J. CO~IP. PATH. 1960. VOL. 70.

59
OVARIAN ABNORMALITIES IN THE BITCH
By

C. Dow
Veterinary School, Universi!J of Glasgow

INTRODUCTION

Pathological studies of the canine female genital tract have been

largely concerned with uterine disease; ovarian abnormalities have
received little attention. Mulligan (1949) observed 7 ovarian
tumours in a survey of 1000 tumours of the dog. Cotchin (1951,
1954) found that only 24 of 2361 canine tumours were of ovarian
origin. Bloom (1954) recorded a variety of ovarian tumours in the
bitch but gave no indication of incidence. None of these workers
gave any indication of the frequency of ovarian tumours in the dog
population, nor did they record the incidence of these tumours
with respect to age or parity. There is no adequate description of
the histological and histochemical features of these canine neoplasms.
This publication is based on the examination of the ovaries of
400 unselected bitches submitted for routine autopsy in the Univer-
sity of Glasgow Veterinary Hospital.
MATERIALS AND METHODS

Each ovary was sectioned through the hilus, fixed in formol-sublimate

or neutral formol, dehydrated and cleared in an alcohol-amyl acetate-
benzene series and double-embedded in celloidin and paraffin. Routine
staining was by haemalum and eosin; other methods used in selected
cases were picro-Mallory, Gordon and Sweet's reticulin stain, toluidine
blue, alcian blue, Southgate's mucicarmine, sudan black B, periodic
acid-Schiff before and after hydrolysis with diastase and the methylene
blue extinction test.
RESULTS
Incidence
One hundred and fifteen of the 400 bitches examined showed
ovarian lesions, an incidence of 28'75 per cent. The relationship
of the various changes to age is shown in Fig. I. As would be ex-
pected these are diseases of adult life and increase with age. Of the
400 animals in the survey, 93 had a total of 127 tumours of various
types in one or more sites. As twenty-five bitches had primary
ovarian tumours, 27 per cent. of all tumour cases and 20 per cent.
of all tumours were ovarian in origin. In only one case was the
ovarian tumour considered to be the primary cause of disease.
All ovarian tumours were in bitches of 5 years and over. The
frequency of each ovarian lesion is shown in Table I.
Tumours
Granulosa Cell Tumours
Though tumours of granulosa cell ongm were found m 13
60 OVARIAN ABNORMALITIES IN THE BITCH

Fig. I

100 r-- r--

90
80

70
r0-
6O r0-
c-
r 50 I-
Z r--r--
UJ
U 40
a:
~ 30 r-
r--
20
-

rIl-f
IC

I 2 345 6 8 9 10 II 12 13 14 15 16
AGE
Fig. I. The age incidence of ovarian abnormalities in the bitch.

animals, only in 9 were the ovaries considered abnormal at autopsy.

The bitches ranged from 5 to 15 years and IO of them were nulli-
parous. The tumours were commonly round or oval with a smooth
or slightly lobulated surface and ranged from 0'4 to IO cm. in
diameter. The smaller tumours were solid on section, but some of
the larger ones were soft and friable and contained cystic spaces of
various sizes. The cut surface had a granular appearance and was
cream or faintly yellow with areas of haemorrhage and necrosis in
the larger masses. Metastases were not observed in any of these
cases though a microscopic tumour nodule was found in the con-
tralateral ovary of one case. The unaffected ovaries contained
corpora lutea in 9 animals and were inactive in the other 4 cases.
There was an ascites and hydrothorax of undetermined origin in
one animal.
Histology. The predominant cell type in 9 cases was similar to the
granulosa cells present in normal medium-sized follicles. The cells were
small and polyhedral with a small amount of palely eosinophilic cyto-
plasm in which there were a moderate number of argentophil granules.
The relatively large round or oval nuclei were central in position. They
had an abundant chromatin network and a well-defined nuclear mem-
brane. Mitotic figures were rare in most cases.
The histological pattern varied considerably, not only from case to
case but also in different fields of individual sections. All were well
encapsulated and showed no evidence of local infiltration. The most
common arrangement was diffuse fields of granulosa cells in which a
variable number of folliculoid structures occurred. These acini were
lined by a layer of columnar type cells and contained an eosinophilic
fluid. They varied in size from small Call-Exner rosettes to relatively
 TABLE I

AGE INCIDENCE AND LESIONS FOUND

Granulosa I I Pseudo- Solitary Multiple

Age No. oj cell I Serous mucinous Adeno- Fibroma follicular follicular Lutein Germinal Rete
animals tumours I cystadenoma' cystadenoma carcinoma
1 _ _1 1- cysts
-- cysts cysts cysts cysts
1
1----
I 39 0 'I 0 0 0 I 0 I 0 0 0 I 0 0
2 27 0 0 0 0 1 0 [ 0, [ '0 0

3 23 0 I' 0 0 o! 0 2 1 0 I' 0 0 0
4 33 0 0 0 0 1 0 '0 0 0 0 ()
5 32 I 0 0 0 0 3 0 I 0 0 0
6 39 0 I 0 0 I 0 4 I I 2 tI
7 42 2 0 I 0: 0 3 I, I 3 o
8 39 2 I 0 0 I 4 2 2 3 3 :E
9 37 I 2 i I [ 0 5 4 0 2 2
10 34 2 2 I 0 0 0 5 4 4
II 23 2 0 0 0 0 5 3 I' 2 I
12 18 I 0 0 0 4 3 3 0
13 6 I I 0 0 0 2 2 I 0
14 3 0 0 0 0 I 0 0 0 I 0 0
15 3 I 0 I 0 0 0 I 0 0 0

,6 ,: .--I~---- :--1---;---- :--1" ,: " -~:~I ,: :

Ol
 OVARIAN ABNORMALITIES IN THE BITCH

large cysts (Fig. 2). In one of the tumours there were several large cystic
cavities lined by many layers of granulosa cells which were surrounded
by a distinct connective tissue capsule. These structures resembled the
folliculoma malignum of von Kahlden. The fluid within the cysts was
weakly P.A.S. positive, but was not metachromatic and did not stain with
alcian blue or with Southgate's mucicarmine. Methylene blue extinction
occurred at pH 5.
The connective tissue stroma in the majority of these cases was not
conspicuous and reticulin fibres did not penetrate the granulosa cell
masses. In 2 cases there were numerous tissue trabeculae extending in
from the capsule and splitting up the granulosa cells into round or oval
columns. This connective tissue proliferation was very prominent in
one case and granulosa cells appeared as small isolated islands or columns.
In this cylindromatous pattern, the cells immediately adjacent to the
trabeculae were columnar in type and lay on a thin layer of argyrophil
fibres. In one specimen of the diffuse cellular type there were areas of
transition from typical granulosa cells to plump, fusiform cells resembling
those of the theca interna. These thecal cells were arranged in an irregu-
lar interlacing manner and were separated by distinct bands of fibrous
tissue. Unlike the granulosa cells, they had a well-developed reticulin
network and did not have intra-cytoplasmic argentophil granules. Both
the granulosa and thecal cells in this tumour contained small numbers of
lipid granules.
There was transformation of the cells into typical granulosa lutein
cells in 3 of these tumours. In 2 cases this change was focal and occurred
mainly in the centre of diffuse cellular masses, but in the third case
luteinisation had occurred in the majority of the cells. The transitional
stages between granulosa and lutein cells were similar to those observed
in the normal follicle during the later stages of maturation. There was a
gradual increase in the size and in the lipid content of the cells as the
degree of luteinisation increased.
Though hormone assays were not performed on body fluids or on
tumour tissue some evidence of ovarian functional activity could be gained
from histological examination of the uterus, vagina and skin. The vaginal
epithelium was hyperplastic and exhibited a degree of cornification
indicative of oestrogenic activity in 3 cases in which the contralateral
ovary was atrophic. In these, the endometrium showed slight glandular
dilatation and stromal fibrosis similar to that observed following pro-
longed oestrogen treatment. One of these animals showed atrophy of
the epidermis and hair follicles suggestive of prolonged oestrogenic
activity. There were 9 cases in which the vaginal and endometrial
histology was compatible with metoestrus. In 7 of them the contralateral
ovary contained corpora lutea and the other 2 were associated with
luteinised tumours. There was no evidence of progestational activity in
the endometrium or vagina of the third luteinised tumour.
Serous Cystadenoma
Tumours of this type were found in 8 animals ranging from 6 to
13 years old. Five of them were nulliparous and only one had
whelped more than one litter. Six of the tumours were small
unilocular structures of 0·8 to 1·5 cm. in diameter and 2 were
multilocular masses of 6 to 8 cm. in diameter. Intraluminal papillary
 C. DOW

growth was prominent in most specimens. The contralateral ovary

contained follicular cysts in 3 cases and corpora lutea in 2 cases.
Histology. There was evidence of multicentric origin in all the small
tumours with the formation of microscopic papillary cysts in other parts
of the ovarian cortex. Papillary cysts were present in the contralateral
ovary in 2 cases. The walls of the cysts were composed of dense vascular
connective tissue which was hyaline in some of the larger specimens.
Arising from this capsule were a number of intracystic papilligerous
processes which almost occluded the lumen in some of the smaller cysts.
These processes varied greatly in size and configuration. They were
commonly slender and villiform with fine connective tissue cores in the
smaller cysts. In the larger cysts, the processes were thicker and more
irregular in shape. Some were simple papillae with broad cores of
oedematous connective tissue, whilst others exhibited a more complex
arborescent pattern (Fig. 3). In the latter, numerous acini were included
in the substance of the processes, producing an adenomatous appearance.
Extracystic growth was not prominent but small solid papillomata were
present in 3 cases. Small calcified granules, the so-called psammoma
bodies, were present in the stroma of 2 of the tumours.
The lining epithelium was composed of a single layer of cells which
varied considerably in type, even in individual cysts. The predominant
type of epithelium was composed of cuboidal or low columnar cells with
central vesicular nuclei and homogeneous cytoplasm. The epithelium
in 2 cases showed certain similarities to that of the oviduct and was com-
posed of tall ciliated columnar cells and intercalary cells with deeply
basophilic cytoplasm. A few Schiff-positive granules were present in
these tubal-type cells but not elsewhere. Lipid was not present in the
epithelium of any of the tumours. The cyst lumina contained pale
eosinophilic fluid with an admixture of cell debris and blood in some cases
This fluid was Schiff-positive, but was not metachromatic and did not
stain with alcian blue or Southgate's mucicarmine. It did not contain
lipid.
There was no histological evidence of derangement of the oestrus
cycle due to these tumours. The endometrial and vaginal histology was
compatible with the functional activity shown by the contralateral ovary.

Pseudomucinous Cystadenoma
Two tumours of this type were found in maiden bitches of 7 and
9 years old. The older animal had shown some evidence of oestral
abnormality for almost 2 years. The tumours formed unilateral
lobulated masses of 7 to IO cm. in diameter. On section, each was
composed of a number of lobules containing a viscid milky fluid.
The cyst walls were thin and translucent with only occasional
papillary growths.
Histology. The tumours were composed of a number of relatively large
cysts surrounded by a honeycombed mass of microscopic acini (Fig. 4).
The cysts had a well-defined connective tissue capsule containing coarse
collagen fibres and dense bundles of elastin. Smooth muscle fibres were
not evident in the capsule. The few papillae which projected into the
cyst lumina were long and slender. The cyst epithelium rested on an
 ov ARrAN ABNORMALITIES IN THE BITCH

argyrophil basement membrane which was particularly prominent In

the small locules.
The cysts were lined by a single layer of very tall columnar cells with
clear refractile cytoplasm. The oval nuclei which were deeply basophilic
were situated close to the basement membrane. Small nucleoli were
evident in many nuclei. The cell membranes were prominent and there
were no cilia on the free border. Large goblet cells were numerous in
the epithelium of some cysts and absent in others. The cytoplasm of all
the epithelial cells contained aggregated masses of Schiff-positive material.
This material also stained with mucicarmine and alcian blue and showed
B-metachromasia with toluidine blue. The cyst lumina also contained
fluid of this nature. The cytoplasm of some of the cells also contained a
number of minute, finely dispersed lipid droplets.

Adena-carcinoma
Autopsy of a 9 year old maiden bitch revealed a nodular mass
12 X 9 X 7 cm. in the left ovary. On section, the bulk of the tumour
was firm and solid, but a cystic cavity of 2 cm. diameter was present
in the centre. There was widespread peritoneal dissemination of
the tumour with the formation oflarge solid masses in the omentum
and mesenteries. Small discrete metastatic nodules were present in
the sublumbar lymph glands, liver and lungs. There was a moderate
degree of ascites and hydrothorax.
Histology. The structure of the primary tumour varied in different
areas. Long branching papillary processes extended into the lumina of
the central cystic portion (Fig. 5) and were covered by a tall columnar
epithelium with central deeply staining nuclei similar to those of a serous
cystadenoma. The epithelium ranged in height from one to many layers
and had a moderate mitotic rate. Some of the central cvsts had well-
defined connective tissue capsules, but elsewhere the papillary processes
sprung from broad fields of solid adenocarcinoma. The major portion
of the tumour was less well differentiated and was composed of solid
sheets of cells with only occasional acini. The connective tissue stroma was
fine and diffusely arranged throughout the tumour. The metastases were
of a similar solid pattern with only a few scattered acini. There was a
small amount of Schiff-positive fluid in some of the acini and in a few
of the surrounding epithelial cells. This material was not metachromatic
and did not stain with mucicarmine or alcian blue.
The contralateral ovary contained a number of corpora lutea which
were regressing, The endometrial and vaginal histology was consistent
with the later stages of metoestrus.

Fibroma
A single rounded mass of 9 cm. diameter was an incidental
finding at autopsy in an 8 year old bitch which had borne 3 litters,
the last 6 months prior to death. The tumour was solid and hard
to cut and had a whitish, homogeneous surface. There were no
corpora lutea or follicles in the other ovary and the uterus appeared
normal.
 c. DOW

Histology. The tumour was composed of interlacing bands of fibrous

tissue. The majority of the connective tissue bundles were moderately
cellular with a fine collagenous stroma. The cells were fusiform with
plump, deeply basophilic nuclei resembling those of the theca interna.
Unlike the latter they did not contain lipid or P.A.S.-positive material.
In other bundles, the connective tissue was relatively acellular and the
collagen fibres were coarse and frequently hyalinised. In such bundles,
the cells were small with scanty cytoplasm and elongated dense nuclei.
There were no mitotic figures in any part of the tumour and smooth
muscle cells were present only in the walls of vessels. Though normal
ovarian structures were present in the hilar portion of the capsule, no
epithelial elements were present within the tumour. The other ovary
contained only primary follicles and remnants of corpora lutea. The
endometrial histology was consistent with the terminal stages of metoes-
trus.
Secondary Tumours
Though 74 of the bitches submitted to autopsy had metastases
from tumours arising in a variety of sites, only in 3 cases were second-
ary deposits found in the ovaries. Gross involvement of both ovaries
was present at autopsy in 2 cases with widespread metastases from
lymphoid tumours of the small intestine. A microscopic secondary
was found in one ovary of an animal with a widely metastasising
mammary carcinoma. Lymphosarcoma and mammary carcinoma
were the commonest malignant tumours found at autopsy.
Ovarian Cysts
Follicular Cysts
Solitary cysts were found in 41 animals of 2 to 15 years of age
and at various stages of the oestrus cycle. Twenty-nine of the bitches
were nulliparous and only 7 were multiparous. The majority of the
cysts measured I to 1·5 cm. in diameter but a few ranged up to
5 cm. On section they were thin-walled, monolocular and contained
a clear watery fluid. Corpora lutea at various stages of growth and
regression were present in the affected and normal ovaries of 3 I
cases. There was cystic hyperplasia of the endometrium in I I cases.
Multiple ovarian cysts were present in a further 22 animals of
5 years and over. Eighteen of these were maiden bitches. The cysts
formed masses up to 10 cm. in diameter. The component cysts
were commonly small and appeared to be monolocular. There
was bilateral involvement in 7 cases. In 5 bitches, there was a
concomitant cystic glandular hyperplasia of the endometrium.
Histology. Evidence of follicular origin was readily apparent in the
smaller solitary cysts. They were lined by several layers of granulosa cells
within a capsule composed of regressing theca and compressed ovarian
stroma. The nuclei of the granulosa cells were less regularly shaped than
those of the normal follicle and showed complete loss of polarity. Degen-
erate remnants of the cumulus 06phorus could be seen in many of the cysts.
The nuclei became compressed and orientated parallel to the capsule
as the size of the cysts increased. The lining of the largest cysts consisted
E
66 OVARIAN ABNORMALITIES IN THE BITCH

of a single layer of cuboidal or flattened cells. The capsule was dense,

fibrous and often hyalinised. Where multiple cysts were present, the
smaller ones were lined by a typical granulosa cell layer whilst the larger
ones were lined by a low cuboidal epithelium. The epithelium in some
of the larger cysts had completely disappeared and they were lined
by dense hyalinised connective tissue. All the cysts presented a simple
cavity with no evidence of intracystic growth or of communication be-
tween individual cysts.
All stages of follicular aad luteal growth and regression were present
in the cases with single cysts and in those with unilateral multicystic
change but were absent in cases with bilateral involvement. There was
no histological evidence of oestrogenic activity in the endometrium or
vagina of any of these cases.
Lutein Cysts
Solitary cysts lined by luteal tissue were found in the ovaries of
9 bitches of 2 to 13 years. Six of the animals were nulliparous.
The cysts ranged from 1·5 to 3 cm. in diameter and had thicker
and more opaque walls than those of the follicular type. The
ovaries in all cases also contained normal corpora lutea.
Histology. The normal corpus luteum in the dog shows central cavita-
tion for a short time after ovulation but this rapidly disappears. None of
the normal corpora lutea in these cases showed such cavitation. Six of
the cysts were completely lined by several layers of granulosa lutein
cells arranged on a capsule of compressed ovarian stroma. The lutein
cells in the smaller cysts were similar to those of neighbouring normal
corpora lutea and were supported by vascular connective tissue trabeculae
extending in from the capsule. A thin layer of fibrin was deposited on
the inner surface of the layer of lutein cells. The cells lining the larger
cysts were less well preserved; the cells on the luminal surface were com-
pressed and many contained pyknotic nuclei. A layer of fine connective
tissue separated the lutein cells from the lumen in several of the larger
cysts.
Only a portion of the wall was lined by lutein cells in 3 cases, the
remainder being lined by granulosa cells like those in follicular cysts
(Fig. 6). Luteinisation of the granulosa cells was focal in 2 cases and a
gradual transition from one cell type to another could be traced. Similar
foci of luteinisation were present in the walls of the cyst in the third case,
but the change appeared to be present in the theca interna since the
granulosa cell layer continued over the lutein cells without interruption.
All these lutein cysts contained a pale eosinophilic fluid which did not
stain with sudan black B or with P.A.S.
The morphology of the uterus and vagina in these cases was consistent
with the progesterone phase of the cycle and this, in the presence of normal
corpora lutea, gave no indication of the hormonal activity of the cysts.
Germinal Cysts
These cysts were found on microscopic examination of the ovaries
of 20 bitches of 6 to 13 years. Eleven of the animals were nulliparous.
They were found in otherwise normal ovaries at all stages of the
 C. DOW

oestrus cycle and also in association with other ovarian abnormali-

ties.
The cysts were microscopic in size, multiple and commonly
bilateral. They were present as irregularly round or oval structures
in the cortices of ovaries of the senile type in which there were numer-
ous indentations of the germinal epithelium (Fig. 7). They were
lined by a non-secretory cuboidal or low columnar epithelium of
the germinal type. There was no evidence of cilia or of metaplastic
change. The epithelium lay directly on the undifferentiated
ovarian stroma with only slight condensation of argyrophil fibres
without the formation of a definite basement membrane. The
cysts contained a pale eosinophilic fluid which did not stain with
sudan black B or P.A.S.
Rete Cysts
Rete tubules were present as a small mass of irregular, anasto-
mosing tubules in the hilar region of over 90 per cent of the ovaries
examined. They were lined by a single layer of closely packed
columnar cells with large, pale basal nuclei and ragged free borders.
Single microscopic cysts were present near the hilus of thc
ovary in close association with groups of rete tubules in 9 animals
of 4 to I I years of age. The cysts were unilateral. The smaller
cysts were irregular in outline and were lined by an epithelium
similar to that of the normal rete tubules. The larger cysts were
more rounded and were lined by an epithelium in which the cells
showed loss of polarity. The cells were cuboidal in type and the
free edge was more even in outline than in the normal tubules.
Intra-cystic papillary processes were present in the smaller cysts but
the larger ones were essentially monolocular. The fluid in the
cysts was eosinophilic and stained pink with P.A.S. The stroma
underlying the cysts was composed of dense fibrous tissue and did
not contain muscle fibres.
DISCUSSION

Twenty-five primary ovarian tumours were found in a histologi-

cal study of the genital tract of 400 bitches submitted to routine
post-mortem examination. Ovarian tumours represented 20 per
cent of all tumours found in the animals under consideration. Both
Mulligan (1949) and Cotchin (1951, 1954) observed that I per cent
of all canine tumours examined by them were of ovarian origin.
This disparity in incidence may possibly be explained by the fact
that many of the tumours included in the present study were found
only on histological examination. The affected animals ranged from
5 to 15 years of age and 18 out of the 25 were nulliparous which
suggests an increased incidence of ovarian neoplasms with age and
with absence of pregnancy.
The survey suggests that there is a close similarity between the
common ovarian tumours in the bitch and in women. Only in the
68 OVARIAN ABNORMALITIES IN THE BITCH

granulosa cell tumours are there obvious structural differences and,

as Willis (1953) points out, the canine tumours show greater varia-
tions in morphology and some show distinct resemblances to the
papillary adenomas. The granulosa cell tumours in the dog show
no evidence of malignancy. Histological evidence of oestrogenic
activity was found in the endometrium and vagina in only 3 of the
13 tumours of this type examined. Traut and Marchetti (1940)
found that 39 out of 54 human granulosa cell tumours showed
evidence of hormonal activity. Another major difference from a
comparable series of human ovarian neoplasms is the absence of
teratomata from the present series though both Storm (1947) and
Cotchin (1956) have observed single specimens. It is noteworthy
that tumours of the canine testis have not been recorded.
It is interesting to note the low incidence of secondary tumours
of the ovary in the bitch. Novak (1952) states that the commonest
metastatic tumours of the human ovary arise from primary carci-
nomas of the pelvic organs and the intestines. Primary carcimoma
of these regions is rare in the dog and though there were 18 cases
of intestinal lymphosarcoma in the animals examined, only in 2
cases were there ovarian secondaries. Twenty-nine of the animals
had carcinomata of the mammary glands with pulmonary meta-
stases, yet ovarian involvement was present in only one case.
Willis (1953) found a similarly low incidence of ovarian metastases
from widely disseminated mammary carcinomas in women.
Non-neoplastic cysts of the ovaries were found in 90 animals.
Follicular cysts were the commonest and were found in 16 per cent
of the ovaries examined. There was no histological evidence of
oestrogen activity in any of the cases of follicular cysts. The
incidence of all types of ovarian cysts was higher in nulliparous
animals and in those over 5 years of age.
CONCLUSIONS

A histological examination of the ovaries of 400 bitches, sub-

mitted to routine post-mortem, revealed primary tumours in 25
cases, secondary tumours in 3 cases and non-neoplastic cysts in a
further 90 animals. A detailed histopathological description of the
individual lesions is given in addition to an examination of their
secretory activity with regard to mucin and lipid. Analysis of age
incidence suggests that both tumours and cysts of the bitch are
more common in animals over 5 years of age and in nulliparous
animals.
REFERENCES

Bloom, F. (1954). Pathology of the Dog and Cat. American Veterinary

Publications; Evanston.
Cotchin, E. (1951). Vet. Rec., 63, 67; (1954). Ibid., 66, 879; (1956).
Neoplasms qf the Domesticated Animals. Commonwealth Agricultural
Bureaux.
c. DOW

[0 face /Jagc 68
 C . DOW 69
Mulligan, R. M. (1949). Neoplasms oj the Dog. Williams and Wilkins Co.;
Baltimore.
Novak, E. (1952). Gynecologic and Obstetric Pathology. W. B. Saunders Co.;
London.
Storm, R. E. (1947). N . arner. Vet., 28,30.
Traut, H. F ., and Marchetti, A. A. (1940). Surg. Gynec. & Obst., 70, 632.
Willis, R. A. ( 1953) . Pathology of Tumours. Butterworth & Co.; London.

[Received for publication, February 13th, 19591

LEGENDS

Fig. G ranulosa cell tumour showing follicular structures of various sizes. Hand E
2.
x 65.
Fig. 3· Serous cystadenoma showing thick branching intracystic papillary processes'
Hand E x 2 0.
Fig. 4· Pseudomucinous cystadenoma composed of numerous cysts of varying size.
The cysts a re lined by a characteristic tall columnar epithelium with clear
refractile cytoplasm. Hand E x 65.
Fig. 5· Adeno-carcinoma showing long branching papillary processes extending into
the lumen of the central cystic portion. Hand E x 65.
Fig. 6. Simple ovaria n cyst lined partly by granulosa cells a nd partly by luteal cells.
Hand E x 65 .
Fig. 7. Group of germinal cysts in the cortex of the ovary. They are lined by a ow l
cuboidal epithelium. Hand E x 2 0.