254 STUDIES ON PATHOLOGIC OVA. 



and gross anatomic findings suggest the conclusion drawn by Scott (1901), on 

 a priori grounds alone, that the conceptus may be completely resorbed. It may, 

 of course, also be aborted or disintegrate completely. That such an assumption 

 is justified is indicated by the lysis of the embryo or fetus in a large number of 

 cases of ovarian pregnancy, and also by the very degenerated condition of some 

 of the vesicles and of the surrounding ovarian stroma. The possibility of such 

 an occurrence in the ovary is established also by similar events in uterine and tubal 

 pregnancies discussed elsewhere (Meyer, 1919 e ). It probably is illustrated also 

 by such cases as those of Anning and Littlewood (1901), in which no mention is 

 made of an embryonic disk in a translucent conceptus the size of a "pea." Then, 

 to be sure, there are the cases of unruptured ovarian pregnancies containing villi 

 only, as well as the rare case, probably of double ovarian pregnancy, of Holland 

 (1911). Although one can not be certain that embryonic tissue was removed 

 from the left ovary with the blood-clot which was forcibly expelled at the time 

 of operation in this case, it is not at all improbable that the small plasmodial 

 masses found in the left ovary were the only remnants of the conceptus. We realize 

 fully that the conclusion that young conceptuses may be wholly dissolved is fraught 

 with great uncertainty, but it nevertheless appears to be justified by the facts, and 

 that it therefore is in the direction of truth. It could only fail to be so if every 

 ovum that becomes implanted within the ovaries were aborted or were removed 

 by operation before lysis was possible. 



One can not rightly refuse to recognize the possibility of the spontaneous 

 disappearance of an ovarian pregnancy. Since implantation in the ovary occurs 

 under such abnormal conditions, it would seem that for this reason alone the great 

 majority of such implantations inevitably must succumb. This would seem 

 probable, wholly aside from considerations regarding the development of the corpus 

 luteum, although lack of, or interference with, the development of the latter 

 also would seem to condition early death of the conceptus if the results of the 

 long series of experiments on rabbits by L. Fraenkel (1903, 1910 b ) are indicative 

 of the role played by the corpus luteum in early implantations in man also. It 

 surely is difficult, if not impossible, to see how implantation within the Graafian 

 follicle, and especially the later development of the conceptus, can fail to inter- 

 fere with the development of a normal corpus luteum. Cases in the literature, 

 and also our case No. 1522, did not reveal the presence of any well-preserved 

 or even true luteal cells at the time the pregnancy was terminated. Although 

 this fact does not presuppose an entire lack of development of these cells in the 

 earliest stages of the implantation, it undoubtedly does imply a defective devel- 

 opment, which in itself may have become responsible for the death of the con- 

 ceptus. Nor should the possible toxic effect of luteal cells upon the conceptus be 

 forgotten in this connection. 



It is not assumed that the clinical symptoms and signs alone should suffice 

 finally to group a specimen as truly ovarian, but when these are indicative of the 

 presence of an ectopic gestation, and when undoubted intrauterine decidual 

 changes are present, in the absence of abdominal pregnancy or tubal involvement 



