. Gyncology clinique, médical et chirurgical des ovaires. à l'emplacement d'un follicule de Graaf, que le tube et l'ovaire agrandir simultanément et que le septum entre le twocavities donne ultérieurement. Mais, étant donné que cette combinaison peut être inconnection avec de gros kystes multiloculaire (et même avec ceux de l'broadligament), il semble juste de conclure qu'il peut y avoir formation d'thecyst avant la tube malades devient adhérente à elle. Ces kystes presenta forme caractéristique, l'existence d'une dilatation progressive de l'extrémité du tube d'itsproximal vers l'extérieur, le kyste allongées se terminant je

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. Clinical gyncology, medical and surgical. ovary at the site of a Graafian follicle, that the tube andthe ovary enlarge simultaneously, and that the septum between the twocavities subsequently gives way. But, since this combination may occur inconnection with large multilocular cysts (and even with those of the broadligament), it seems fair to infer that there may be previous formation of thecyst before the diseased tube becomes adherent to it. Such cysts presenta characteristic shape, there being a gradual dilatation of the tube from itsproximal extremity outward, the elongated cyst ending in a large bulb-ous extremity. They are generally of small size, but may contain twoor three pints of fluid. The disease is usually unilateral. According tothe length of time during which it has existed, the line of demarcationbetween the tube and the cyst becomes less and less distinct, until thefimbriae disappear entirely. The outer surface of the cyst is covered byperitoneum, and its wall consists largely of smooth muscular fibres which. Tubo-ovarian cyst. (Olshausen.) G34 NEOPLASMS OF THE OVARIES, TUBES, AND BROAD LIGAMENTS. become much thinned through distention. It is lined with a layer of colum-nar ciliated epithelium, but the cilia soon disappear. It contains serousfluid with few cellular elements, which, in consequence of hemorrhage, may assume a chocolate color. It is not possible to recognize positivelysuch a growth before operation; it is most apt to be confounded withhydrosalpinx, nor is the diagnosis always clear till the specimen has beencarefully examined by a pathologist. EXTRA-PERITONEAL CYSTS. A peculiar form of cyst described by Tait, 1 which develops from thepatent urachus, is clinically indistinguishable from an ovarian or a par-ovarian cyst. Although cysts of this form are rare, the surgeon shouldbear in mind their existence, in order that he may not be confused by thepeculiar relations of the tumor noted on opening the abdominal cavity.They develop outside

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