i54 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
On November 12, four weeks after the expulsion of the mole, the uterus was 
explored with the finger, and a large ulcerated patch with indurated edges was made 
out on the posterior wall near the fundus (see Fig. 1 1, Plate XI). Extreme soften- 
ing of the wall was noted, and it was feared that perforation was imminent. 
Operation was delayed for a day or two in hopes that the patient's condition 
might improve somewhat, but as she steadily became worse, the uterus was removed 
per vaginam on November 28. The patient survived the operation only eight 
days. 
Unfortunately, a post-mortem examination could not be obtained, so that 
it is not known if metastatic deposits were present. 
The uterus was somewhat enlarged, the body appearing more spherical than 
normally. On laying it open a large necrotic haemorrhagic area was seen on the 
posterior aspect of the fundus, extending over the orifices of both fallopian tubes. 
The growth presented a number of small rounded elevations, several of 
which were dark red in colour and extremely soft to the touch. Although depressed 
towards the centre of the tumour, the edges were raised from the surrounding 
mucous membrane, bulging forward into the cavity of the uterus, the growth also 
penetrating into the muscular wall, almost as far as the serous coat. The mucous 
membrane lining the remainder of the cavity appeared normal, and the cervical 
canal shewed nothing abnormal in its entire extent. 
The condition found in the vesicular mole expelled by this patient has been 
already described, and it will be remembered that the sections shewed intense leuyco- 
cytic exudation round the vesicles. This indicates that the septic infection had 
already occurred before the mole was expelled, and as there was marked prolifera- 
tion of the syncytium, with a great increase in the amount of syncytial buds lying 
free in the blood spaces, it is probable that metastasis, as well as the malignant in- 
filtration of the muscular wall, had also begun. 
But the greatest interest attaches to the uterine tumour, in that it shews on 
microscopical examination two vesicles deeply imbedded in the muscular coat, and 
from them the syncytium is seen budding off and making its way into the venous 
channels. Looking at a section, beginning at the internal surface, we find in 
places remnants of the mucous membrane, which is very thin and atrophied. The 
glands are small and lined by a single layer of rather cubical epithelium which in 
places has fallen out, but they present no other features of importance. It is, how- 
ever, worthy of notice that the inter-glandular stroma appears to have gone back to 
its normal condition. No trace of decidual cells is to be seen, only spindle-shaped 
cells with small round or oval nuclei are present. 
In most of the sections, the mucous membrane has disappeared, its place being 
taken by blood clot, partially organized in places and shewing much leucocytic exuda- 
tion, in others more recent haemorrhages are seen. Here and there, adherent to the 
