Text Appearing Before Image: asimilar manner the appendix is the starting point of an infection inand about the cyst. Adhesions between the appendix and cyst mustbe looked for in the course of the removal of the cyst, otherwisedeath may be caused by tearing through the appendix and bowel. The diagnosis of malignant degeneration of an ovariantumor is of the utmost importance, but unfortunately cannot bemade with certainty without a microscopic examination. Bilateral ovarian tumors of the ovary are often malignant, butall forms of benign tumors of the ovary are occasionally bilateral.The presence of ascites is also suggestive of malignancy, yet malig-nant tumors of the ovary may exist without ascites, and all formsof new-growths of the ovary may be associated with ascites; this isparticularly true of papillomatous growths. The most suggestive signs of maUgnant degeneration of new-growths of the ovary are rapid growth, immobility of the tumor,and their firm, nodular character. Partial development within the -J -1 1. Text Appearing After Image: (« rt o 0) (U (U CO a, (D OS s 0 o o0 s: <D 4) a (0 SI •3 0 0 cc cj /IS W ^ N < C fr 5 ><; (1) ^ 0 t3 *^ fl -0 • 0 2 DIAGNOSIS OF DISEASES OF THE OVABY 467 broad ligament Is also said to be suggestive of malignant degenera-tion. Metastatic growths may be found on the peritoneum and inthe viscera. Finally, an exploratory incision will be required inmany cases, and even then the diagnosis must sometimes be deferredfor a microscopic examination. The consideration of the age ofthe patient is not of great importance in that malignant tumors ofthe ovary are known at all ages from the time of puberty. OVARIAN TUMORS COMPLICATING PREGNANCY. All forms of ovarian tumors may complicate pregnancy. Prob-ably the most frequent are the dermoids, because they occur earlyin life, grow slowly, and are very often fixed in the pelvis, wherethey offer obstruction to labor. The dangers to be apprehended during pr
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