ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 13 



TUBAL PREGNANCY WITH PATHOLOGICAL EMBRYOS. 



One-half of the specimens containing pathological embryos were accompanied 

 with data bearing upon their age. A few data also were given regarding the con- 

 dition of the lining of the tube. Specimen No. 479 came from a woman who had 

 been suffering from pelvic attacks for at least four years. At the time of the opera- 

 tion it was found that the other tube was adherent to the appendix. In No. 524 

 a pathological embryo, 15 mm. long, was found within a large amniotic cavity 

 surrounded by a hemorrhagic chorion at least 15 mm. thick. The tube wall around 

 it was markedly inflamed, numerous abscesses being present. At one point within 

 the sections made, the folds were very hypertrophic and the tips were adherent to 

 one another, forming numerous pockets sufficient to account for the arrest of the 

 ovary in the tube. 



No. 697, which contains a small pathological embryo and a very hemorrhagic 

 chorion, was surrounded by a slit which separated it from the tube wall. This 

 space contained numerous folds of the tube which were united to one another, 

 forming a reticulated zone of mucosa between the hemorrhagic mass and the mus- 

 cular wall of the tube. Outpocketings and follicular salpingitis were found in the 

 uterine end of the tube. There was no history of venereal infection or pathological 

 change in the uterus, although the woman had aborted four times. However this 

 may be, there was evidently a pathological condition of the tube wall sufficient to 

 account for the tubal pregnancy. 



No. 729 is an unusually interesting specimen containing a pathological embryo. 

 The illustrations (plate 10) show a case of ruptured tubal pregnancy with the ovum 

 still attached to the tube walls. Sections were cut through the middle of this speci- 

 men and through the tube on both the distal and central sides of the pregnancy. 

 From the sections it is seen that the trophoblast is extremely active, eating its way 

 through the muscular wall and into the sides of the large blood-vessels. In one 

 instance one-half of a thick-walled artery has been eaten away, the other side, 

 however, appearing to be perfectly normal. We have here a case in which the 

 implantation was certainly sound. Sections through the uterine end of the tube 

 show that the mucosa is thrown into folds, but they are not adherent to one 

 another. The ephithelial lining, however, has formed diverticula into the muscular 

 layer, giving a glandular appearance which will be discussed in speaking of the next 

 group. This type of change is by no means uncommon; in one instance, instead of a 

 single lumen, there are at least 20 lumina. Into one of these, if the main lumen 

 should be missed, the ovum could easily implant itself. At any rate, we seem to 

 have here a specimen of implantation in the muscular wall, because the ovum is 

 burrowing through it so rapidly. The history of the case shows that rupture 

 occurred at a point about 1 cm. from the uterus and that the outer end of the tube 

 was matted together by adhesions. The woman had been married for 6 years and 

 had been pregnant 4 times; the first two pregnancies had ended in an abortion at 6 

 weeks, and the third went to full term, ending in the birth of a healthy child. The 

 patient had acquired syphilis 2 years before she was married; a gonorrheal infection 

 was doubtful. 



