358 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



to two moles and then to a normal full-term child and secundines. In this case 

 curettage was done in connection with each mole. Apparently the new endo- 

 metrium, which had formed after the second abortion and curettage, permitted 

 normal implantation and normal development to progress to term. To ignore the 

 condition of the endometrium in this case and attribute the development of hydati- 

 form degeneration to the successive release of abnormal ova would seem to dis- 

 regard important facts especially so since no one has established the occurrence 

 of abnormal ova within the Graafian follicle, a possibility which I do not wish to 

 deny, although Donskoj's report of a case of hereditary mole must surely be taken 

 /n/ii (/rii no salis. 



That an abnormal nidus may be responsible for the advent of hydatiform 

 degeneration would seem to be indicated also by the fact that the process usually 

 was better developed and more general in the tubal than in the uterine cases. That 

 both endometrium and decidua show astonishing differences in structure under 

 pathological conditions is well known. The entire tubal mucosa, on the other hand, 

 even when normal, forms an abnormal nidus which would affect all portions of early 

 chorionic vesicles somewhat alike, and since, as found by Mall, inflammatory 

 conditions in the tubes predispose to tubal implantation, the higher incidence of 

 hydatiform degeneration in the tubes is easily explained. Nor does the existence 

 of partial hydatiform degeneration argue against such an explanation. 



Although Kehrer reported not a single fatality in 50 cases of hydatiform mole, 

 Hirtzman (according to von Winckel) gave the fatality as 13 per cent, Borland and 

 Gerson as 18, and Williamson as 20 to 30 per cent. Von Winckel (1904) regarded 

 these percentages as entirely too high, however, although Oster reported 2 cases of 

 malignancy out of 15 among cases in which the late results were asccrtainable 

 an incidence of 13.3 per cent. Kroemer (1907) found that chorio-epithelioma 

 developed in 5 out of 15 cases of hydatiform moles, or in 33.3 per cent, but only 

 twice in 3,841 "normal implantations." Daels (1908) says La Torre claimed a 

 malignancy of 64 per cent; de Senarcleus one of 28.7 per cent, or 14 out of 49 cases. 

 Friienkel (1910) emphasized that the estimates of the number of cases in which 

 hydatiform degeneration is followed by malignant disease vary greatly, while 

 Robertson (1915) quoted Findley as finding that 16 per cent of 250 hydatiform 

 moles collected from the literature were followed by malignant disease. Briggs, 

 who reported 21 cases of hydatiform degeneration with 2 of chorio-epithelioma or 

 an incidence of malignancy of 9.5 per cent, called attention to the "diminishing 

 ratio in the tendency to malignancy shown by his series." 



Findley stated that chorio-epithelioma developed in 131 out of 500 cases 

 gathered by him from the literature, which is an incidence of 26.2 per cent; but, as 

 already stated, most of these cases from the literature are old, advanced degen- 

 erations, many of which have been retained for a long time. The tendency to 

 malignancy in these probably can in no way be compared to that in smaller and 

 younger specimens, many of which are aborted entire _with the surrounding decidua. 

 Consequently, it need not surprise us that out of 19 cases of this series, in which 

 later reports were obtainable, none were reported as having developed chorio- 

 epithelioma. 



