116 



STUDIES ON PATHOLOGIC OVA. 



parent chorion can be seen. On the opposite side the 

 shaggy villi reach probably 10 mm. in length. They are 

 extremely complex, branching many times, and almost 

 all of the stems have a clear, bulbous appearance. The 

 ovum, which was opened through a careful slit in the 

 denuded area, contained a voluminous cavity filled with 

 a fluid, and was crossed by extremely delicate strands of 

 reticular magma. An embryonic remnant was not found. 

 In the part of the wall where the most luxuriant villi 

 occur, many circular, opaque white nodules, about 1 mm. 

 in diameter, could be seen. 



(5) The villi seem to have undergone mucoid degenera- 

 tion. The trophoblast is scanty and mostly takes the 

 form of buds of syncytium and nodules which have under- 

 gone partial fibrinoid degeneration. These nodules of 

 trophoblast are frequently vacuolated. 



(6) Hydatiform degeneration. Decidua absent. 



No. 865. 



(1) Walter Tobie, Portland, Maine. 



(2) A 50X20 mm. 



(3) Woman aged 35 years, married 10 years. Six preg- 

 nancies: five abortions and one birth at 7 months, dead. 

 Beginning of last menstrual period uncertain; said to have 

 been about \Yi to 2 months pregnant. At operation 

 amputation of uterus at cervix; double salpingo-oopher- 

 ectomy and appendectomy. No definite history of vene- 

 real disease. Dilatation and curettage, with ventral sus- 

 pension, 4 years before. Said to have had tubal preg- 

 nancy one year ago. Family fertile on both sides and 

 easily pregnant. 



(4) The specimen consists of the uterus with both 

 tubes and ovaries. The uterus measures 65X58X58 

 mm. It was cut six times in the antero-posterior plane, 

 disclosing an implanted ovum 55X20 mm., apparently 

 beginning to dislodge, the portion pointing toward the 

 cervix being free. The small slit in the chorion measures 

 about 26X3 mm. 



(5) The right ovary measures 32X18 mm. and con- 

 tains six old copora and a small carcinoma measuring 

 10X12 mm. in cross-section. This shows to the right 

 in figure 78, and upon higher magnification is seen to be 

 studded with numerous small cell-nests which are barely 

 visible in the mounted section with the unaided eye. 

 Practically all of these nodules are discrete, as shown in 

 figure 79, and all look decidedly quiescent, for very few 

 nuclear figures suggesting mitosis were seen. All these 

 cell-nests are well defined and none are edematous in 

 character. Some of them contain a few small areas of 

 calcification, and some of the latter are contained also 

 in the ovarian stroma of the carcinomatous nodule. 



The left ovary, shown in section in figure 80, which 

 contains several old corpora and a recent one, measures 

 35X19 mm. and is cystic. The largest of these cysts, 

 which by reference to the original specimen is found to 

 be approximately spherical, measures 11.5X9 mm. on 

 section. It is devoid of contents and immediately outside 

 of the lining epithelium a small teratoma is found. Ex- 

 amination of the original specimen shows that this tera- 

 toma extended somewhat farther into the lateral half, 

 and that the greater part of it still is contained in the 

 more medial portion of the ovary (which is embedded in 

 celloidin) and lies in the dorso-medial area of this portion. 

 As shown in figure 81, it is represented by a grayish-white 

 cartilaginous plaque, 8 mm. long by 1.5 mm. thick, with 

 a markedly triangular process extending outward from 

 its medial side. An examination of the stained sections 

 shows this teratomatous mass to be composed of cartilage, 

 at one extremity of which small plaques of bone are found. 

 Surrounding this there is some adipose tissue which con- 

 tains a number of tubules cut mainly in cross-section 

 which from their appearance suggest those of suderiparous 

 glands, but which probably are sebaceous. At the oppo- 

 site extremity a considerably larger lobulated mass of 

 glandular tissue is found, which seems to be sebaceous in 

 nature. A few small tubules also are found near these 



lobules, which are partly separated from each other by 

 trabeculae of fibrous tissue. No remnants of epidermis, 

 but some of a few hairs were found. A few degenerate 

 hair-follicles also are present, and considerable accumu- 

 lations of round cells are found near some portions of 

 the teratoma. 



After cutting the uterus into blocks, it was found that 

 part of the ovum is detached and protrudes from the 

 cervix. A portion of the chorion is well implanted and 

 to the naked eye shows mottling. These spots, when 

 cut into sections, are shown to be composed partly of 

 hypertrophic degenerated villi, mostly with a mucoid 

 stroma, some of which are very rich in Hofbauer cells. 

 The villi, which are of all shapes and sizes, are matted 

 together with fibrinoid substance and a great quantity of 

 leucocytes and pus. At points the leucocytes burrow into 

 the trophoblast and also enter the mesenchyme of the 

 villi. Most of the trophoblast is necrotic and contains a 

 great many plaques of nuclear dust. The leucocytes have 

 entered the cavity of the ovum and line the inside of the 

 chorion, which is undergoing fibrous degeneration. Nei- 

 ther .'iininon nor embryo was found. 



(6) Severe infiltration; hydatiform degeneration. 



No. 876. 



(1) C. W. R. Crum, Brunswick, Maryland. 



(2) A 46X30X23 mm. 



(3) Patient aged 25, married in 1909. Five pregnan- 

 cies: two children at term, followed by three abortions; 

 August 1913, January 1914, and this one, April 19, 1914. 

 Last menstrual period February 3 to 8. On February 15 

 patient was nauseated as in early pregnancy. No infec- 

 tion of uterus. Temperature normal. Retroversio uteri. 

 No venereal diseases. Family fertile. 



(4) The specimen consists of an irregularly shaped, firm 

 abortion mass which measures 46X30X23 mm. Villi 

 protrude at one end, but most of the surface seems to be 

 firm decidual tissue. The specimen contains a perfectly 

 smooth-walled cavity measuring about 32X22 mm. in 

 diameter, with no trace of an embryonic rudiment. 



(5) Sections of the wall show that the chorionic mem- 

 brane is of normal texture, but thickened. Some of the 

 villi are somewhat fibrous, but most of them show marked 

 mucoid degeneration. Some are intermingled with active 

 trophoblast, which in some instances contains fibrinoid 

 substance and coagulated blood. The surrounding de- 

 cidua is markedly inflamed and contains abscesses. 



(6) Marked infiltration; hydatiform degeneration. 



No. 883. 



(1) G. H. Hocking, Govans, Maryland. 



(2) A 37X26X20 mm. 



(3) Patient aged 34 years, married May 4, 1905. Two 

 pregnancies; birth at term P'ebruary 2, 1906, and abortion 

 April 21, 1914. Slight flow which continued until abor- 

 tion on April 21. Condition of uterus negative. No 

 venereal diseases. Family small. 



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

 measuring 37X26X20 mm. It is friable, and on being 

 opened, a smooth- walled, oval chorionic cavity 20X9 mm. 

 is disclosed. This is filled with a coagulated albuminous 

 material containing cellular elements. The remains of 

 the embryo could be seen. 



(5) Sections show that the cavity of the ccelom is 

 almost obliterated. On one side there are curious 

 globules of degenerated pus which stain with eosin. The 

 chorionic membrane and villi have undergone mucoid 

 degeneration, and the latter are embedded in a clot of 

 blood. There is a great deal of leucocytic infiltration, 

 especially in the degenerated inflamed decidua. Leuco- 

 cytes have invaded the mesenchyme of the chorionic 

 membrane as well as that of the villi, and numerous small 

 pus cavities are found between the chorionic epithelium 

 and the stroma of this membrane. 



(6) Severe endometritis and intra-chorionic infection; 

 some hydatiform degeneration. 



