HYDATIFORM DEGENERATION IN UTERINE PREGNANCY. 



209 



the well-authenticated cases found in the litera- 

 ture. This specimen is of interest not only for 

 the numerous large, clear cysts, one of which 

 measures 30 by 25 mm., which it contains, but 

 because it accompanied the birth of a living 

 child and because of the relative rareness of such 

 a coincidence. In regard to the latter, Dr. 

 McCormick added that in his experience of over 

 1,000 labors he had never before met this coin- 

 cidence. The rareness of the specimen is em- 

 phasized still further by the statement of Pro- 

 fessor Williams that such an instance has not 

 been observed in a series of over 17,930 osbtetri- 

 cal cases from the Department of Obstetrics of 

 the Johns Hopkins Medical School, as well as 

 by the small series of such cases recorded in the 

 literature. 



No. 1926, a companion specimen to No. 1640, 

 is composed of material from curettage received 

 through the courtesy of Dr. Karl Wilson, of the 

 Department of Obstetrics of the Johns Hopkins 

 Medical School. It was removed from the same 

 patient about a year after specimen No. 1640. 

 Upon gross examination the hydropic nature of 

 some of the villi is plainly evident, and upon 

 microscopic examination the diagonosis of hyda- 

 tiform degeneration could be confirmed, al- 

 though the villi were extremely degenerate. 

 The menstrual history of this case fortunately 

 is known and is thoroughly reliable. The last 

 menstruation occurred January 24 and curettage 

 was done August 4. Bleeding occurred every 

 two or three weeks during March and April and 

 was repeated throughout May. Since the 

 uterus, which had reached the symphysis, had 

 not enlarged any for months, in view of the long 

 duration of pregnancy the operation was per- 

 formed. The major portion of the specimen is 

 very small. The chorio-decidual portion was 

 felt-like in consistency and extremely fibrous, 



This short review of the gross appearance of the cases of hydatiform degen- 

 eration recognized by the unaided eye with the customary criteria, originally 

 classed as such in the Carnegie Collection, shows that they vary decidedly in their 

 gross, naked-eye characteristics, both as to size and appearance. No. 1640 scarcely 

 is distinguishable as a case of hydatifo m degeneration from gross appearances 

 alone, unless one's attention is directed especially to the matter, but all the rest 

 of the specimens, both small and large, not only are easily recognizable, but are 

 so characteristic that they could not possibly be overlooked. As was indicated 

 above, the incidence of these specimens of hydatiform degeneration among the 

 first 2,400 accessions in the Carnegie Collection was 1 in every 261 abortuses, or 

 more than 8 times the incidence given by Williamson, and 1.3 times that given 

 by Essen-Moller. Although this incidence is so much higher, it does not necessarily 

 contradict the statements of Williamson, for it represents the incidence of hydati- 

 form degeneration in abortuses belonging very largely below 7 months, 

 it tell the whole story for these months, for since the incidence of hydatiform 



due largely no doubt to the long retention. Most 

 of the accompanying material looks like mucosa 

 rather than decidua, although some of the larger 

 pieces very evidently contained villi. Some of 

 these were relatively thick and fibrous, and 

 others were vesicular. All of the material was 

 extremely fibrous, making it difficult to get a 

 satisfactory teased preparation. Accompany- 

 ing this material was a small body 5 by 7.5 by 

 30 mm. Both nodule and stalk contained some 

 remnants of the embryo. Although the appear- 

 ance of the stalk suggests the umbilical cord, it 

 contains fragments of the body of the embryo, 

 some of which evidently are composed of nerve- 

 tissue. 



Microscopic examination of the pedunculated 

 mass further shows it to be composed of degen- 

 erate remnants of organs, tissues, and cells. It 

 is partly denuded and partly covered by a layer 

 of fibrous connective tissue which contains local 

 thickenings. In other areas this fibrous layer 

 gives place to a single or more-celled layer, or to 

 polygonal, epithelioid cells. The interior of this 

 specimen is composed of a degenerate jumble 

 including fragments of the central nervous sys- 

 tem, the heart, liver, and cartilages. The entire 

 body is chaotic in its structure, and small frag- 

 ments of the nervous system are scattered 

 throughout its entire extent. This would seem 

 to indicate that the disruption of the tissues 

 was mechanical. The material in which the 

 organic remnants are contained is composed of 

 coagulum, some mesenchyme, cellular detritus, 

 blood, and polymorphonuclear leucocytes, de- 

 generated cells, which appear to have been 

 phagocytic, but which are more likely fusion 

 products or "symplasma" (as Bonnet called 

 them). A few remnants of vessels are found 

 only in the fragments of cartilage. 



