no pedicle separating them. The drawing shows these appearances very well. o a A The lower tumour was a heavy, solid body 3 in. in long diameter, ft s If in. in short diameter, and If in. thick. It was very irregular in frtjfcSmUj form and tuberous, like a small potato. It was composed of a capsule of vascular reddish brown tissue, and interiorly of a very tough mass of fibrous structures, arranged in oval and spherical nodules like balls of worsted. This arrangement, so common in interstitial uteru^f myomata, is not seen in ovarian fibroma. Microscopic sections of one of these nodules were made at the museum of the Royal College of Surgeons. As may he seen from the drawing (Fig. 2), the substance consisted of almost pure plain muscle cells, arranged in an irregular manner. In short, the tumour was a myoma, histologically identical with the common uterine “ fibroid.>4-J /i/wA. cafrtAv fr.CJ Thus, in this case, there was some doubt as to whether/ toe r - pelvic swelling was an inflamed ovary or a solid ovarian tumour. It proved to be the latter, and, what is more, a rare disease, true myoma of the ovary. Clinical evidence of this form of new growth is much to be desired. At present there seems to be no means of diagnosing myoma from fibroma of the ovary. The former is much too rare a disease to be ranked as yet as more than a pathological curiosity; but, as has been the case with many other affections no longer reputed rare, it may often have been overlooked. Observers may fail to recognise plain muscle cells. Only on the high authority of Mr. Shattock do I feel certain that the tumour in my case was a pure myoma. In the case of fibroma of the ovary, we know that microscopists, working at the very same section, have disagreed as to whether cellular elements amidst the fibres represent connective tissue or sarcoma. When, however, the spread of knowledge of histology renders reports of myoma and fibroma more trustworthy, and pathological and clinical records can be safely compared, a means of diagnosis may present itself. That time, however, has not yet come. Hence comparisons are useless; thus, if we begin with the catamenial history, we find ourselves confronted by the fact that, in fibroma of tbe ovary, the better known of the two forms of tumour, menstrua- tion seems not essentially affected, as I was able to show two years since,1 Briggs of Liverpool confirming my observations a few months later.2 Menorrhagia, when present, may be due to the tumour dragging the uterus upwards; but in this communica- tion growths of sufficient size to drag on the uterus lie beyond the limits of discussion ; moreover, the dragging has little or nothing to 1 “Cases of Fibroma of the Ovary and Ovarian Ligament,” Trans. Obst. Soc. London, 1896, vol. xxxviii. p. 187. 2 “Fibroma of the Ovary and Ovarian Ligament,” Brit. Med. Journ., London, 1897, vol. i. p. 1083.