ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



85 



No. 762 



(Dr. Leonard, Baltimore.) 



Unruptured tubal mass, 65X45X35 mm. From a 

 white woman, who has been married 6 years. Soon after 

 marriage she missed four periods and then aborted. The 

 last period began on August It, 1913, the previous one 

 having occurred on July 3. After the last period there 

 were bleeding and pain until the operation, which took 

 place September 24. The uterus was found somewhat 

 enlarged and covered with adhesions. The left tube and 

 the ovary were found plastered to the side of the uterus 

 and covered with omentum which was densely adherent. 

 There were no signs of venereal disease. The tubal mass 

 consists of a convoluted tube, 20 mm. in diameter, remind- 

 ing one much of a dog's intestine. The fimbria." are matted 

 together and the ovary is attached. Uterine scrapings 

 were also secured. These were fixed in corrosive-acetic 

 mixture and cut into serial .sections. The tubal mass was 

 cut in three places, as the figure shows. Sections of the 

 mass show that the tube is filled with blood and at certain 

 points it appears as if the ovum were present. Micro- 

 scopic examination shows that the clot is well organized 

 and much infiltrated with leucocytes. A few villi are 

 present and some of them have been nearly destroyed by 

 the leucocytes. Small patches of syncytium are occa- 

 sionally seen, but are not connected with the villi. The 

 villi are swollen throughout the specimen, showing that the 

 remnants of the ovum have been scattered far and wide. 

 The uterine scrapings are composed of small clots of mucosa 

 and blood. They do not show inflammatory reaction. 



FIG. 12. Outline of the matted tube of No. 762, the mass of 

 which is composed of very large vessels interlacing the 

 rlistended tube wall. X *. 



No. 765a. 



(Dr. Harvie, Troy, New York.) 



Unruptured tube, 75 mm. long and 30 mm. in diameter. 

 It is filled throughout with blood and is apparently ready 

 to rupture. On one side there is attached to it a small 

 white body about 20 mm. long, 15 mm. wide, and 5 mm. 

 thick; probably the ovary. 



The specimen was removed al an operation from a 

 Jewess, aged 10 years, this being her eighth pregnancy. 

 She has had two miscarriages and several normal labors 

 since her last miscarriage. There are six healthy children, 

 all living. The last menstruation occurred on July 2IJ, 

 1913. She began to flow again August 26 and continued 

 to do so until the operation. September 20. Sections were 

 taken through the middle of the tube which passed throiinh 

 a stellate-shaped cavity, about 5 mm. in diameter. This 

 cavity is lined with a membrane', the chorion, from which 

 there radiate a few long fibrous villi. Between the cavity 

 which is the cavity of the ovum and the tube wall is a 

 well-organized clot. At the periphery of the clot is an 

 extensive infiltration with leucocytes. Tin- chonon and 

 radiating villi are mostly necrotic. However, the few- 

 cells remaining, which cover the main wall of the chorion, 

 take the hematoxylin stain. It appears as if the detach- 

 ment of the ovum had caused its strangulation and death. 

 A secondary inflammation on the periphery of the clot 

 involves the tube, but does not reach the ovum. The 

 section through the ovary shows numerous corpora fibrosa 

 and very few Graafian vesicles, all of which are unrupt ured. 

 One large Unruptured follicle has a layer of lutein cells, 

 forming a zone around the granulosa cells. 



No. 766. 



(Dr. Haskell, Bridgeport, Connecticut.) 

 Unruptured, 55X45X40 mm. Embryo 10 mm. 

 "The specimen conies from a patient 27 years old, who 

 has been married 7 years. She has never been pregnant 

 and is very anxious to have children. No measures to 

 prevent conception have ever been taken. She has had 

 pain and tenderness in the right lower quadrangle for two 

 years, but recovered without operation. Dilatation and 

 curettage was performed 6 months ago, when a small 

 polypus was removed from the minor as. On September 

 22, 1913, she was taken suddenly with pain in the lower 

 abdomen; the pain was not definitely located. She had 

 numerous fainting spells followed by collapse. Since then 

 she has had more or less pain and marked tenderness in the 

 lower left side, but little abdominal distention. There 

 were intermittent bloody discharges from the uterus. 

 The last period occurred early in August, but she missed 

 the one due in September, and, therefore, believed herself 

 pregnant. Operation, October 2, 1913." 



The specimen resembles a walnut; it is hard and hemor- 

 rhagic, and measures 55X45X40 mm. It has a very 

 thin wall, which appears to be a well-developed chorion 

 infiltrated with blood. Within is a cavity, 15 mm. in 

 diameter, partly filled with reticular magma and partly 

 with free blood clot, as well as a degenerated embryo and 

 an ovary. The specimen is attached to the ovary. The 

 embryo is granular and degenerating. Sections were 

 made through the ovary and through the middle of the 

 tube, striking the embryo. The section is circular in form, 

 measuring 42 mm. in diameter. In the middle is a cavity, 

 15 mm. in diameter. The thickened tube wall consists 

 of a mass of organized clot which has destroyed the 

 ovum (?). This clot is permeated with villi in all stage's o! 

 degeneration, syncytium, and masses of leucocyte's. Man\ 

 of the villi are necrotic. The trophoblast upon the chori- 

 onic membrane is quite active, while that at the tips of the 

 villi is scanty or necrotic. The chorionic membrane is 

 clear and quite normal in appearance and lined with a 

 thin amnion. The embryo is completely dissociated; 

 individual structures can not be made out. Many of the 

 villi are being invaded by leucocytes, which often appear 

 in great hordes. 



