NODULAR CYEMATA. 



125 



tion. Within the cord there is an epithelial vesicle, 

 possibly the remnant of the allantois. Besides the cord 

 there is the amnion, which is thrown into many folds 

 and which has also become very fibrous and degenerate. 

 (6) Marked infiltration. 



No. 1001. 



(1) Geo. Heller, Baltimore, Maryland. 



(2) A 65X43X25 mm. (abortus); 42X30X20 mm. 

 (chorion). 



(4) The specimen is composed of a partially torn 

 decidua containing a chorionic sac partly filled with clear 

 fluid, and a small oval mass 1 mm. long which may be the 

 remains of an embryo. The amnion, which is partially 

 fused with the chorion, is approximately two-thirds its 

 size. Where it is separated from the chorion reticular 

 magma is present. When examined under the binocular 

 microscope the presence of hydatiform degeneration easily 

 is revealed. The decidua is only slightly hemorrhagic. 



(5) The best examples of hydatiform villi which are 

 already vesicular in form are found near the basalis, which, 

 like all the rest of the decidua, has undergone autolysis 

 and shows a few small areas in which there is an increase 

 in round cells. Otherwise no evidence of infiltration was 

 noticed. Some of the villi and membranes contain small 

 numbers of atypical Hofbauer cells, and the stroma of 

 all the villi is degenerate. The epithelium is not well 

 differentiated and shows no evidence of unusual growth. 

 The trophoblastic nodules also are degenerate and no 

 remnants of an embryo were seen. A fair quantity of ill- 

 preserved blood is found between the villi. 



(6) Hydatiform degeneration with slight infiltration 

 and autolysis of the decidua. 



No. 1005. 



(1) H. B. Titlow, Baltimore, Maryland. 



(2) A 48X36X35. mm. 



(4) On cutting the clot, "caseous magma" welled out, 

 clotting immediately in the bichloride in which the clot 

 had been placed. No embryo was found in the necrotic 

 contents, which apparently represents the degenerate con- 

 ceptus. 



(5) Microscopic examination reveals nothing but the 

 very degenerate vesicles with villi and decidua. 



GROUP 4. 



No. 11. 



(1) F. E. Kittridge, Nashua, New Hampshire. 



(2) A 10X7X7 mm.; embryo 0.8 mm.; umbilical vesi- 

 cle 1.5X1 mm. 



(3) Patient aged 25; menses regular every 4 weeks, 

 periods lasting from 4 to 5 days. She gave birth to a 

 child Spetember 19 and had the first recurrence of men- 

 struation December 19. The second period followed on 

 January 25, was very profuse, and lasted until February 

 1. She missed her next period, concluded she was preg- 

 nant, and called upon the physician a few days later. 

 March 1 she fell and hurt herself, and during the 

 night had a scanty flow. This recurred each day, and on 

 March 7 she passed the ovum. 



(4) The ovum is very large for its age, having a long 

 diameter of 10 mm. and a short diameter of 7 mm. It is 

 covered with villi only around its greatest circumference, 

 having two spots without villi, as was the case with Reich- 

 ert's ovum. The villi of the chorion are from 0.5 to 0.7 

 mm. long, branched and somewhat fibrous in structure. 

 Upon opening the chorion it was found that the embryonic 

 vesicle was situated just opposite the edge of the zone of 

 villi. About it there was a considerable quantity of 

 magma reticule which was not removed. The portion 

 of the chorion to which the vesicle was attached was cut 

 and from the sections a reconstruction made in wax. 



(5) The sections and reconstruction show that the 

 embryonic vesicle is attached to the chorion by means of 



a stem. The greater part of the vesicle itself is composed 

 of two layers, ectoderm and mesoderm. In the neighbor- 

 hood of the embryonic stem there is a third outer layer 

 which shows all of the characteristics of the ectoderm. 

 Just beside the attachment of the vesicle to the stem 

 there is a sharp, deep, and narrow invagination of all 

 three embryonic membranes. Within the stem a sharply 

 defined allantois communicates with the cavity of the 

 vesicle just below the cavity of the ectoderin. The 

 ectodermal plate of the evagination is very broad, but 

 not of equal thickness throughout. It extends to the 

 outside of the vesicle and ends quite abruptly in the 

 neighborhood of the stem. The blood-vessels of the 

 mesodermal layer extend to the stem, but do not enter it, 

 nor are there any blood-vessels in the chorion. Since the 

 first publication of this specimen our studies, both of 

 normal and pathological material, have been greatly 

 extended, and seem to prove even more clearly that this 

 specimen must belong to the pathological class. The 

 other pathological specimens in our collection, as well as 

 the perfect, normal specimen described by Peters, all 

 speak for this conclusion. Yet the presence of all three 

 blastodermic membranes, with blood-islands in the meso- 

 derm and an allantois in the embryonic stem, indicate 

 that the specimen can not be far from the normal, but 

 represents the earliest changes in the blastodermic mem- 

 branes of an ovum of the Peters stage under pathological 

 conditions. The villi coalesce and are matted somewhat. 

 The chorion is macerated. 



No. 14. 



(1) J. Friedenwald, Baltimore, Maryland. 



(2) A 30X30X30 mm.; within is a small double vesi- 

 cle with a short pedicle 1.5 mm. in diameter. 



(5) The mesodermal layer of the chorion is thin and 

 decidedly fibrous, with but few cells scattered through 

 it. There are groups of cells in the chorion at the base of 

 the vesicular embryo. The walls of the vesicle are thick, 

 without blood-islands, and covered with a single layer of 

 epithelial cells which have fallen off at points. Scattered 

 throughout the mesoderm are numerous cells. At the 

 base of the vesicle there are a few blood-spaces containing 

 blood-cells. At the base of the larger vesicle is a large 

 closed space. A similar space lies immediately below the 

 smaller vesicle. The small embryonic nodule shows but 

 slight differentiation, and the whole specimen is con- 

 siderably macerated. 



No. 24. 



(1) C. O. Miller, Baltimore, Maryland. 



(2) Chorion 21X16X5 mm., with vesicular nodule. 

 (4) The ovum was completely covered with villi which 



branch a number of times. Upon opening the specimen, 

 it was found that the coslom was filled with magma 

 reticule of moderate density; no trace of an embryo could 

 be found. When placed in direct sunlight a small nodule 

 became visible. The walls of the vesicle are composed of 

 three layers, the outer being greatly thickened at points, 

 but retaining sharp borders. The mesoderm is hyper- 

 trophic. The inner layer is irregular thick and thin 

 with a tubular branching process which extends to the 

 stem of the vesicle. There are blood-islands in the vesicle 

 and stalk, and the vessels extend to the villi of the chorion. 

 The trophoblast is very extensive, forming large buds 

 upon the chorion as well as upon the villi. At points these 

 buds coalesce to form islands, the centers of which are 

 composed of a necrotic mass filled with fragmented nuclei. 

 The amnion is absent, but a remnant of the allantoic 

 stalk is found in the chorionic membrane. A small mass 

 of tissue near the yolk-sac, and continuous with it, may 

 be a remnant of the embryo. This shows but little differ- 

 entiation. The villi show typical hydatiform degeneration. 

 (6) Hydatiform degeneration. 



