82 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



of them are necrotic. At no point in the sections does the 

 chorion come in contact with the tube wall, but is separated 

 by the clot, which is ramified by many bands of fibrin. 

 This clot is markedly free from lymphocytes. Some of 

 the villi are covered with an active syncytium, which 

 extends into the clot, and forms pronounced trophoblast; 

 in places there are also individual cells. The mesoderm 

 and some of the villi are also being invaded by the syn- 

 cytium. The tube is hypertrophied, but at no point in 

 the sections does it show an invasion of trophoblast cells; 

 it is, however, infiltrated with leucocytes. Follicular sal- 

 pingitis and outpocketings are present. 



No. 706. 



(Dr. H. M. Tony, Detroit, Michigan.) 



Ruptured tubal pregnancy, 55X15X15, containing a 

 normal embryo 6.5 mm. long. American, aged 31 years. 

 Contracted pelvis (anterior superior spine 20 cm., crests 

 23 cm., trochanter 31 cm., external conjugate diameter 

 16 cm.). This is the fourth pregnancy. Abortion by 

 surgeon five years ago because of contracted pelvis, birth 

 at 6 months two years ago. Patient seen on June 8, 1913. 

 Periods have been regular, but last was missed 3 weeks ago. 

 On June 2 had labor pains and a bloody discharge, passed 

 clots, but the temperature and pulse were normal. At the 

 time of examination the uterus was found enlarged and 

 very tender, and there was a mass to its left. There was 

 no evidence of infection. Venereal disease was positively 

 denied. Diagnosis: Left tubal pregnancy. 



The patient was taken suddenly with intense pain in 

 the left lower abdomen on June 0. Pulse of collapse, 120; 

 temperature 97.6. Improvement was gradual. Operation 

 on June 10. The abdominal cavity contained many large 

 clots, but. no fresh hemorrhage. The left tube contained 

 a fetus and membranes, which had ruptured downward. 

 Both ovaries appeared to be normal. No salpingitis, 

 no pelvic imflammatory disease. The uterus waa en- 

 larged but appeared to be normal. When the specimen 

 came it contained a clot protruding from the ruptured tube. 

 Within this there was a cavity, about 7 mm. in diameter, 

 just large enough to hold an embryo. We were probably 

 dealing with an unruptured specimen, as only the clot pro- 

 truded from the ruptured tube wall. No description of the 

 embryo was given. Sections of the clot containing the 

 chorion show that the chorionic wall is fibrous, with few 

 long, slender villi extending from it in various directions 

 through the blood clot. Some of them contain blood-vessels 

 and the blood-vessels are filled with blood like the main 

 wall of the chorion. The blood clot is not infiltrated to 

 any extent with leucocytes nor with trophoblast cells; there 

 are, however, numerous isolated cells in the probable neigh- 

 borhood of the villi and occasionally they run together and 

 form a syncytium. The lymphocytes or leucocyt.es seem 

 to accumulate more in the neighborhood of the villi. The 

 ovary contains numerous corpora fibrosa and also a large 

 cavity which is filled with clear fluid and is surrounded 

 by small patches of lutein cells. This cavity communicates 

 with the protrusions upon the surface of the ovary, but do 

 not contain any fluid. 



No. 720. 



(Dr. J. M. Hundley, Baltimore.) 



(Plate 8, figs. 1, 5.) 



Unruptured right tube, 90X30 mm. This specimen 

 consists of an unopened tube which has a smooth surface 

 and is considerably swollen in its middle third. The 

 straightened-out tube measures 90 mm. and the middle 



distended third 30 mm. The diameter of the inner third is 

 5 mm., the middle third 14 mm., and the outer third 9 mm. 

 The patient, aged 40 years, has had seven live-born 

 children and six miscarriages. The youngest child is 

 4 years old. She has had two miscarriages since his birth. 

 The menstrual periods have recurred every 3 weeks and 

 are more profuse than formerly. The last menstrual 

 period began on May 14. In June she should have men- 

 struated 3 weeks after that date (June 4), but did not flow 

 until June 29. On that date she was taken with violent 

 pains in the abdomen and then with uterine hemorrhages. 

 She bled profusely for 2 hours and then the bleeding ceased, 

 but returned on July 3. She was operated on by Dr. 

 Hundley July 4. She was brought to the University 

 Hospital to be operated on for appendicitis, but a diagnosis 

 of a possible tubal pregnancy was made before operation. 

 The abdomen contained about a pint of old blood clot. 

 The pregnancy had occurred in the right tube. 



The specimen was received at the laboratory in formalin 

 July 11, 1913, in which it was carefully preserved. A draw- 

 ing of it, natural size, is shown in the illustration. It was 

 cut into blocks, sections being taken from four portions of 

 the tube. The smooth tube was found filled with a blood 

 clot, apparently organized, but not adherent to the tube 

 wall. At certain points the collapsed ovum could be 

 made out. Sections through the tube near the uterine 

 end of the clot show that the mucous membrane is in folds 

 which are not in apposition with a small extension of the 

 clot into this region. This portion of the clot is granular, 

 apparently being composed of degenerated red blood 

 corpuscles. The two sections through the clot (6 and c 

 in the figure) show a well-organized clot with fibrin bands 

 extending through it, degenerate villi, and masses of white 

 blood-cells. The trophoblast is generally wanting, except 

 where the villi come in contact with the tube wall, where 

 it is quite active. At these points the epithelium of the 

 tube wall is wanting and the trophoblast is invading the 

 muscle wall, which shows an active inflammatory reaction. 

 The villi show all stages of mucoid degeneration and 

 at certain points some are necrotic. The section through 

 the fimbriated end of the tube shows that its folds are 

 intact, but bound together more or less by a fluid exudate. 

 There is no inflammation here. 



No. 726. 



(Dr. Wright, Baltimore.) 



Tubal mass, unruptured, 60X40X30 mm. The speci- 

 men came from a white woman, 30 years of age, who 

 had been married two years, and had had an abortion at 

 3 months, and one full-term child was born in February, 

 1913. She menstruated in March and again from April 25 to 

 29. Ten days later began to flow, and continued to do so 

 up to the day of operation. At first the flow was bright red, 

 later it was scanty and dark colored. She denies having 

 had venereal disease. Operation for ectopic pregnancy 

 July 15, 1913. Right tube and ovary removed. The 

 specimen came to the laboratory in formalin. The tube 

 and ovary together form an irregular mass 60X40X 

 30 mm. The proximate end of the tube is small, and the 

 distal fimbriated end can not be found. Towards the 

 distal end there is a hemorrhagic mass, 20X35 mm., 

 which had been cut into after the specimen was fixed. 

 Sections were cut through the ovary and through three 

 portions of the tube. The tube on the central side of the 

 pregnancy has very extensive foldings, the section of the 

 mucosa forming a network with numerous processes end- 

 ing blindly in the mesh The spaces are filled with blood 



