=Ovarian Papillomata.=--Superficial papillomata of the ovary are of very rare occurrence. In many of the cases in which the papillomata appear to grow from the surface of the ovary there had previously been a papillomatous cyst of paroöphoritic origin, which had become perforated and perhaps inverted, so that, after the cyst had become destroyed, the growths appeared to spring from the ovarian surface. Careful dissection and search for the remains of the old cyst should always be made in such cases. In superficial papilloma of the ovary the growths are in all respects similar to those found in the interior of papillomatous cysts. They may be isolated upon the surface of the ovary, or they may cover it so completely that the ovary is hidden from view. A section, however, will reveal the ovary lying in the centre of the growth. The papillomata may be pedunculated or sessile. They vary in size. In some cases they form a mass larger than the adult fist. The disease is often bilateral. Secondary involvement of the peritoneum occurs, as in the case of papillomatous cyst. The course of the disease is similar to that of a perforated papillomatous cyst. The treatment is immediate celiotomy and removal. As in the case of papillomatous cysts, involvement of the peritoneum is no contraindication to operation. =Tuberculosis of the Ovary.=--Tuberculosis of the ovary is usually secondary to tuberculosis of the Fallopian tubes. In tuberculosis of the peritoneum the ovaries are often found to be involved, in some cases without accompanying disease of the tube. In phthisical women the ovaries have been found, in rare instances, to be the only portion of the genital apparatus in which secondary deposit of tubercles took place. Williams states that primary tuberculosis of the ovaries has not yet been described. The surface of the ovary may be covered with miliary tubercles, or they may be scattered through the substance of the gland. In other cases the ovary contains cavities filled with cheesy material or pus, forming a tuberculous abscess. There are no characteristic symptoms of tuberculosis of the ovaries. The condition is usually found at operation or at autopsy, associated with tuberculosis of the peritoneum or of some other part of the genital organs, as the Fallopian tubes and the uterus. The treatment consists in oöphorectomy, unless operation is contraindicated on account of extensive involvement of other structures. =Tumors of the Ovarian ligament.=--Fibroid and sarcomatous tumors have occasionally been found in the ovarian ligament. Doran has reported a fibroid of the ovarian ligament that weighed 17 pounds. The writer has removed a sarcoma of the ovarian ligament that weighed 5 pounds. It is impossible to distinguish these tumors from similar growths of the ovary. They demand like treatment. CHAPTER XXXIII. MALFORMATIONS OF THE GENITAL ORGANS.