236 STUDIES ON PATHOLOGIC OVA. 



in the survey originally planned by Mall, a study of these specimens formed an 

 excellent opportunity for observations on this subject. 



That the case of Otto, with its pathetic history, really was one of tubal hydati- 

 form mole, can not be doubted, in view of the careful description of the whole case 

 its clinical history, necropsy, and the histologic examination. This case is interest- 

 ing also because the degeneration was in its early stages, the hydatids being only as 

 large as a pinhead and the embryo still being present. Moreover, from Otto's 

 description it is very likely that the specimen contained Hofbauer cells, discussed 

 in a later chapter. 



The history of the case observed by Wenzel in 1855 and reported in 1893 is 

 equally complete and equally pathetic, as could be surmised by all familiar with 

 the history of tubal pregnancy. In this case the mole was as large as a "hen egg," 

 the hydatids varied in size from a dot to a "bird cherry" (wild? cherry), and the 

 degeneration was universal, although the menstrual age of this specimen was given 

 as only 51 days. It is significant that Wenzel expressed surprise that even excellent 

 handbooks of the day had nothing to say about hydatiform mole in cases of tubal 

 pregnancy, except perhaps to refer to the case of Otto. Nor does the case of Wenzel 

 seem to be the first one observed or that of Otto the first one reported, for Storch 

 (1878), in truly epochal, though largely ingored, observations on hydatiform mole, 

 cited Hennig (1876) as stating that two cases of moles in the tube were reported by 

 Blasius (very likely E. Blasius, 1802-75). Since Storch wrote on hydatiform mole, 

 it is implied that Blasius saw one of these and not one of another type of mole, and 

 since hydatiform mole is such a striking condition and has evoked much more 

 interest than the other forms, an observation regarding it in the tubes well might 

 travel down the decades, particularly since, until recently, the occurrence of 

 hydatiform degeneration in the tubes was regarded as extremely rare. This is 

 indicated also by the fact that Menu (1899) still referred to the case of Otto as a 

 curiosity. 



Pazzi (1908 b ) stated that two cases of extrauterine moles have been described 

 each by Hennig (1872), Farell (1893), Donald (1902), and one case each by Otto, 

 Freund, Theileher, Maret, Matwjew (Matwejew?) and Sycow (Sykow?), and' 

 Bland-Sutton, and one case of ovarian mole by Wenzel (1893). Wilkinson also is 

 said to have described a case of rupture of the tube with reduction of the mole to the 

 size of a cherry, and Lob (1902) a case of molar tubal pregnancy without cessation 

 of menstruation. Since I am quoting Pazzi essentially verbatim, it is evident that 

 he did not read the literature critically or discriminate between ordinary and 

 hydatiform moles, but was misled by the old inclusive and confusing usage of the 

 terms mole and molar, still current at the present day. 



Krueger (1909) also reported a case of hydatiform mole with a cyst as large as 

 a "walnut." The pedicle was 4 cm. long and attached to the amnion near the 

 insertion of the cord. Krueger spoke of this as a placental cyst, but regarded it 

 as a hydatiform-mole-like structure which, microscopically, was limited to a single 

 villus. If this were the only evidence presented by Krueger, one might well ques- 

 tion the nature of the cyst, but he added that microscopically the beginnings of 



