72 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



No. 369. 



(Professor Brodel, Baltimore.) 



Ovum 7X3X3 mm. The specimen was removed by 

 operation on October 9, 1906. The woman's last period 

 began September 17. The distended tube measured 25 

 mm. in diameter and when cut open a small lump, 2 cm. 

 in diameter, was seen on one side of its cavity. This was 

 believed to be the embryo, but serial sections proved it to 

 be a small mass of blood very rich in leucocytes. The 

 sections show the chorion pretty well folded upon itself, 

 and torn at several points. The torn edges are well rounded, 

 that is, they have healed and are therefore not due to the 

 operation. Only a few villi are left, and these, with the 

 main walls of the chorion, are very fibrous in structure. 

 There is but little syncytium present. The entire chorion 

 is separated from the wall of the tube by a thick layer of 

 blood, and the tube wall is well infiltrated with leucocytes. 

 What is most remarkable in this specimen is that the 

 amnion lines the chorion completely and all of the meso- 

 derm of the chorion is well filled with blood-vessels from 

 the embryonic mass, which must have been present at 

 one time. 



No. 378. 



(Professor Brodel, Baltimore.) 



Ovum, 12 mm. in diameter. From a tubal pregnancy, 

 dumb-bell-shaped. It had been opened by Professor Brodel, 

 who found no trace of an embryo in it. It was hardened 

 immediately and later cut into serial sections. At no point 

 in the sections could any trace of an embryo be found, 

 although it is possible, but improbable, that it was lost 

 while the fresh specimen was being examined. The ccclom 

 contains some granular magma. The mesoderm of the 

 main wall of the chorion is apparently normal, but that 

 of the villi is edematous. There are no blood-vessels pres- 

 ent. At many points the syncytium is necrotic, frequently 

 rising from the villi, leaving small vesicles below. The 

 necrotic masses are held together by a slimy mass, within 

 which there are a great many small round cells, undoubt- 

 edly leucocytes. 



FIG. 6. Diagram showing relation of the ovum to 

 the tube lumen, which is ruptured and filled 

 with blood. Natural size. (No. 378.) 



No. 389. 



(Dr. Casler, Baltimore.) 



Embryo, CR 8, AR 8, GL 9 mm. Normal. Tubal 

 abortion occurred several hours after severe hemorrhage. 

 Large clots were found in the peritoneal cavity. These 

 with the tube which was removed were placed in formalin. 

 Before the clots were examined a normal embryo was 

 found among them. It was surrounded by the amnion, 

 but only a few villi were present. Sections show that the 

 embryo is normal. 



No. 390. 



(Professor Brodel.) 



Embryo, CR l.i.n, AR 11. f> mm. 



No. 396. 



(Dr. Casler, Baltimore.) 



(Plate 5, fig. 1.) 



Ovum, about 7 mm. in diameter; within the ccelom a 

 body measuring 2X1 mm. 



"The tube was removed April 24, 1907, from a woman 

 21 years old. Last period, March 5, followed by a brown- 

 ish discharge on April 11. Diagnosis of tubal pregnancy 

 on April 23. The abdominal cavity was found well filled 

 with blood and the tube was still bleeding through the 

 internal ostium. The whole tube was removed and 

 placed in a 10 per cent solution of formalin." 



The hardened tube is 40 mm. in length and 20 mm. in 

 diameter. It was cut into blocks 5 mm. thick and im- 

 bedded in celloidin. Two of the blocks were found to 

 contain the ovum and these were cut out and reimbedded 

 in paraffin and cut into serial sections. The sections show 

 that the ovum has unusually long villi, fully 5 mm. long, 

 which ramify throughout the blood in the tube and in many 

 instances are attached to the decidua. The trophoblast 

 is well developed. The walls of the tube are markedly 

 distended and infiltrated with red corpuscles and leuco- 

 cytes. Many contain fragmented nuclei, which are also 

 scattered throughout the decidua. Within the ccelom 

 of the chorion there is a double vesicle, the large one, 2 X 

 1 mm. in diameter, showing all the characteristics of the 

 umbilical vesicle. Its Ia3 r er of mesoderm appears to be 

 thickened and at numerous points it has become adherent 

 to the inner wall of the chorion. At these points the 

 blood islands extend over to the mesoderm and from them 

 blood-vessels ramify to all of the villi. These vessels are 

 all lilled with nucleated blood cells. The smaller vesicle 

 is about a millimeter in diameter, is lined with cylindrical 

 cells, and is covered with quite an even layer of mesoderm, 

 in which there are some quite large blood-vessels, but no 

 blood. Towards one of its ends it is covered with a 

 marked layer of cylindrical cells. It may be that this 

 second vesicle represents what is left of the embryo. 

 Around these two vesicles, filling the whole ccelom, there is 

 a dense reticular magma. The main wall of the chorion 

 and many of the villi are somewhat fibrous in structure. 

 Some of the villi are being invaded by sync} r tial cells. 



This specimen is especially valuable, inasmuch as it 

 shows the early changes which take place in an ovum after 

 it has become lodged in the uterine tube. No doubt, 

 owing to its faulty implantation, the nutrition of the 

 embryo was affected and it consequently grew in an irreg- 

 ular fashion. The umbilical vesicle became adherent to 

 the chorion and its blood-vessels grew out into most of the 

 villi. The trophoblast is active in places and wanting 

 in others (?). Apparently the ovum has been only partly 

 implanted. Some villi are fibrous and denuded, some 

 show mucoid degeneration, and others are normal and well 

 implanted into the tube wall. All stages of destruction of 

 the villi are seen and in many places they are being de- 

 stroyed by leucocytes. Elsewhere the trophoblast is 

 extensive and many of its single cells are wandering into the 

 blood clot. 



No. 415. 



(Dr. Casler, Baltimore.) 



Villi in tube. The unruptured tube is 40X20X20 mm. 

 and filled with a blood clot. The operation took place 

 6 weeks after the last period. The entire tube was hard- 

 ened in formalin and then cut into blocks. The region 

 containing villi was then cut into serial sections. There are 

 a few villi almost hydatiform and there is extensive mucoid 



