348 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



rarity of this condition, erroneously stated that the German literature reveals only 

 a single instance of missed abortion in case of hydatiform mole, viz., that of Poten 

 (1901). In this case a hydatiform mole of the size of a duck egg was said to have 

 been aborted approximately one month beyond term. Hence growth must have 

 ceased long before and the mole have remained in utero as a "harmless body." To 

 this case of Poten, Sternberg adds a case in which a hydatiform mole of 14X9.6 

 X4.3 mm. was aborted in the twelfth month after the cessation of menstruation. 

 Although Sternberg included 4 cases from other countries among these missed- 

 abortion moles, viz., those of Sheil (undated), Ferguson (also undated), Colorni 

 (1908), and Gaifani (1908), one can hardly doubt that more cases could be added. 

 Since the case of Sheil was one of twin pregnancy in which one conceptus became 

 hydatiform, it is not at all unlikely that some other cases among this rather small 

 series of twin pregnancies accompanied by hydatiform degeneration may belong 

 in this category. 



Mayer also emphasized the fact that, although instances of retention of fetuses 

 are very common, instances of retention of hydatiform mole are very rare, only a 

 few cases having been recorded. Mayer refers to 2 cases by Kehrer, 3 of Borland 

 and Gerson, and to 1 case of Lange, and reports 4 of his own. These 4 were found 

 among 10 cases of hydatiform mole, an incidence of retention of 40 per cent. They 

 are interesting, especially in connection with the observation of Briggs that, con- 

 trary to current belief, uterine enlargement often is not beyond the normal. Mayer 

 says that this enlargement was too great in but 1 of the 4 cases, and that retention 

 lasted as long as 4 to 5 months. 



At least 3 of the cases of hydatiform mole originally recorded as such in the 

 Mall Collection belong among retained specimens, as the illustrations alone suggest. 

 But a fair percentage of detached chorionic vesicles included in the list of cases 

 here reported undoubtedly also was retained after the cessation of growth, and it is 

 for this reason that I further emphasize the fact that the uterine volume in a con- 

 siderable percentage of these cases also, instead of having been too great for the 

 duration of the pregnancy unquestionably was too small. This is well illustrated 

 by the histories of specimens Nos. 70, 323, 1640 and 1926, and by the specimens 

 themselves. 



The average menstrual age of 51 of 112 uterine specimens of this series of 

 hydatiform degeneration in which the data were available was 66.6 days, or 

 2| months. As will be seen, this is a far lower average age than heretofore reported, 

 a difference which explains itself from what has been said already. It is interesting 

 that the average menstrual age of 5 of the 8 specimens in the Mall Collection 

 originally classed as hydatiform degenerations is 168.2 days, or 1\ times as great, 

 thus being in substantial agreement with the usual results. Three of these 5 are 

 large specimens, the fourth measures 40X20X15 mm., and the other is composed 

 of small fragments contained in material from curettage. From this alone it follows 

 that the menstrual age is a very uncertain guide, especially as to the size of a hydati- 

 form mole. 



