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The above distinctive details are illustrated in the accompanying microphotographs
(figs. 1 and 2).
The first report of an ovarian tumour of a similar type was in 1895 by von
Kahlden. Since then, some 60 further cases have been reported. A summary of
the findings was delivered by Lepper, Baker and Vaux, and appeared in the Proc.
Royal Society of Medicine XXV. 8 (June, 1932), p. 1241. A number of articles
have been published since then, in some of which aspects such as secondary sex
changes (Novak) and metastases (Holmer) have been reported and discussed.
Discussion.
These tumours may be met with at various stages in growth, the largest reported
being nearly 12 inches long. They are enclosed in a tough fibrous capsule,
which shows no tendency to form adhesions. On section, the substance is spongy,
partly solid and partly cystic. Yellow or hæmorrhagic patches, spots or streaks
are often to be seen. The microscopical appearances have been divided into three
groups or types:—
(1) Follicular, in which the appearances resemble those of Graafian follicles,
or may be much larger;
(2) Cylindroid, in which trabeculæ are prominent, containing a fibrous
tissue core covered by columnar, cubical or polygonal cells;
(3) Irregular, in which, though one or other of the former patterns is
present on search, the predominant pattern is of epithelial cells irregularly
arranged in a scanty fibrous tissue stroma.
Though usually occurring in patients who have experienced the menopause,
this is not an inevitable rule. In any case, however, the history is usually one of
a period of amenorrhœa followed by metrorrhagia which may be prolonged. Metastatic
development is rare, but may occur. As to treatment, simple removal should
be followed by radio-therapy. In the event of encountering secondary deposits,
they also should be removed.