264 STUDIES ON PATHOLOGIC OVA. 



Instead of undergoing hyperplasia, the ovarian stroma in this case is found 

 invaded, stretched, compressed, and degenerate, and the germinal epithelium is 

 entirely absent. The fact that several observers have seen what they took for the 

 fibrin layer of Nitabuch also shows that degenerative changes i-n the ovarian im- 

 plantations may be extensive. Hence, it would seem to follow that the absence 

 of symptoms of rupture merely may mean that the ovarian stroma and epithelium 

 which happened to overlie the fetal membranes have gradually died and degenerated 

 before being forced apart by the expanding conceptus or the increasing hemorrhage. 

 That such a sequence of events is possible would seem to be undoubted, and mere 

 distention of the ovarian stroma until it completely surrounded a full-term preg- 

 nancy is hardly conceivable; whereas, the absence of pain upon the yielding of an 

 exceedingly thin degenerate layer of ovarian stroma is quite conceivable. 



That rupture may occur very early is exemplified also by the cases of Chiene 

 (1913), Seedorff (1915), and especially by that of Aiming and Littlewood (1901) 

 and of Holland (1911). In such curious instances as that of Grimsdale (1913) 

 one can hardly assume that the ovarian tissue was preserved about the entire 

 conceptus, and it is not at all unlikely that full-term ovarian pregnancies, which, 

 according to Warbanoff, supplied a surprisingly large percentage of all cases 

 collected by him, will form a far smaller percentage in the statistics of the near 

 future. Indeed, they already form a far smaller percentage of those reported up 

 to the present, and the advances in diagnosis alone make it very unlikely that in 

 the future many cases of ovarian pregnancy will advance far before being detected. 



A feature noticeable in both of these cases, and not heretofore described, we 

 believe, is the presence of clubbing of some fibrous villi, as shown in figure 168. 

 This is marked in the villi from case No. 550. It is less pronounced in case No. 

 1522. The villi and vesicles of both these specimens are so degenerate that one 

 is almost led to surmise that these vesicles never became properly implanted, but 

 depended very largely upon the surrounding blood for nutriment. As long as the 

 fetal circulation was not established these conditions would seem to offer no specia) 

 obstacles, for up to that time the conceptus necessarily is dependent upon other 

 means of nutrition in uterine implantation also. Moreover, it may be doubted 

 whether anything akin to true implantation can occur in the ovary or tube in the 

 absence of decidual formation, and hence also of a capsularis. For even if the 

 ovum buried itself in the ovarian stroma, the continued hemorrhage and the 

 failure of a similar and proper response on the part of the ovarian stroma never- 

 theless would furnish decidedly abnormal conditions. 



