A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The typical parovarium consists of three parts: a series of vertical
tubules; a series of outer tubules free at one extremity; and a larger
longitudinal tubule.
The vertical tubules range from five to twenty-four in number. They
converge somewhat toward the ovary, where they end in blind extremities
and become closely associated with the paroöphoron. At the other end
they terminate in the larger longitudinal tubule.
The series of outer tubules are called Kobelt’s tubes. They are free
and closed at the distal extremity, while at the proximal extremity
they join the longitudinal tubule. The larger longitudinal tubule is
called the duct of Gärtner. It may sometimes be traced traversing the
broad ligament to the uterus, and through the walls of this organ and
of the vagina to its termination at the urethra. It corresponds to the
vas deferens in the male. When persistent in the vaginal wall it may
become the starting-point of a vaginal cyst.
The vertical tubes of the parovarium are from 0.3 to 0.5 millimeters
in diameter. They are occasionally found lined with ciliated columnar
epithelium. Usually they contain a granular detritus representing the
remains of broken-down epithelium.
Cysts may arise from any of the parts of the parovarium.
Kobelt’s tubes frequently become distended, and form small
pedunculated cysts about the size of a pea. They are of no clinical
importance (Fig. 145). They are often observed in operations for
ovarian disease, and are very often mistaken for the hydatid or the
cyst of Morgagni which springs from the Fallopian tube, and which has
already been described.
[Illustration: FIG. 170.--Cyst of the parovarium. There is no
distortion of the ovary. The Fallopian tube has been much elongated.]
The difference between these two varieties of small cysts may be
determined by careful examination of the point of origin and by
means of the microscope. Sutton states that the cyst of Morgagni has
muscular walls and is lined by ciliated columnar epithelium. In the
cyst of Kobelt’s tubes the walls are fibrous and the lining is cubical
epithelium.
Large cysts of the parovarium originate from the vertical or the
longitudinal tubules, and usually remain sessile and develop between
the layers of the mesosalpinx and the broad ligament. As the cyst
grows and separates the layers of the mesosalpinx, it comes into close
relationship with the Fallopian tube. This structure, being held by its
uterine connection and the tubo-ovarian ligament, becomes stretched
across the surface of the cyst and very much elongated. The elongation
of the Fallopian tube is a very constant accompaniment of parovarian
cysts. The tube may attain a length of 15 or 20 inches. The fimbriæ may
also become much stretched and elongated by the traction of the growing
cyst, and may attain a length of 4 inches.
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