CHAPTER IX. 



HYDATIFORM DEGENERATION IN TUBAL PREGNANCY. 



Strangely enough, the occurrence of chorio-epithelioma arising from tubal 

 pregnancy seems to be better known and also better established than the occurrence 

 of hydatiform mole within the tube. This is especially surprising in view of the 

 stress laid by Marchand (1895) upon epithelial proliferation in cases of hydatiform 

 mole and in view of the fact that trophoblast formation and epithelial prolifera- 

 tion in general have been regarded as being greater in tubal than in uterine 

 implantation. This is illustrated well by such cases as that of Fellner (1907), in 

 which it was impossible to distinguish, by histologic examination, between the 

 epithelial proliferation present in a case of tubal pregnancy and chorio-epithe- 

 lioma. From these circumstances alone it seems to me that one might expect 

 hydatiform degeneration to be relatively more common in the tubes. Moreover, 

 when it is recalled that experts still regard it as impossible to decide upon the ques- 

 tion of malignancy or benignity in cases of suspected uterine chorio-epithelioma 

 from histologic preparations alone, this surmise gains more in probability. The 

 presence of hyperactivity in the trophoblast in many cases of tubal as compared 

 with that in uterine pregnancy was confirmed also by personal observation, and 

 if, as stated by Teacher (1903), chorio-epithelioma arose in hydatiform moles in 

 approximately 40 per cent of 287 cases, and according to Seitz (1904 b ) and Fraenkel 

 (1910) even in 50 per cent, the occurrence of hydatiform degeneration in tubal 

 pregnancy can hardly be doubted because of this fact alone. 



Nevertheless, of the 7 cases of tubal hydatiform moles cited by him, Werth 

 (1904) regarded only the case reported separately by von Recklinghausen (1889) 

 and by W. A. Freund (1889) as well authenticated. Werth reserved judgment, how- 

 ever, on the case of Matwejew and Sykow (1901), a report upon which was acces- 

 sible to him, and to me, in a short review only. Seitz, however, accepted the short 

 review of this case as convincing, nor did he question the case of Otto (1871), or 

 that of Wenzel (1893), and he incorrectly credited Wenzel with two cases. Werth, 

 on the contrary, regarded these last two cases, and also that of Groom (1895), 

 which was accepted also by Veit (1899), as undoubted instances of "simple 

 hydropic degeneration of the connective tissue of the villi so common in aborted 

 chorionic vesicles, both from the tubes and from the uterus." Werth unfortunately 

 did not state just what he meant by "simple hydropic degeneration", but since 

 he spoke of it as common in aborted ova, one may conclude that he referred to 

 changes in the chorionic vesicle which followed its isolation within the uterus after 

 complete detachment from its implantation site. For want of a better term, such 

 changes may, I presume, be spoken of as maceration changes, although usually 

 they occur under non-putrefactive conditions. However, I do not thereby imply 

 that these changes are similar under sterile and under putrefactive conditions. 



Since Werth spoke of simple hydropic degeneration in aborted ova, he did 

 not, I take it, refer to a dropsical condition of the villi, possibly due to an obstruc- 



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