. Operative gynecology. e touch and by the uni-formity of the abdominal enlargement, that they are unilocular and thin-walled,and although they may have well-defined pedicles, usually they fill out the meso-salpinx at least, and so have a broad base of origin. Cysto-carcinomata and cysto-sarcomata convey the impression of unilocularcysts often with thick resilient walls; in their earliest stages they present nocharacteristic features, but later there is ascites, emaciation, and cachexia, and, itmay be, metastases. Among the hard tumors we have to distinguish the solid carcinomata,,the fibromat
. Operative gynecology. e touch and by the uni-formity of the abdominal enlargement, that they are unilocular and thin-walled,and although they may have well-defined pedicles, usually they fill out the meso-salpinx at least, and so have a broad base of origin. Cysto-carcinomata and cysto-sarcomata convey the impression of unilocularcysts often with thick resilient walls; in their earliest stages they present nocharacteristic features, but later there is ascites, emaciation, and cachexia, and, itmay be, metastases. Among the hard tumors we have to distinguish the solid carcinomata,,the fibromata, and some sarcomata. The fibroid is usually a dense tumor accompanied by ascites and unaccompaniedby any serious constitutional depression, in marked contrast to the loss of appe-tite and strength, the emaciation, cachexia, and edema of the malignant growths. The carcinoma often involves both ovaries, is hard and nodular, and is foundin much younger patients than the fibroma; metastases are, of course, Fig. 406.—Typical Polycystic Ovarian Tumok, niTii Loho Twisted Pedicle. The larger portion of the ovary (Ov) is intact, and the tumor occupies its outer extremity. The abdominalendof the uterine tube lies below the ovary. Jan, 23,1897. )^ natural size. ? MULTILOCULAE OVARIAN CYST-ADENOMA. 259 Multilocular Ovarian Cyst-adeaoma.—The multilocular ovarian cjst-adenoma isthe classical tumor of the gynecologist, recognized and operated upon for manyyears before any clear distinctions as to the microscopical or clinical charactersof other ovarian tumors obtained recognition (see Fig. 406). Pathology.—The ovarian cyst-adenoma owes its origin to a multiplica-tion of the glandular elements of the ovary ; these glands become distendedwith secretion, the fluid accumulating with varying degrees of rapidity to formcysts of all sizes. The cysts are usually unilateral, occurring somewhat moreoften on the right side than on the left, but they may occur in both ovaries att
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