HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 333 



divided the tube somewhat unequally, as shown in figure 1 . Although the embryo 

 and the amnion long had disintegrated completely, and although the chorionic 

 membrane itself is thin, covered by degenerate epithelium and also disintegrating, 

 the epithelium of the villi not only is well preserved but is accompanied by large 

 masses of trophoblast and considerable syncytium. Syncytial buds are found on 

 the chorionic membrane also. The tubal mucosa is largely and the tubal wall partly 

 destroyed by the invading trophoblast. Only a few small vestiges of the walls of the 

 villous vessels remain, and the stroma of all the villi has undergone changes charac- 

 teristic of hydatiform degeneration represented in figure 2. One villus also contains 

 an epithelial cyst resulting from epithelial invagination with subsequent isolation of 

 the distal extremity, a process to be referred to later in connection with uterine 

 specimens. Since most of the villi of this and similar specimens still are implanted 

 in the tube, there can no longer be any question as to the time in which hydatiform 

 changes in the stroma of the villi may be inaugurated. As illustrated in other 

 instances in which isolated and small groups of villi still were implanted, the advent 

 of degeneration of the stroma occurs, in part at least, before the villus is detached. 

 Hence it is not merely a post-mortem or maceration change. 



Another very interesting specimen of tubal implantation is No. 1771, received 

 from Dr. H. M. N. Wynne, of the Johns Hopkins Hospital. The menstrual age of 

 this specimen is 49 days, but its anatomic age, as based upon length according to 

 Dr. Streeter's curve (unpublished), is 37 days, thus showing a discrepancy between 

 the menstrual and anatomic ages of 12 days. The embryonic length is only 12.5 

 mm., although with a menstrual age of 49 days it should be at least 18 mm. Upon 

 examination, Dr. Streeter found the chorionic vesicle to contain a good deal of 

 magma, some of which still was adherent to the embryo, as figure 3 shows. As has 

 been repeatedly emphasized in the literature, the presence of this coagulum in 

 itself probably indicates that the embryo died some time previously. 



The wall of the tube is quite thin, as figure 4 shows, but the implantation is 

 fairly well preserved around the whole perimeter of the specimen. The mucosa 

 is destroyed throughout the greater extent of the section and the trophoblast is 

 abundant, except in one rather degenerate and hemorrhagic area. The chorionic 

 membrane is thin but contains some vessels distended with blood. The stroma 

 of many of the villi also contains vessels filled with blood, but the vessels in many 

 others are very evidently in degeneration. The syncytium is scanty and many 

 of the villi are very plainly hydatiform, as seen in figures 5 and 6. 



A third exceptionally fine specimen of tubal hydatiform mole is No. 2052, 

 donated by Dr. N. M. Davis, of Washington, D. C. Figure 7 shows a portion of 

 the tube containing the hydatiform mole, some hydatiform villi of which protrude 

 through an incision in the wall of the tube. The whole opening is filled with typical 

 hydatiform villi barely detected by the unaided eye but perfectly evident under 

 an enlargement of 4 diameters. They present an extremely fine picture when seen 

 with the binocular under a magnification of 10 to 20 diameters. Examination under 

 a higher magnification shows that the preservation of the specimen is unusually 

 good and that all the villi arc markedly hydatiform. Trophoblastic proliferation 

 is so marked that in some places it gives the appearance of decidual formation. 



