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



villi reaching through a blood clot, the normal trophoblast surmounting the villus 

 and clot, and at the border the cells are undergoing hyaline degeneration, which 

 grades over into strands forming the fibrinoid substance. In the course of time the 

 degenerate cells coalesce to form either a stratified mass or irregular plaques. This 

 is all shown in the figure. The larger plaques are now often invaded by fresh tropho- 

 blast cells, and so the process continues. Such a condition is found just as fre- 

 quently in tubal as in uterine pregnancy. Another type of degeneration of the 

 trophoblast is well shown in specimens which have become suddenly detached from 

 the tube wall. Here large masses of cells become necrotic suddenly, and this con- 

 dition I have usually spoken of in my notes as an indication of strangulation of the 

 ovum. Such a specimen is well illustrated in plate 2, figure 4. Here we have a villus, 

 the core of which is almost entirely destroyed, surmounted by an irregular layer of 

 trophoblast from which the nuclei have largely vanished. From this degenerate 

 covering fibrils run out in all directions, becoming continuous with the adjacent 

 fibrinoid substance. In this specimen there has been a secondary invasion of the 

 dead villus by maternal leucocytes which are polymorphonuclear and also show 

 fragmentation. A more intense reaction in the sudden death of the trophoblast is 

 seen in plate 2, figure 6. Here also there is no inflammatory reaction, so that the 

 process of histolysis is not complicated by it, but the protoplasm of the trophoblast, 

 forming an irregular hyaline mass, also continues to surround the fibrinoid sub- 

 stance. In this specimen the arrangement of the nuclear granulars is especially 

 interesting; they have run together, forming large masses, which stain intensely in 

 hsematoxylin. In some portions of the specimen these masses may be so large as to 

 be seen with the naked eye. In general the mass of nuclear substance grades off into 

 fine particles, as shown in plate 2, figure 3. Sometimes these particles are arranged 

 in streaks or they are scattered irregularly and may then be spoken of as nuclear 

 dust. This is often seen in specimens which have become detached suddenly from 

 the tube wall. A similar condition, but not so intense, is shown in plate 4, figure 1. In 

 this we have all stages of destruction of the stroma of the villus. On account of its 

 peculiar appearance, as well as on account of the fact that it often takes up the 

 hsematoxylin stain, I have termed this kind of degeneration "mucoid." At any 

 rate, whether it be mucoid or not, the core of the villus gradually breaks down and 

 disintegrates. While this process is taking place, we often see scattered through 

 the stroma of the villus large protoplasmic cells, first observed by Hofbauer 

 (plate 2, fig. 7) . These cells, which I have repeatedly seen in the villi of pathological 

 ova, may be a type of wandering cells; at any rate, when the villus is being invaded 

 by the leucocytes and trophoblast, it might be thought that they arise from the lat- 

 ter, but this is improbable. Plate 2, figure 4, and plate 11, figure 2, are taken from the 

 same specimen and represent two stages of "mucoid" degeneration. In both 

 stages the villi are being attacked by the leucocytes. In plate 7, figure 2, there is a 

 large area of blood around the villus which contains no strands of fibrin or fibrinoid 

 substance. The leucocytes are scattered throughout this area as well as the adja- 

 cent area containing the fibrils. This picture is seen very frequently in sections 

 from tubal pregnancies. Immediately around the villi there is no fibrin whenever 



