HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 349 



It seems superfluous to add anything to the good description of the gross 

 appearance of the typical hydatiform mole currently reported in the literature. 

 Such cases are so characteristic that even a novice can recognize them at sight.. 

 Yet if the findings reported here are reliable, or even approximately so, it never- 

 theless must be evident that, in the past, the great majority of specimens of true 

 hydatiform mole have remained unrecognized merely because they did not happen 

 to present the customary, well-known picture to the unaided eye. Small chorionic 

 vesicles, such as No. 2077 shown in natural size in figure 18, which attract no atten- 

 tion upon cursory inspection may, and often do, present the most exquisite picture 

 of hydatiform degeneration when seen under a magnification of 3 to 20 diameters, 

 as illustrated in figure 19. This is true especially if the examination is made with 

 the binocular microscope. Since I have adopted this method of examination it has 

 been possible to recognize instances of decidedly general and typical hydatiform 

 degeneration in chorionic vesicles less than 2 cm. in size, with later confirmation of 

 the diagnosis by a histologic examination. However, I have not been able to rec- 

 ognize very early stages merely by examination of the gross specimens, for gross 

 recognition is possible only when portions of at least some of the villi have 

 become sufficiently elliptical or globular to attract attention. Histologic recognition 

 is possible far earlier than this, as shown in figure 20. 



The general appearance of the whole chorionic vesicle sometimes is an aid in 

 gross identification, for the villi not infrequently are smooth, slightly branched, 

 and unusually long, so that the vesicle looks shaggy, as illustrated in figure 21. 

 The typical gross, hydatid or watery, translucent nature of the villi can not be relied 

 upon in early stages, for normally shaped villi, which have undergone considerable 

 lysis, may be almost transparent and also somewhat more than normally bulbous. 

 However, save in the case of some specimens of tubal pregnancy, the swelling of the 

 villi, due to maceration or to luetic changes, is quite different in character from 

 that characteristic of hydatiform degeneration, and usually quite easily distinguish- 

 able from it. Judging from several specimens of villi which were macerated in 

 distilled water during a period of weeks, post partum maceration never could cause 

 confusion and the same thing undoubtedly is true of intra-uterine maceration. 



Since numerous trophoblastic nodules are present also in other conditions, 

 notably in retained placentae as found by Aschoff and others, I have not been able 

 to regard their presence in unusual numbers, in some cases of hydatiform degenera- 

 tion, as of crucial value, but the absence of placental differentiation at a time when 

 it should be present, with a uniform and unusual development of the villi over the 

 whole exterior of relatively large chorionic vesicles, is decidedly significant and has 

 often been found to imply the presence of hydatiform degeneration. The same 

 thing is true of a very irregular distribution of the villi, or of uniformly distributed 

 fusiform enlargements on the villi and of the loss of the dull appearance of their 

 cut surfaces, as seen under the binocular. As soon as the stroma becomes hydati- 

 form, and even before liquefaction is present, the cut surfaces of hydatiform villi 

 look somewhat shiny and waxy or, perhaps better still, paraffine-like, as in the speci- 

 men in situ shown in figure 21. A bluish tinge always is present, and this appear- 

 ance is very characteristic. However, how easily a specimen of hydatiform mole 



