68 STUDIES ON PATHOLOGIC OVA. 



vesicle. Not rarely the apposed fibrous surfaces of these folds had been fused so 

 intimately that they simulated villi very closely indeed and could easily be mis- 

 taken for them. Both isolated villi and chorionic vesicles were almost invariably 

 embedded in blood-clot, and in some instances hyaline outlines only remained of 

 the villi. Villi with a dense, fibrous, non-vascular stroma were seen in a few 

 instances only, and they usually were found in the presence of severe infections. 



Infiltrations of the tube-wall or of the clot were found in 20 (or 57.1 per 

 cent) of the specimens in which it was cut, as compared with 93.3 per cent of infil- 

 tration of the deciduaB in the uterine series. Of the former, 65 per cent showed 

 slight and 35 per cent marked infiltration. In by far the majority of cases the 

 picture was that of a low-grade chronic, rather than of a severe acute infection. 

 Moreover, in several instances the infiltration was so slight that one possibly 

 might attribute it to the effect of the pregnancy itself. Chronic changes, especially 

 in the mucosa of the tube, were quite common, however. 



Of the 37 cases in this group, 17, or 46 per cent, showed the presence of un- 

 doubted hydatiform degeneration. In one additional case its existence was doubt- 

 ful. Of these 17 cases of hydatiform degeneration, 12, or 70.6 per cent, came from 

 tubes which were infiltrated. In 4, or 23.5 per cent, of these cases, the infiltration 

 was marked, and in the rest it was slight. Although the incidence of infiltration 

 is high, it is decidedly lower than in the corresponding uterine group, in which 

 it was 100 per cent. The incidence of infiltration of the tube- wall or of the clot, 

 usually sufficiently pronounced to be indicative of infection, was 70.6 per cent, 

 as compared with 93.3 per cent in the corresponding uterine group. Nevertheless, 

 the incidence of hydatiform degeneration was somewhat higher in the tubal cases, 

 in which it was 46 per cent, as compared with the uterine, in which it was 40 

 per cent. Furthermore, the fact that many of these tubes showed the effects of 

 chronic rather than of acute changes seems to suggest that the mere presence 

 of an infection is not enough to cause the advent of hydatiform degeneration. 

 These changes would seem to result rather from the modifications produced in 

 the decidua and in the tube by the infectious process, and it is not unlikely that 

 the greater incidence of hydatiform degeneration in the tube may, as already sug- 

 gested, be due in part to the absence of a nidus comparable to the endometrium, 

 for it is not unlikely that even a somewhat fibrous decidua may offer better con- 

 ditions for implantation than a perfectly normal tube. 



Some fibrous villi were found, and matting and gluing of the villi occasionally 

 were present. Degenerative changes in the nuclei of the syncytium, up to and 

 beyond the stage designated by Mall as "nuclear dust," were noticed in several 

 specimens, which probably had been retained longer after isolation within the 

 blood-clot so as to inaugurate calcification. Contrary to what one might assume, 

 the length of the period of recurring hemorrhages is not a reliable guide to the 

 condition of the villi. Indeed, one can not say even that the longer the duration 

 the greater the degeneration and necrosis, for repeated hemorrhage apparently 

 may and does occur as a result of only partial detachment of the chorionic vesicle. 



