240 STUDIES ON PATHOLOGIC OVA. 



of which protrude through an incision in the wall of the tube. The whole opening 

 is filled with typical hydatiform villi which are noticeable with the unaided eye and . 

 perfectly evident under an enlargement of 4 diameters. They present an extremely 

 fine picture when seen with the binocular under a magnification of 10 to 20 diam- 

 eters. Examination under a higher magnification shows that the preservation of 

 the specimen is unusually good and that all the villi are markedly hydatiform. 

 Trophoblastic proliferation is so marked that in some places it gives the appear- 

 ance of decidual formation. Relatively little syncytium is present, but the tro- 

 phoblast invades the muscularis in many places and a good deal of coagulum is 

 present, most of it apparently having arisen from degeneration changes in the 

 stroma of the mucosa and from similar changes in the trophoblast and the mus- 

 cularis. The latter is moderately invaded by round cells. No remnant of the 

 wall of the chorionic vesicle or of the amnion or embryo could be detected in 

 the sections examined, both evidently having been absorbed completely, only some 

 of the villi remaining behind ; or, the chorionic vesicle may have been aborted and 

 these villi left implanted within the tube. 



Some exceedingly fine hydatiform villous trees were found among the speci- 

 mens in this group. Scaffoldings or frameworks formed by proliferating syncytium 

 arising from the epithelium of the chorionic membrane also were seen. Since the 

 syncytial buds were found far out on proliferations of trophoblast which capped the 

 villi, and also in the center of trophoblastic nodules, the origin of the syncytium 

 from the Langhans layer again would seem to be exceptionally well confirmed. 

 In some cases a detached hydatiform villus was fastened by opposite extremities 

 to two portions of the tube wall. It is well to remember, however, that one of these 

 attachments probably was gained before the separation of the particular villus 

 from the chorionic vesicle. 



Of the 36 cases remaining in this group of chorionic vesicles without amnion, 

 after deducting 8 (7 of which belong in group 1 and 1 which belongs in group 2), 

 50 per cent showed the presence of undoubted hydatiform degeneration, and in 



1 additional case its existence was doubtful. 



Since only a few specimens are contained in each of the last five groups, I shall 

 treat them as one. Among 28 specimens remaining in these groups, 12, or 43 

 per cent, showed the presence of hydatiform degeneration, and 4 others were doubt- 

 ful. From this percentage it is evident that the incidence of hydatiform degenera- 

 tion among tubal specimens seems to increase rather than decrease with advancing 

 age of the conceptus, as was emphasized in connection with the uterine specimens. 

 This probably can be attributed to the fact that the specimens in the first group 

 are composed of villi only, and that many of the empty chorionic vesicles in group 



2 were detached from the wall of the tube by hemorrhage before hydatiform degen- 

 eration had developed sufficiently to enable me to recognize it. Moreover, it must 

 be remembered that all tubal specimens, no matter in what group they are clas- 

 sified, are in fact young specimens, and since those falling in the latter groups 

 succeeded in maintaining a foothold in spite of repeated hemorrhages, a large num- 

 ber of them might rightly be expected to show the presence of a hydatiform change. 



