260 STUDIES ON PATHOLOGIC OVA. 



spoken of in the history. This clot contains an empty vesicle, the wall of which is 

 formed for the greater part of its extent by a thin fibrous layer, except near the 

 proximal or lower portion in the figure, where a thicker portion of ovarian tissue 

 hoods the clot. Approximately only about one-third of the ovarian stroma seems 

 to be preserved. 



Near the exterior of the thicker portions of the latter, a small cyst with clear 

 content is found directly beneath the surface, as indicated in figure 166. The 

 distal or upper portion in the figure shows the clot to contain an empty, smooth- 

 walled, degenerate chorionic vesicle, such as is frequently seen in tubal clots. 



Examination of the cut surface with the binocular microscope shows the pres- 

 ence of only a few isolated, degenerated, and some hydropic villi scattered through 

 the clot. Examination of the chorionic vesicle shows the presence of only a few 

 attached villi and that the amnion is fused to the chorion. Since the entire speci- 

 men obtained at operation is covered still by a layer of ovarian tissue which is 

 unbroken save in a few very small areas, it is evident that we are dealing with a 

 very good example of an undoubted ovarian pregnancy in spite of the absence of 

 an embryo. The latter undoubtedly did not escape through the small rupture 

 in the capsule, for the chorionic vesicle seems entirely intact. Although the ab- 

 sence of a corpus luteum in the opposite or left ovary was not especially mentioned, 

 lack of comment would seem to suggest that none was present, for the ovary very 

 evidently was examined. Hence, this implantation probably took place within the 

 Graafian follicle itself, and not in some other area of the ovary. 



Celloidin sections of the excised portion show that the blood-clot contains 

 no fibrin and that it is composed of relatively fresh and fairly well-preserved cells 

 in the region near the main body of the ovarian stroma. The latter is quite normal, 

 although decidedly vascular, and contains ova. The layer of the ovarian stroma 

 which surrounds the clot becomes thinner and thinner the nearer the free border 

 is approached. It also becomes more trabeculated, hemorrhaglc, and degenerate. 

 No overlying layer of smooth muscle, as mentioned by Young and Rhea (1911) 

 and also by Kantorowicz, was seen. Some infiltration with polymorphonuclear 

 leucocytes is noticeable. Degenerate villi are scattered about in the blood and a 

 few others are apparently still attached to the equally degenerate ovarian stroma. 

 Trophoblast is absent on these, although some of the villi that lie isolated in the 

 clot possess a very evident epithelium and also are associated with a few small 

 masses of very degenerate syncytium. Only a few degenerate, nonvascular villi 

 are still seen on the chorion. Very little evidence of epithelial proliferation is 

 present on these, despite the fact that the blood in which the vesicle is embedded 

 is not very degenerate. This seems to suggest that the hemorrhage which caused 

 the rupture of the ovary was comparatively recent, although the conceptus had 

 been dead for some time. Some of the villi scattered about in the blood-clot are 

 outlined by degenerate syncytium only, and nothing but small degenerate masses 

 of the latter are seen on the chorionic membrane or lying about isolated in the 

 degenerate blood found in other places. Nevertheless, the epithelium of the cho- 

 rionic vesicle is thickened at several points. The amnion is fused with the chorion 



