108 



STUDIES ON PATHOLOGIC OVA. 



These protocols are not presumed to be complete descriptions of the specimens. 

 To have made them such would have required considerably more revision and would 

 often have been superfluous for the present purpose. In many cases the decidua 

 and the chorionic vesicles really require further description, but since my attention 

 was directed especially to them, and since their condition was particularly noted in 

 the discussion, this deficiency in the protocols in no way prejudices the discussion. 



The clinical histories we owe to the donors of the specimens; the original de- 

 scriptions of the first 827 specimens were made by Dr. Mall himself, and the later 

 gross descriptions are based on original notes by various associates of Dr. Mall, 

 expecially Drs. Evans and Streeter. A few protocols were entirely rewritten by 

 Dr. Wheeler at Dr. Mall's request. 



GROUP 1. 



No. 223. 



(1) Max Brodel, Baltimore, Maryland. 



(2) A 40X18X15 mm. 



(4) At the point of attachment to the uterus the " fibroid 

 mass" is very rich in villi. At its rounded end it is com- 

 posed wholly of blood. 



(5) The entire mass is surrounded by a layer of pus and 

 necrotic decidua. In certain portions the intcrvillous 

 spaces are filled with degenerating trophoblast. Where 

 the trophoblast cells are far removed from the blood they 

 are often necrotic. Some villi contain numerous Hofbauer 

 cells and the stroma of many suggests a rapid degeneration 

 of a rather fibrous non-vascular stroma. 



(6) Marked infiltration of the decidua. 



No. 290. 



(1) S. P. Warren, Portland, Maine. 



(2) A 50X15X10 mm. 



(3) The specimen is said to be from a six weeks' gesta- 

 tion and the abortion is believed to have been induced by 

 some emmenagogue. 



(5) Sections were cut from different portions of this 

 irregular mass and the remnants of a few villi, more or less 

 infiltrated with leucocytes, were found. The bulk of the 

 specimen is composed of decidua, mucous membrane, 

 blood, fibrin, pus, and a few degenerate, necrotic villi. 



(6) Marked infiltration of the decidua. 



No. 323. 



(1) V. Van Williams, Baltimore, Maryland. 



(2) A 120X90x65 mm. 



(4) The specimen was brought fresh to the laboratory 

 and was found to be composed of enlarged villi and vesicles, 

 most of which measure 5 mm. and a few fully 20 mm. in 

 diameter. On one end the specimen is fibrous, and from 

 there the villi extend into a bloody mass. 



(5) The latter villi are very irregular in form, the mesq- 

 derm being hyaline, with numerous spindle-shaped nuclei. 

 Between the villi there are great masses of necrotic tropho- 

 blast, some blood, and occasionally small masses of leuco- 

 cytes. A few of them contain irregular clefts with cells, a 

 clear fluid, and some coagulum. 



(6) Slight infiltration and decided hydatiform degenera- 

 tion. 



No. 395. 



(1) R. M. Pearce, Albany, New York. 



(2) A 17X10X7 mm. 



(3) Dr. Pearce writes: "I am sending you today a 

 small encapsulated mass, found among curettage material, 

 which appears to be a young ovum. I have refrained 

 from attempting to determine definitely whether or not it 

 contains an embryo, for fear of injuring a specimen which 

 might be of value to you. The specimen was removed 



six weeks after the last menstruation. The uterus was 

 emptied because the patient had eclampsia three years 

 ago, and since then has had premature delivery of two 

 dead children. The specimen is preserved in'lO per cent 

 formalin." 



(4) The whole mass was cut into serial sections, but no 

 embryo was found. 



(5) The sections show it to be composed of a few very 

 degenerate villi and inflammatory decidua. Most of the 

 villi are also fibrous and degenerate. A few, however, 

 contain blood-vessels filled with blood; others contain 

 obliterating vessels. The fragmentary wall of the chorion 

 is very fibrous and the growth of the syncytium is very 

 irregular. Undoubtedly the ovum "collapsed" some days 

 before the uterus was scraped. The whole specimen is 

 buried more or less in a slimy mass rich in leucocytes, 

 which indicates that the uterine mucosa was markedly 

 inflamed. 



(6) Marked infiltration. 



No. 565. 



(1) Dr. W. A. Duvall, Baltimore, Maryland. 



(2) A SOX 20X20 mm. 



(4) The solid mole appeared to be composed of mucous 

 membrane of the uterus, fibrin, and blood. Its macro- 

 scopic appearance was much like that of the decidua. 



(5) Sections show that it is composed almost entirely 

 of decidua containing spaces lined with fibrinoid substance. 

 These seem to be degenerating uterine glands. There are 

 isolated villi which have undergone marked degeneration, 

 and also a few buds of syncytium. Portions of the mass 

 are very markedly degenerated, there being large groups of 

 pycnotic nuclei in certain necrotic areas. 



No. 644. 



(1) Edwin B. Fenby, Baltimore, Maryland. 



(2) A 45X29X35 mm. 



(3) Patient a rather frail, nervous woman, 35 years old, 

 who, since January, had been nursing a sick child. Last 

 regular period December 15. February 15 she felt badly: 

 menses appeared and continued with intermissions until 

 March 9, when her physician curetted. 



(4) The specimen consists of a pear-shaped mass, the 

 small end of which includes long, delicate, bulbous villi, 

 some of which had the appearance of blood-clot. 



(5) Transverse section of the block shows that its 

 interior is filled entirely with blood. Around the periphery 

 are villi and remnants of a degenerate decidua showing 

 very extensive inflammatory reaction. Most of the villi 

 are necrotic, but a few of them still seem to be preserved. 

 These have undergone fibrous and mucoid degeneration, 

 and occasionally are capped by trophoblast which has 

 undergone almost complete fibrinoid changes. Extremely 

 degenerate portions of the chorionic wall are present 

 throughout the clot. 



(6) Marked infiltration and hydatiform degeneration. 



