96 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



and the follicles arc filled with inflammatory exudate. 

 The trophoblast colls and many leucocytes have invaded 

 the folds of the tube as well as its main wall. In certain 

 regions the trophoblast is very active. The process 

 required to clear up the tube and return it to its normal 

 condition, after the tubal abortion, is probably just at its 

 beginning. 



No. 890. 



(Dr. G. P. Evans, Baltimore.) 



Ruptured tube containing normal embryo, CR 13 mm. 

 White woman, 29 years old, pregnant once before, having 

 a child 3^ years old. The last menstrual period began 

 about 3 weeks before the operation, May 22, 1914. No 

 history of venereal disease. The right tube was found 

 inflamed. The specimen was sent fresh to the laboratory 

 immediately after the operation. It was hardened in 

 Bourn's fluid. It consists of a ruptured tube, measuring 

 30X18X15 mm. and a free embryo, which was fished out 

 of the peritoneum by Dr. Cullen at the time of the opera- 

 tion. The uterine end of the tube is lined with well- 

 developed folds, and its lumen contains a slight amount of 

 inflammatory exudate. The fimbriated end appears to 

 be normal. The cavity containing the ovum is lined 

 mainly with normal and active trophoblast, intermingled 

 with a considerable amount of fibrinoid substance. The 

 space in which the ovum lies contains a considerable 

 amount of inflammatory exudate, but the surrounding 

 wall appears to be quite normal. However, the trophoblast 

 invades the wall as in the case of a normal implantation. 

 Apparently the rupture must have been very recent. 



Xo. 9006. 



(Dr. R. AY. Hammack, Manila, Philippine Islands.) 

 Ruptured tubal mass, 60X45X35 mm. From a Malay 

 woman, 19 years of age, who was married in 190S and who 

 had only had one previous pregnancy, a full-term child in 

 1910. She had been troubled with pelvic pains since 

 Sept ember 13, 1913, and was operated upon on October 

 30 of the same year. At that time she was suffering with 

 leucorrhea. A left tubal pregnancy was found. 



When the specimen came into our hands it was quite 

 fibrous in consistence. Several blocks had been removed 

 for microscopic examination before it was forwarded to us 

 from the Philippines. Transverse sections were taken 

 from the uterine end of the tube and through the middle 

 of the ruptured block. The mucous membrane of the 

 uterine end is thrown into numerous folds, which are more 

 or less adherent and also end in numerous villus-like proc- 

 esses. There is a marked inflammatory exudate and a 

 very pronounced follicular salpingitis. The tube wall 

 of the rupture is also well infiltrated and there is a large 

 fibrous clot within its lumen. At the junction of the clot 

 and the tube wall is a zone of cells, which at one side appear 

 to be decidua, but as they have a tendency to form the 

 syncytium and as they appear morphologically quite like 

 Hofbauer's cells, I am inclined to think of them as such. 

 There are numerous large outpocketings from the tube 

 lumen and numerous accumulations of leucocytes. No 

 trace of the ovum is found. Otherwise the specimen ap- 

 pears very much like one of tubal pregnancy. 



Xo. 900c. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Pathological embryo, 6 mm. long. From a Malay 

 woman, 20 years old, who had been married 4 years. She 

 had aborted "once or twice" before the present pregnancy. 

 Her last period began 3 weeks before the abortion and 

 bleeding was continuous until the time of the operation. 



The omentum was found adherent to the pelvic organs; 

 and the left tube was distended and had ruptured at its 

 outer end. The specimen consists of the left Fallopian 

 tube, which is practically spherical, measuring 45X53X40 

 mm. A transverse section 

 through the middle portion 

 discloses a chorionic cavity, 

 measuring 19X8 mm., the 

 walls of which are made up 

 of organized blood. A well- 

 preserved pathological em- 

 bryo with a greatest length 

 of 6 mm. projects from the 

 wall of the chorion. 



A section through the uter- 

 ine end of the tube shows 

 that the tube wall is mark- 

 edly hypertrophied and that 

 there are numerous out- 

 pocketings from the tube 

 lumen. Of these there must 

 be at least 100, arranged in 

 large clusters, reminding one 

 very much of Brunner's 

 gland. The tube lumen is 

 lined with folds which are FlG , 3 ._ Pathological ,, mbrvo 

 markedly infiltrated with from spcc i mcn NO. 900c. 

 leucocytes and some of the x 8. 

 folds have also been invaded 



by tube-like processes from the epithelial lining. Sections 

 through the chorionic wall show that it is fibrous and many 

 of the villi permeating the clot are necrotic. Others 

 have undergone mucoid degeneration. Where the villi 

 come in contact with the tube wall, the trophoblast is 

 active and invades the wall, which in turn is also active 

 and markedly inflamed. The blood-clot is mottled, ap- 

 parently consisting of organized clot and recent hemor- 

 rhage. The blood-corpuscles, which are of recent origin, 

 stain intensely with iron hematoxylin. The rest do not. 

 The embryo is distorted and atropliic; serial sections show- 

 that it is dissociated and very much macerated. How- 

 ever, the position of the main organs can still be made out, 

 although they have entirely lost then' contour. 



No. 900rf. 



(Dr. R. W. Hammack, Manila, Philippine Islam I- . i 

 Tube-wall fragments, measuring 50X50X50 mm. From 

 a Malay woman, 35 years of age. The patient had been 

 bleeding for one month previously and at first had been 

 curetted. As the bleeding continued the operation was 

 performed, when the omentum was found to be adherent 

 to the pelvic organs; the left tube, which was in the pouch 

 of Douglas, was adherent to the rectum, and had ruptured 

 in its middle portion. X T o embryo was found. The speci- 

 men received by us consists of fragments of tube wall 

 which together measure about 50 mm. in diameter. A 

 section from one of the larger blocks consisted mnsllv of a 

 mass of fibrin in which were embedded numerous necrotic 

 villi. No satisfactory examination could be made of the 

 tube wall. 



Xo. 900c. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Tubal mass, 25X15X15 mm. From a Malay woman, 

 23 years old, with an uncertain history; when operated 

 upon the right tube was found ruptured near its fimbriated 

 end. To this mass the ovary was attached and contained 

 a very pronounced corpus hit cum. The specimen consists 



