ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREONANCV. 



93 



It appears then that tho cavity of the ovum is lined by a 

 layer of fibrinoid t issue, to which the villi attach I hernsolves 

 and occasionally perforate it to gain nutrition from the 

 blood vessels of the tube wall. In many respects the condi- 

 tions here do not differ much from those found in the uterus 

 as described by Grosser. 



No. 867. 



(Dr. Branham, Baltimore.) 



Ruptured tubal pregnancy with a normal embryo, 

 CR 37 mm.; separate ovum, and broken embryo. The 

 operation was performed by Dr. Branham on April 9, 

 1914, at Franklin Square Hospital. The ruptured tube 

 was sent to the laboratory, fixed in neutral formalin, 3 

 hours after the operation. The ovum is collapsed and 

 covered with some very long, well-developed villi with 

 numerous opaque white nodules, about 1 mm. in diameter, 

 attached to them. The collapsed tube is 60X35X30 mm. 



Sections were cut through tho uterine and fimbriated 

 ends of the tube and through the middle of the implanted 

 cavity. The folds of the uterine end of the tube are 

 hypertrophic, markedly infiltrated, and rendered more or 

 less adherent to one another by an inflammatory exudate. 

 There are numerous outpocketings from the epithelial 

 covering both into the tube wall and in the larger folds. 

 A like condition, although not so marked, is found in the 

 mucous lining of the fimbriated end. The implanted 

 cavity is lined with a layer of fibrinoid tissue. It is more or 

 less riddled by the trophoblast and has attached to it on its 

 inner side numerous tips of villi. Between the fibrinoid 

 layer of the tube wall are some remnants of the folds of the 

 tube and often patches of inflammatory tissue. Some of the 

 villi have also reached this same zone (between the tube 

 and fibrinoid zone). 



No. 874. 



(Dr. Vineberg, New York.) 



(Plate 11, fig. 1.) 



Tubal mass, 80X30X25 mm., with a fragment of an 

 embryo 1 mm. long. The specimen came from a Jewish 

 woman, aged 27 years, married 4 years, and the mother of 

 one child. The last period began February 23, 1914, and 

 the operation was performed on April 15. The first symp- 

 toms began April 1, when the patient complained of abdom- 

 inal pains. At the time of the operation the uterus ap- 

 peared to be normal and there were no signs of inflammatory 

 or venereal diseases. The specimen, which came fixed in 

 formalin, is kinked upon itself and irregularly distended, 

 as shown in the figiire. The clot is protruding through the 

 abdominal opening, and opposite this point is a small 

 perforation. Between the distended portion of the tube 

 and the one near the inner opening is a contraction of the 

 tube wall. The specimen was cut into numerous small 

 blocks which disclosed to the naked eye an ovum near the 

 abdominal end in process of abortion. No chorion is 

 present at the point of contraction between these portions 

 of the ovum. 



Sections were made through these regions of the tube, 

 and the microscopic examination confirmed the observa- 

 tions made by the naked eye. A section through the uter- 

 ine end shows large tubal folds projecting into the lumen. 

 The muscular wall seems hypertrophied, and there is an 

 inflammatory reaction in the tissues of the folds. The 

 block through the distended area near the uterus (marked 

 2 in the drawing) passed through the tube lumen and a mass 

 of chorionic tissue is implanted within the tube wall. It 

 is clearly a case of interstitial implantation. The im- 

 planted cavity is surrounded by a layer of trophoblast 

 and the ovum consists of a general conglomeration of 



villi, trophr iblasl, swieytium, and fresh blood. At a 

 place 25 mm. beyond this (marked X in I he figure) we liavc 

 the same mix-up, ti> which is added a collapsed and turn 

 chorionic membrane. Here the rhorioiiie ma.ss lie.- within 

 the tube lumen. At one point is the remnant of an embr\ci. 

 which seems to be composed cif the body wall. Its tissues 

 are also intermingled with maternal blond, and there are 

 signs of irregular growths resembling a tissue culture. 

 This fragment from the embryo is about 1 nun. in length. 

 Judging by its shape it should have come from an embryo 

 about 7 mm. long. At no point is the trophoblast altaelicd 

 to the tube wall; the tube wall, however, shows inflam- 

 matory reaction and the spaces within the folds arc' tilled 

 with an unusually large number of leucocytes. The tro- 

 phoblast covering the villi, which are intermingled with 

 fresh blood, is very active, but these clots are partly organ- 

 ized. Beyond this, at the point marked 4, the tube 

 lumen contains blood, but no remnant of the chorion. A 

 section through the outer end of the tube includes the point 

 of rupture and the abdominal opening. It contains a 

 large piece of ruptured ovum with numerous villi and tro- 

 phoblast and maternal blood, some of which lies within the 

 cirlom. The chorionic wall and the mesoderm of the villi 

 are quite fibrous and a good portion of the trophoblast 

 is neerotic. The clot surrounding this mass is more highly 

 organized and has in it numerous strands of leucocytes, 

 which at some points are destroying the villi. At the bases 

 of some of the folds of the tube are marked pockets. There 

 are also large flakes of granular magma taking on the 

 peculiar hematoxylin stain in this portion of the tube. 



We undoubtedly have in this specimen an ovum which 

 has broken in half; one part has remained near the point 

 of implantation, while the other has moved to the outer 

 end of the tube and is being aborted. The part near the 

 point of implantation is fresh and normal in appearance. 

 The part being aborted is fibrous and neerotic, showing 

 that when fully detached from the tube wall the ovum has 

 difficulty in finding adequate nourishment. 



No. 881. 



(Dr. Neel, Baltimore.) 



Tubal mass, 110X35X35 mm., containing a pathological 

 embryo 3 mm. long. The specimen came from a white 

 woman, who had been married 16 years and who had had 

 seven children, the youngest 2 years old; no previous 

 abortions. She was operated upon April 30, 1914. The 

 periods had been regular. The last had begun 4 weeks 

 previously and continued until the time of the operation. 

 No history of venereal disease. At the time of the opera- 

 tion a few adhesions were found on the outer third of the 

 tube; otherwise, the pelvic organs were normal. Over a 

 liter of blood was found in the peritoneal cavity. 



The tube was quite evenly distended. After being fixed 

 it was cut into slabs about 15 mm. thick. Oneof the cuts 

 is 40 mm. from the outer end and passes through the 

 amniotic cavity, which is 5X7 mm. in diameter and con- 

 tains an atrophic embryo, about 3 mm. long. The contents 

 of the rest of the tube appear to consist mostly of fresh 

 blood. In the neighborhood of the embryo the ovum is 

 attached to the lateral border of the tube; elsewhere the 

 tube is lined with flattened folds. The clot is not attached 

 to the tube wall except at the point of implantation. The 

 opening at the fimbriated end seems to be obliterated. 

 From an examination of the specimen we would conclude 

 that there had been no escape of blood into the abdominal 

 cavity. 



The uterine end of the tube is distended, and projecting 

 into it are small finger-like processes, but no inflammatory 



