. Clinical gyncology, medical and surgical. to undergo cancerous degeneration is wellknown, though so sweeping a statement as that of Wells, that they areall malignant, is, of course, based on clinical rather than on anatomicalobservations. The cancerous change may be limited to small portions ofthe cyst, discoverable only on careful microscopical examination, or it mayinvolve the entire growth and be accompanied by metastases in distantorgans. The question of metastasis in connection with simple non-malig-nant papillomatous cysts is au interesting one, and is of great importancesurgically. By
. Clinical gyncology, medical and surgical. to undergo cancerous degeneration is wellknown, though so sweeping a statement as that of Wells, that they areall malignant, is, of course, based on clinical rather than on anatomicalobservations. The cancerous change may be limited to small portions ofthe cyst, discoverable only on careful microscopical examination, or it mayinvolve the entire growth and be accompanied by metastases in distantorgans. The question of metastasis in connection with simple non-malig-nant papillomatous cysts is au interesting one, and is of great importancesurgically. By metastasis we understand not the direct extension of thegrowths to adjacent organs (the bladder, rectum, or uterine cavity) afterperforation of the cyst, but the development of independent secondarygrowths on the peritoneum, with accompanying ascites. These are producedby the implantation of fragments of the original growth which are detached, float about in the peritoneal fluid, andlodge at various points, where they Fig. 8. ^x^Ti V^^pr. Section of papillomatous ovary. (Coblenz.)—hfg, dropsical Graafian follicle; ep, cysts filledwith papillary vegetations; bs, pedicle; is, inter-papillary spaces; pi1, superficial papillary vege-tations. become fixed and undergo an inde-pendent growth. Cases of true metas-tasis in the lungs have been reported,emboli being carried by the vessels inthe usual manner. As regards their frequency of oc-currence, papillomatous cysts are nowknown to be more common than wasusually supposed, their proportion to-the glandular being about one to related to these cysts is theinteresting condition known as super-ficial papilloma of the ovary, or clinically warty ovary. This is quiterare, many gynaecologists with a large experience in abdominal surgerynever having encountered a case. In a typical specimen the ovary is enlargedto the size of a walnut or a goose-egg, its exterior being studded with cauli-flower growths identical in appearance wit
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