NODULAR CYEMATA. 



133 



No. 660. 



(1) Wm. J. Todd, Mount Washington, Maryland. 



(2) Ovum 40X35X30 mm.; B 1 mm. long. 



(3) Married woman 17 jears old. Last menstruation 

 January 17, and abortion March 25. 



(4) A pear-shaped ovum, mostly covered with decidua. 

 At one pole a third of the ovum protrudes and is covered 

 with ragged villi. The interior is filled with a jelly-like, 

 translucent reticular magma. No remnant of the embryo 

 was seen at this time, but the search was incomplete. 



(5) Sections through the chorion include the decidua, 

 which shows considerable round-cell infiltration. The 

 chorionic wall is thin and the villi, which are fibrous and 

 non-vascular, are attached to the decidua by a thick layer 

 of fibrinoid substance, the trophoblast having almost com- 

 pletely undergone this sort of transformation. There are, 

 however, numerous buds of syncytium. The amnion is 

 markedly fibrous and thickened, and within are numerous 

 spaces containing some Hofbauer cells. The nodular 

 embryo is quite completely dissociated, but not macera- 

 ted. It is impossible to recognize any organs. 



(6) Mild infiltration. 



No. 674. 



(1) Guy L. Hunner, Baltimore, Maryland. 



(2) B 3.5 mm. 



(3) "Patient is 42 years of age; has had 11 children and 

 one miscarriage. Youngest child 2 years old. Normal 

 labors. For several months the periods have been profuse, 

 but she thinks the last period was three weeks ago, when 

 she bled unusually. For the past six weeks there has been 

 some bleeding off and on most of the time. She is now 

 suffering with a great deal of pain in the lower quadrant 

 and about the umbilicus, and is tender over the appendix 

 region. I think that whatever pathological condition you 

 find was due to the threatened miscarriage as expressed 

 by the recent bleeding. There was no evidence of in- 

 flammation anywhere except in the appendix, and this was 

 not of an acute character, and probably had not influenced 

 the pelvic organs. The extreme retroversion of the uterus 

 may have had something to do with the threatened 

 abortion." 



(4) When received the fresh uterus had been opened 

 in front and a pathological ovum protruded. Ovum was 

 opened and an atrpphic embryo 3.5 mm. long and 2 mm. 

 wide, was found within. Sections were taken through the 

 middle of uterus and chorion, then at right angles to it 

 through the fundus. The ovum is almost entirely de- 

 tached from the uterus, but we succeeded in getting good 

 transverse as well as longitudinal sections through it 

 without disturbing the relation. The transverse section 

 is near the os. In this region the chorion is fully separated 

 from the mucous membrane and the latter has practically 

 degenerated. The longitudinal section shows this de- 

 generation on one side of the chorion, while on the other 

 side the villi are still in contact with the uterus. 



(5) Over the villi are long strands of decidua reaching 

 far into the mucous membrane. The villi, which are 

 closely attached to the uterus, are surrounded in many 

 places by a large mass of fibrinoid substance. They, too, 

 have undergone fibrous degeneration, are non-vascular, 

 and frequently are intermingled with large plaques of 

 nuclear dust. At other points the trophoblast pierces the 

 glands and blood-vessels, while between the mucous mem- 

 brane and the greater portion of the amnion there is a 

 large organized clot composed of stratified fibrin, some 

 leucocytes and small masses of red blood-corpuscles which 

 do not serve to nourish the ovum. The chorionic wall is 

 fibrous and the villi few in number. The specimen repre- 

 sents well the last stages of an abortion in which the ovum 

 has gradually become detached and the mucous membrane 

 is regenerating. However, sufficient nutrition may have 

 been carried to the embryo to allow it to continue to grow 

 in an irregular fashion. The embryo is very irregular in 

 form. Near the sharp tip are two pigmented spots the 

 eyes. The embryo is completely dissociated and macer- 



ated, and entirely covered with a poorly preserved epider- 

 mis. The pigmented spots are separated from the brain, 

 and a pronounced central nervous system does not make 

 its appearance until the region of the heart is reached, and 

 even then does not extend very far into the body. It is 

 composed of round cells and is sharply separated from 

 the body of the embryo by a fibrous layer of mesenchyme. 

 Most of the tissue has undergone a pronounced fibrous 

 degeneration. Along the ventral side of the body there 

 are numerous sharply defined cavities, devoid of cells 

 which ramify in all directions and convert the body at the 

 point of its attachment to the umbilical cord into a curious 

 cavernous mass. It is impossible to determine whether 

 the system of spaces is vascular or coelomic; probably the 

 latter. In the neighborhood of the degenerated heart 

 there are several large blood-vessels, but these do not 

 communicate with the system of spaces. There are also 

 numerous wart-like processes extending into this cavity. 

 The decidua is locally infiltrated, especially in the region 

 of the implantation site, where the peri-glandular infiltra- 

 tion is very evident. 



(6) Marked focal infiltration. 



No. 677. 



(1) Thomas Brayshaw, Glenburnie, Maryland. 



(2) A 18X21 X 12 mm.; B 1.5 mm. long. 



(3) Patient had been married 3 years, this being her 

 first pregnancy. The last period was February 15 to 19; 

 abortion April 17. 



(4) The fresh specimen, measuring 18X21X12 mm., 

 was brought to the laboratory immediately after the 

 abortion. It was well covered with villi, having bulbous 

 tips to which adhered scraps of decidua as well as blood- 

 clot. The ovum was opened in warm saline solution and 

 sketches of its contents made under the binocular. It is 

 filled with a delicate web-like transparent system of 

 reticular fibers containing the flattened, transparent yolk- 

 sac and blood-vessels, which lead to a white embryonic 

 rudiment. This shows four processes, possibly the ex- 

 tremities. Wliile the specimen was fixed in sublimate and 

 glacial acetic, the reticular magma immediately became 

 dense, completely obscuring the nodular embryo. 



(5) The latter is completely dissociated, and over its 

 body are numerous irregular warts which are difficult to 

 interpret. The whole rests upon a large umbilical vesicle. 

 There are slight traces of the central nervous system, and 

 within the body is a curious mass which may represent 

 the degenerated heart. The brain and spinal cord can 

 barely be outlined. Towards its lower part the specimen 

 contains a lumen. The umbilical cord, or what amounts 

 to the same, passes along one side of the umbilical vesicle 

 before it reaches the wall of the chorion. The chorionic 

 wall is somewhat fibrous and contains numerous very 

 large, almost empty blood-vessels. The mesenchyme of 

 the villi is mostly degenerated and disintegrated, and 

 practically all of the trophoblast is necrotic. The villi 

 are glued together by strands of fibrin, blood, syncytium, 

 and fine fragments of extremely degenerate decidua. 



(6) Hydatiform degeneration. 



No. 692. 



(1) James L. Huntington, Boston, Massachusetts. 



(2) A 20X20X20 mm.; B-3 mm. 



(3) Patient aged 40 years; married 6 months. This may 

 be the second pregnancy, as patient gives a history sugges- 

 tive of an early abortion February 10, when she was 19 days 

 overdue and flowed profusely. She had no medical 

 attendant. Last menstrual period March 10 to 16; 

 abortion May 19 following. No evidence of syphilis, 

 gonorrhoea, or endometritis due to other infections. 

 Uterus involuted normally and well. 



(4) Specimen measured in formalin. The ovum is 20 

 mm. in diameter, and one half of it is covered with ragged 

 villi, the other half beLag quite smooth. The interior is 

 filled with a delicate reticular magma. Within the amnion 



