266 



STUDIES ON PATHOLOGIC OVA. 



The fundus of the uterus is about normal in 

 size and is in anteposition. A boggy mass fills 

 the cul-de-sac and to the right of the uterus a 

 fairly firm mass, the size of a small orange, which 

 is somewhat movable, can be felt. Definite 

 blood-clot crepitus can be felt on rectal examina- 

 tion. 



Pre-operative diagnosis. Extra-uterine preg- 

 nancy, ruptured. 



Operation. A free midline incision was made 

 below the umbilicus. The peritoneum was 

 blood-stained. The abdomen contained 200 to 

 300 c.c. of dark fluid blood and clots, and a large 

 clot filled the cul-de-sac. Active bleeding had 

 ceased. The left tube and ovary were normal 

 and free of adhesions. The right tube, which 

 was quite normal in appearance, lay over a mass 

 which had replaced the right ovary. This mass 

 was roughly spherical, 5 to 6 cm. in diameter and 

 semi-solid in consistency. Over the surface 

 there were six or eight nodular projections, about 

 1 cm. in diameter. At the top of one of these 

 projections there was a very small opening, 

 from which bloody fluid could be squeezed. 

 The surface of this mass was white, with spots of 

 bluish-black discoloration. 



The appendix was normal, except at the tip, 

 where it was adherent to a blood-clot. 



The tumor was removed by clamping, tying, 

 and cutting into the right infundibulo-pelvic 

 ligament and the right utero-ovarian ligament. 

 The right tube was not removed. The appendix 

 was also removed and all blood and clots were 

 cleaned out of the abdomen. The incision was 

 closed without drainage. At the close of the 

 operation the uterus was curetted. The uterine 

 cavity measured 7.5 cm. in length. 



A subcutaneous salt solution infusion was 

 started on the table and continued on the ward 

 until 2,000 c.c. had been absorbed. 



The patient was in good condition at the end 

 of the operation and made an uneventful 

 recovery. 



The urine on admission contained red blood- 

 cells, white blood-cells, no casts, acetone, a 

 trace of albumin, and no sugar. Several days 

 after the operation it was negative, except for 

 a faint trace of albumin. 



August 2, 1916. Discharged in good condi- 

 tion. 



Gyn. Path., No. 22346- Normal endometrium 

 from curettage. 



DESCRIPTIONS OF PLATES. 



PLATE 15. 



Fio. 157. Drawing of posterior view of pregnant ovary with tube. No. 550. 



FIG. 158. Transverse section of pregnant ovary cut at point of rupture. 



FIG. 159. Outline of transverse section of ovary taken in the region of the letter o in "Ovary" (fig. 157). Cl, 

 lutein cells; Bel, Blood clot; Cf, corpus fibrosum; G, Graafian follicle. X2. 



Fio. 160. Drawing of portion of the corpus luteum, indicated by small square to the left in fig. 159 (marked fig. 4 

 in drawing). Ot, tissue of ovary. X70. 



Fio. 161. Drawing of a portion of the ovary, indicated by small square to the right in fig. 159 (marked fig. 5 in draw- 

 ing). X70. 



FIG. 162. Drawing of a section through free surface of clot, illustrated in section in fig. 158, showing wall of chorion 

 and a villus surrounded by clot. Tr, trophoblast; L, leucocytes; Ch, chorion; V, villus; Coe, 

 ccelom. X50. 



PLATE 16. 



Fia. 163. External appearance of intact specimen. No. 1522. X0.75. 



FIG. 164. External appearance of same specimen, showing where block was removed. X0.75. 



FIG. 165. Appearance of cross section of pregnant ovary and tube, same specimen. X0.75. 



FIG. 166. Photograph of a section taken from the thick portion of the ovarian stroma near the mesovarium, showing 



a well-developed Graafian follicle. Same specimen. X2.25. 

 FIG. 167. Section of part of the same specimen, showing the clot which contains the empty vesicle largely surrounded 



by ovarian stroma. XI. 9. 



FIG. 168. Marked clubbing of villi of No. 550. X2.25. 



Fia. 169. Cross section of decidua and conceptus. No. 698. (See Chapter XII.) X4.5. 

 FIQ. 170. Section of conceptus, decidua, and muscularis. No. 970. (See Chapter XII.) X4.5. 

 FIG. 171. Section of decidua and conceptus. No. 962. (See Chapter XII.) X4.5. 

 FIG. 172. Section of a part of the conceptus, showing chorionic membrane, cyemic (?) rudiment (x) and yolk-sac. 



No. 1843. (See Chapter XII.) X51.5. 



FIG. 173. External view of No. 2047, showing the distended amnion. (See Chapter XII.) X2.25. 

 FIG. 174. Section of the tube and the conceptus. No. 977. (See Chapter XII.) X3.3. 



