262 STUDIES ON PATHOLOGIC OVA. 



regarded as a placenta, remained. The latter was said to be composed of a narrow 

 layer of plasmodium and a much thicker layer of trabeculated syncytial tropho- 

 blast containing blood between the trabeculse. 



Because of the singular structure of this placenta and also because of the 

 failure to find villi or any remnant of the membranes, the authors concluded that 

 the chorionic vesicle therefore could not have reached the villous stage. How such 

 a supposition can be reconciled with the survival of a portion of an umbilical 

 cord entirely normal in structure it is difficult to see. The ovary concerned was 

 brown, of the size of a "large fresh walnut," and contained a tumor, apparently 

 the so-called placenta, which was 2 cm. in diameter. Although these fetal rem- 

 nants had brought about not only almost complete amenorrhea for two years and 

 also atrophy of the ovary and uterus, ablation of the affected ovary was followed 

 not only by a return of the menses, but by a normal pregnancy within 7 months. 



A second instance of ovarian pregnancy of special interest was that of -Giles. 

 No fetus was found, although the pregnancy was unruptured, and Giles estimated 

 that the conceptus had died in the third or fourth week. The operation was not 

 done until 5 months after the onset of the pregnancy. What is particularly inter- 

 esting in this case is that Giles speaks of the mucoid degeneration of the connective 

 tissue of the villi. The latter were found to be large, much branched, and had 

 ramified in the clot. Since Giles also spoke of one of the illustrations as showing 

 a vesicular state of some of the villi, it seems possible that this was a case of hydati- 

 form degeneration, even though there were no signs of activity of the syncytium. 

 Since the fetal membranes were isolated in a blood-clot, very much degenerated, 

 and the villi were without a Langhans layer, one scarcely could expect to find much 

 evidence of epithelial proliferation so common (but not essential) in hydatiform 

 degeneration. Giles estimated that 4 months had elapsed since death of the con- 

 ceptus, and if this specimen really was a hydatiform degeneration, it is the first 

 one observed in ovarian pregnancy and hence of particular interest for this reason 

 alone. 



Several features in the clinical history of our second case deserve comment. 

 First among these is the menstrual age as compared with the size of the chorionic 

 vesicle. Since the cross-sections of the latter measure 15 by 18 mm. and since it 

 and the amnion are degenerated and devoid of an embryo, it is evident that the 

 latter must have died a good while before the time of operation. Hence, the 

 menstrual period reported for June 25, 1916, very evidently was not the last 

 period before pregnancy supervened, but the first period which recurred after 

 the death of the conceptus. Consequently, this pregnancy undoubtedly dates 

 from near April 13, the time of the first omitted period. Moreover, the conceptus 

 must have died long enough before June 25 to have made inhibition of the suc- 

 ceeding period impossible. It should be noted, however, that the original menstrual 

 cycle apparently was broken, for with the customary intermenstrual period of 

 28 days, menstruation normally would have fallen due on June 7 instead of June 

 25. Hence the maintenance of the original cycle would have brought rupture 

 of this ovarian pregnancy, as indicated by the symptoms, on July 7, in direct 



