HYPATIFORM DEGENERATION IN TUBAL AND UTERINE 



PREGNANCY, 



BY ARTHUR WILLIAM MEYER. 



The following study is an outgrowth of a survey (planned by Mall) of the 

 embryological collection of the Carnegie Institution of Washington. It was my 

 privilege to share in this undertaking and to be permitted to follow any matters of 

 special interest to me. The following report concerns itself especially with the 

 occurrence of hydatiform degeneration in abortuses and specimens in the Mall 

 Collection which were obtained through operation and were classed as pathological. 

 My attention was attracted to the subject while engaged in an examination of the 

 Hofbauer cells, begun at the suggestion of Mall. For the purpose of convenience I 

 shall discuss the tubal and uterine cases separately, including what is common to 

 both with the latter. 



TUBAL. 



Strangely enough, the occurrence of chorio-epithelio ma arising from tuba 

 pregnancy seems to be better known and also better established than the occurrence 

 of hydatiform mole within the tube. This is especially surprising in view of the 

 stress laid by Marchand (1898) upon epithelial proliferation in cases of hydatiform 

 mole and in view of the fact that trophoblast formation and epithelial proliferation 

 in general have been regarded as being greater in tubal than in cases of uterine 

 implantation. This is illustrated well by such cases as that of Fellner (1903), in 

 which it was impossible to distinguish by histologic examination between the 

 epithelial proliferation present in a case of tubal pregnancy and that from a chorio- 

 epithelioma. From these circumstances alone it seems to me that one might expect 

 hydatiform degeneration to be relatively more common in the tubes. Moreover, 

 when it is recalled that experts still regard it as impossible to decide upon the 

 question of malignancy or benignity in cases of suspected uterine chorio-epithelioma 

 from histologic preparations alone, this surmise gains more in probability. The 

 presence of hyperactivity in the trophoblast in many cases of tubal pregnancy as 

 compared with the uterine was confirmed also by personal observation, and if, as 

 stated by Teacher (1903), chorio-epitheh'oma arose in hydatiform moles in approxi- 

 mately 40 per cent of 287 cases, and according to Seitz (1904) andFraenkel (1910) 

 even in 50 per cent, the occurrence of hydatiform degeneration in tubal pregnancy 

 can hardly be doubted because of this fact alone. Nevertheless, of the 7 cases of 

 tubal hydatiform moles cited by him, Werth (1904) regards only the case reported 

 separately by von Recklinghausen (1889) and by Freund (1889) as well authenti- 

 cated. Werth reserves judgment, however, on the case of Matwejew and Sykow 

 (1901), a report upon which was accessible to him, and to me, in a short review only. 

 Seitz, however, accepted the short review of this case as convincing, nor did he ques- 



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