342 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



This abortus, received through the courtesy of Dr. J. W. Williams, measured 40X20 

 X15 mm. Upon examination Dr. G. L. Streeter found it to be composed of a flattened 

 decidual and chorionic mass which, upon section, showed "pearl-like vesicular enlarge- 

 ments which suggest hydatiform degeneration." The exterior of this specimen is com- 

 posed of a thin, hemorrhagic decidua which completely surrounds the villi. The hydatid 

 nature of this clearly is recognizable upon close scrutiny with the unaided eye, and easily 

 becomes evident upon magnification of 12 diameters with the binocular microscope. 

 Examination of the histologic preparations reveals it to be a very fine specimen of 

 relatively early hydatiform degeneration. 



No. 1914 (Dr. G. C. McCormick) is a fine, very characteristic mass, part of which is 

 shown in figure 13. It is like Nos. 749 and 1323, but very much larger, for in fluid it com- 

 pletely fills a 2-liter jar. This specimen was said to have accompanied a living, 7-months 

 fetus, having been expelled between the fetus and the placenta. Only a small amount of 

 clot, and what seems to be a small portion of placenta and membranes, accompanied it. 

 Since the placenta was not saved it is impossible to say whether the mass resulted from 

 partial degeneration of the placenta belonging to the living child, or whether it represented 

 a degenerate twin placenta, which is rather unlikely but not impossible, in view of the well- 

 authenticated cases found in the literature. This specimen is of interest not only for the 

 numerous large, clear cysts, one of which measures 30X25 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 coincidence. The rareness of the specimen 

 is emphasized still further by the statement of Professor Williams that such an instance has 

 not been observed in a series of over 17,930 obstetrical cases treated by 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 later 

 than specimen No. 1640. Upon gross examination the hydropic nature of some of the villi 

 is plainly evident, as shown in figure 14, and upon microscopic examination the diagnosis of 

 hydatiform degeneration could be confirmed, although 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 performed. The major por- 

 tion of the specimen is very small. The chorio-decidual portion was felt-like in consistency 

 and extremely fibrous, due largely no doubt to the long retention. Most of the accom- 

 panying 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 satis- 

 factory teased preparation. Accompanying this material was a small body 5X7.5X 

 .30 mm., shown in figure 15. Both nodule and stalk contained some remnants of the embryo. 

 Although the appearance 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 

 degenerate 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 frag- 



