Book - Contributions to Embryology Carnegie Institution No.56-9

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Chapter 9. Hydatiform Degeneration in Tubal Pregnancy

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Mall FP. and Meyer AW. Studies on abortuses: a survey of pathologic ova in the Carnegie Embryological Collection. (1921) Contrib. Embryol., Carnegie Inst. Wash. Publ. 275, 12: 1-364.

In this historic 1921 pathology paper, figures and plates of abnormal embryos are not suitable for young students.

1921 Carnegie Collection - Abnormal: Preface | 1 Collection origin | 2 Care and utilization | 3 Classification | 4 Pathologic analysis | 5 Size | 6 Sex incidence | 7 Localized anomalies | 8 Hydatiform uterine | 9 Hydatiform tubal | Chapter 10 Alleged superfetation | 11 Ovarian Pregnancy | 12 Lysis and resorption | 13 Postmortem intrauterine | 14 Hofbauer cells | 15 Villi | 16 Villous nodules | 17 Syphilitic changes | 18 Aspects | Bibliography | Figures | Contribution No.56 | Contributions Series | Embryology History

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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)


Strangely enough, the occurrence of chorio-epithelioma arising from tubal pregnancy seems to be better known and also better established than the occurrence of hydatiform mole within the tube. This is especially surprising in view of the stress laid by Marchand (1895) upon epithelial proliferation in cases of hydatiform mole and in view of the fact that trophoblast formation and epithelial proliferation in general have been regarded as being greater in tubal than in uterine implantation. This is illustrated well by such cases as that of Fellner (1907), in which it was impossible to distinguish, by histologic examination, between the epithelial proliferation present in a case of tubal pregnancy and chorio-epithelioma. From these circumstances alone it seems to me that one might expect hydatiform degeneration to be relatively more common in the tubes. Moreover, when it is recalled that experts still regard it as impossible to decide upon the question of malignancy or benignity in cases of suspected uterine chorio-epithelioma from histologic preparations alone, this surmise gains more in probability. The presence of hyperactivity in the trophoblast in many cases of tubal as compared with that in uterine pregnancy was confirmed also by personal observation, and if, as stated by Teacher (1903), chorio-epithelioma arose in hydatiform moles in approximately 40 per cent of 287 cases, and according to Seitz (1904 b ) and Fraenkel (1910) even in 50 per cent, the occurrence of hydatiform degeneration in tubal pregnancy can hardly be doubted because of this fact alone.


Nevertheless, of the 7 cases of tubal hydatiform moles cited by him, Werth (1904) regarded only the case reported separately by von Recklinghausen (1889) and by W. A. Freund (1889) as well authenticated. Werth reserved judgment, however, on the case of Matwejew and Sykow (1901), a report upon which was accessible to him, and to me, in a short review only. Seitz, however, accepted the short review of this case as convincing, nor did he question the case of Otto (1871), or that of Wenzel (1893), and he incorrectly credited Wenzel with two cases. Werth, on the contrary, regarded these last two cases, and also that of Groom (1895), which was accepted also by Veit (1899), as undoubted instances of "simple hydropic degeneration of the connective tissue of the villi so common in aborted chorionic vesicles, both from the tubes and from the uterus." Werth unfortunately did not state just what he meant by "simple hydropic degeneration", but since he spoke of it as common in aborted ova, one may conclude that he referred to changes in the chorionic vesicle which followed its isolation within the uterus after complete detachment from its implantation site. For want of a better term, such changes may, I presume, be spoken of as maceration changes, although usually they occur under non-putrefactive conditions. However, I do not thereby imply that these changes are similar under sterile and under putrefactive conditions.


Since Werth spoke of simple hydropic degeneration in aborted ova, he did not, I take it, refer to a dropsical condition of the villi, possibly due to an obstruction of the venous return, for such a condition necessarily would be rare and not common. Moreover, this condition of necessity would have to arise before and not after the death of the embryo and detachment of the chorionic vesicle. As in one of the cases of Hiess (1914), such a specimen also should contain blood-vessels; for, as emphasized also by Ballantyne and Young (1913), the hydatiform villus is not merely an edematous villus.


That any one at all familiar with hydatiform degeneration, in its earlier as well as its later forms, could, upon gross and microscopic examination, confuse it with maceration changes in a fairly well preserved specimen in any but its very earliest stages does not seem possible to me. Normal villi contain capillaries, not to mention other things characteristic of them. Hydatiform villi, on the contrary, do not contain them, or only very rarely so, and only in the early stages. When a villus becomes hydatiform that is, when liquefaction of the stroma occurs this liquefaction appears in more or less restricted portions of the villus, thus giving rise to the long fusiform and later spherical vesicles so characteristic of hydatiform mole. But when a villus becomes macerated the change is general, and usually is noticeable also in the embryo and chorionic membrane itself, or at least within the epithelium. The latter usually is lifted from the stroma here and there, the caliber of the entire villus is increased, and the capillaries and the stroma show maceration changes as the villus becomes more translucent. This increase in caliber of the entire villus is not due to local liquefaction of the stroma, but to the pseudo-edema occurring in a villus of normal structure and form. In hydatiform moles, on the contrary, the epithelium not only is firmly attached but usually hyperactive. The changes characteristic of hydatiform degeneration may and often do appear in the villi while they are still implanted, and not only after the chorionic vesicles are detached. This does not imply, however, that the villi of a detached hydatiform mole can not also undergo maceration changes. They frequently do so, and it is in such cases as these that differentiation may be difficult or impossible, especially if it is to be made from an examination of ill-preserved fragments only. The same thing is true also of the villi in the early stages of hydatiform degeneration and maceration, especially when the latter masks the former. The difficulty would be still greater in case of whole chorionic vesicles which are almost completely dissolved, leaving only a shadow picture formed by a coagulum without nuclei, which nevertheless may retain almost perfectly the form of the chorionic vesicle and of the individual villi. It may long be impossible to differentiate such cases as these, but they form only a relatively small proportion of the whole. The many cases both of uterine and tubal chorionic vesicles which still were implanted and show exceedingly fine instances of hydatiform degeneration, as well as the many splendid examples of groups of villi which were still implanted in the tube or in the decidua, and which were equally good examples of hydatiform degeneration, leave no room for doubt as to the surprising frequency in the occurrence of this condition, even after due allowance is made for the doubtful cases.


A careful examination of the few cases from the literature which have been regarded as instances of pseudo-hydatiform degeneration leave one wholly unconvinced as to the occurrence of such a phenomenon. No one will deny that many hydatiform chorionic vesicles are retained long after the death of the cyema. The material with which I dealt suggested very plainly that even isolated villi can and do survive a surprisingly long time; but Herzog (1898), from an examination of 7 tubal pregnancies, came to the conclusion that "chorionic villi degenerate with astonishing rapidity after the death of the embryo. This appears to be especially true of villi of young placentae." Although the use of the word placentae suggests that Herzog really was not speaking of very young conceptuses, he nevertheless added that only the most intimate acquaintance enables one to recognize villi after the embryo has been dead two or three weeks.


As stated in the preceding chapter, the cyema usually is absent in older, large hydatiform masses, only remnants of the chorionic membrane and villi remaining. Were these hydatiform vesicles not retained, the cyema would not be missing in any but possibly some extremely young vesicles, and if retention per se were the cause of hydatiform degeneration, then the latter should not only be best developed, but also most frequent among those longest retained. This, however, is not the case. Furthermore, the high incidence of hydatiform degeneration in tubal pregnancies, to which attention was called by Meyer (1919 a ), also shows that long retention is not necessary for the development of splendidly typical and universal hydatiform degeneration. Some of the finest specimens were found among tubal pregnancies in small chorionic vesicles in which cyemata still were present. If retention alone were the sine qua non, then hydatiform degeneration should not be so common under conditions which preclude long retention. Even Marchand (1895) found it well to emphasize that "Nicht jedes abortiv-Ei wird zur Blasenmole, nicht jede Blasenmole zeigt denselben Grad der Epithel Wucherung."


Werth further concluded that not one of the 7 cases of chorio-epithelioma regarded as having arisen from tubal pregnancies recorded before 1904 was sufficiently authenticated. Nevertheless, by 1910 Veit felt justified in saying that a considerable number of cases of chorio-epithelioma arising from tubal pregnancies had been described. He added that Risel (1895) gathered 11 cases from the literature and that a second case had been reoprted since Risel's paper. Since my interest in the subject is largely incidental, I have not taken the trouble to gather from the literature cases of chorio-epithelioma alleged to have arisen from tubal pregnancies which may have been reported since Veit wrote. Moreover, I could not presume to judge these cases critically. Hence I will accept the fact that chorioepithelioma arising from tubal pregnancy is regarded as established by a number of investigators. If the conception regarding the relation of chorio-epithelioma to hydatiform mole is justified, then the occurrence of hydatiform degeneration in tubal pregnancy must follow on a priori grounds alone. Moreover, whatever the causes of hydatiform degeneration may be, one is possibly safe in assuming that the condition is not restricted to the uterus, and when I noticed that hydatiform degeneration was so very common in young uterine abortuses the surmise that it might be still more common in cases of tubal pregnancy seemed justified. Since over 100 specimens of tubal pregnancies from the Carnegie Collection were included in the survey originally planned by Mall, a study of these specimens formed an excellent opportunity for observations on this subject.


That the case of Otto, with its pathetic history, really was one of tubal hydatiform mole, can not be doubted, in view of the careful description of the whole case its clinical history, necropsy, and the histologic examination. This case is interesting also because the degeneration was in its early stages, the hydatids being only as large as a pinhead and the embryo still being present. Moreover, from Otto's description it is very likely that the specimen contained Hofbauer cells, discussed in a later chapter.


The history of the case observed by Wenzel in 1855 and reported in 1893 is equally complete and equally pathetic, as could be surmised by all familiar with the history of tubal pregnancy. In this case the mole was as large as a "hen egg," the hydatids varied in size from a dot to a "bird cherry" (wild? cherry), and the degeneration was universal, although the menstrual age of this specimen was given as only 51 days. It is significant that Wenzel expressed surprise that even excellent handbooks of the day had nothing to say about hydatiform mole in cases of tubal pregnancy, except perhaps to refer to the case of Otto. Nor does the case of Wenzel seem to be the first one observed or that of Otto the first one reported, for Storch (1878), in truly epochal, though largely ingored, observations on hydatiform mole, cited Hennig (1876) as stating that two cases of moles in the tube were reported by Blasius (very likely E. Blasius, 1802-75). Since Storch wrote on hydatiform mole, it is implied that Blasius saw one of these and not one of another type of mole, and since hydatiform mole is such a striking condition and has evoked much more interest than the other forms, an observation regarding it in the tubes well might travel down the decades, particularly since, until recently, the occurrence of hydatiform degeneration in the tubes was regarded as extremely rare. This is indicated also by the fact that Menu (1899) still referred to the case of Otto as a curiosity.


Pazzi (1908 b ) stated that two cases of extrauterine moles have been described each by Hennig (1872), Farell (1893), Donald (1902), and one case each by Otto, Freund, Theileher, Maret, Matwjew (Matwejew?) and Sycow (Sykow?), and' Bland-Sutton, and one case of ovarian mole by Wenzel (1893). Wilkinson also is said to have described a case of rupture of the tube with reduction of the mole to the size of a cherry, and Lob (1902) a case of molar tubal pregnancy without cessation of menstruation. Since I am quoting Pazzi essentially verbatim, it is evident that he did not read the literature critically or discriminate between ordinary and hydatiform moles, but was misled by the old inclusive and confusing usage of the terms mole and molar, still current at the present day.


Krueger (1909) also reported a case of hydatiform mole with a cyst as large as a "walnut." The pedicle was 4 cm. long and attached to the amnion near the insertion of the cord. Krueger spoke of this as a placental cyst, but regarded it as a hydatiform-mole-like structure which, microscopically, was limited to a single villus. If this were the only evidence presented by Krueger, one might well question the nature of the cyst, but he added that microscopically the beginnings of hydatiform formations could be recognized on other villi also. Hence it would seem that Krueger's case must be added to the authenticated cases of hydatiform degeneration in the tubes.


So far as I am able to learn, then, the literature contains reports of but 9 cases of hydatiform mole occurring in the tube, and of these 2 or 3 cases are not well authenticated. These 9 cases are formed by the 2 cases of Blasius or Hennig, that of Otto, of von Recklinghausen and Freund, and of Wenzel, the 2 of Groom, that of Matwejew and Sykow, and that of Krueger. A critical reading of Hennig's book on diseases of the tubes and tubal pregnancy makes it quite clear, however, that Hennig merely said that Blasius discovered "tubal moles" and that he observed 2 and Behm 1 case of abortion of tubal moles. From the context it is also very clear that Hennig was not discussing hydatiform moles, although it is not possible to say whether he meant that he himself or Blasius observed 2 cases. I should judge that the latter is the idea it was meant to convey. To these 7 authenticated cases I would add that of Maxwell (1910). In reading Maxwell's description one must feel that he himself regarded the case as one of hydatiform mole, but deferred to the opinion of the "committee." This is suggested also by the title of his article. The illustration which accompanies Maxwell's article is so very suggestive, and his description so characteristic of hydatiform mole, that it seems very probable indeed that the specimen really was such. Maxwell stated, for example, that "sections of the villi embedded in the wall of the tube have the typical structureless, bloated appearance of such pathological villi; and though there is no central cavitation in the villi, their structure, associated with the active proliferation of the Langhans layer, suggests that one is looking at a stage just short of vesicle formation." Moreover, as I am about to show, hydatiform mole is so very common in tubal pregnancies as to increase still further the likelihood that Maxwell's case actually was one of hydatiform mole. However, this is merely an opinion, and only a completer description or an examination of the specimen itself could decide the matter.


In connection with what was said before, it was interesting that Maxwell also emphasized that epiblastic activity is increased in all abnormal sites of implantation, but anyone interested in the problems of tubal pregnancy and acquainted with Mall's (1915) findings will be struck by Maxwell's statement that microscopical examination of many cases of tubal gestation lends no weight to the view that chronic inflammation of the tubes is at all a common causal factor of tubal pregnancy. Nor can I refrain, in this connection, from quoting the uncontradicted opinion of Doran, expressed in the discussion of Maxwell's case, that tubal gestation "probably represents some general deterioration in the generative power among civilized women."


To the 8 cases contained in the literature I wish to add 48 found among the first 1,200 accessions from the Carnegie Collection. Nor is it necessary to stop with these, for this collection contains many more not here included. It is merely a matter of recognizing the specimens by a routine examination, and since this paper has been written a number of specimens have been recognized among the daily accessions of tubes received through the unselfish efforts and the scientific interest of practitioners in all parts of the nation.


In addition to over 100 free specimens of uterine hydatiform degeneration, I have also seen more than a dozen fine specimens in large sections of uterine implantation sites, and some entire specimens still embedded in pregnant uteri and tubes. Indeed, how many cases of hydatiform degeneration one can find in conceptuses in tubal or hysterectomy specimens will depend very much upon the care with which the examination is made, for the condition undoubtedly is extremely common, and not rare, as heretofore supposed.


Although the alleged menstrual age of these conceptuses ranged approximately from 6 to 218 days, most of them were young empty chorionic vesicles or mere remnants of such. Portions of quite a number were still implanted within the tube, however, and among these were two unusually fine ones in a rare specimen of twin pregnancy in a tube donated by Dr. Cecil E. Vest, of Baltimore. Since the question of superfetation has been raised also in connection with twin tubal pregnancies, I hasten to add that such a phenomenon, even if it ever occurs (which seems exceedingly doubtful), can be excluded absolutely in this case. Both chorionic vesicles were approximately of the same size and lay in practically the same cross-section of the tube, the surfaces of contact being flattened.


There were 40 tubes containing villi only, and in 14 of these hydatiform degeneration probably was present. In 10 specimens its presence was undoubted, but in 4 it was probable only. I realize that this margin of probability is exceedingly large, but this is easily understood if it is recalled that often only a few degenerate villi embedded in clot were contained in the cross-sections of the tubes, and that only a few sections were examined, not, of course, a complete series of each tube. Had the entire tubes been examined, or if more villi had been present, and if those present had been better preserved, the difficulty would have been almost wholly obviated. However, it is idle to set forth these things, because such conditions never will obtain, and the margin of probability becomes greatly reduced if it is remembered that in a large series the specimens necessarily supplement each other. Moreover, the changes in the villi often are so typical that they are unmistakable, even if only a few villi are present. Besides, examination in complete series undoubtedly would increase, not decrease, the number found. In some of the doubtful cases the existence of hydatiform degeneration became probable only upon comparison with the many uterine specimens previously examined.


The evidence offered by the 36 tubal specimens in the second group, which is composed of empty chorionic vesicles or parts thereof, was very conclusive, for the cut portions of most of these tubes contained considerable portions or even sections of whole chorionic vesicles, sometimes quite free from clot. Some of them were implanted almost perfectly in the wall of the tube, and although many of them were folded extremely and collapsed more or less, small areas of several were nevertheless implanted undisturbed within the tube. The villi in some of these implanted specimens were so characteristic and the whole picture so exquisite that the specimens rightly belong among the very finest instances of hydatiform degeneration found anywhere so far. This is true in particular of the case of twin pregnancy received from Dr. Vest. In this specimen the two chorionic vesicles, the intervillous spaces of which were devoid of blood, lay in almost the same transverse diameter of the tube, and hence had distended the latter considerably. Both were implanted quite well over the entire area of contact, which included the whole perimeter of the tube. The chorionic vesicles were flattened at the region of mutual contact, which divided the tube somewhat unequally (fig. 13, plate 2, Chap. IV). Although the embryo and the amnion long had disintegrated completely, and although the chorionic membrane itself is thin, covered by degenerate epithelium and also disintegrating, the epithelium of the villi not only is well preserved, but is accompanied by large masses of trophoblast and considerable syncytium. Syncytial buds are found on the chorionic membrane also. The tubal mucosa is largely and the tubal wall partly destroyed by the invading trophoblast. Only a few small vestiges of the walls of the villous vessels remain, and the stroma of all the villi has undergone changes characteristic of hydatiform degeneration, as represented in figure 136. One villus also contains an epithelial cyst resulting from epithelial invagito nation with subsequent isolation of the distal extremity, a process to be referred later in connection with uterine specimens. Since most of the villi of this and similar specimens still are implanted in the tube, there can no longer be any question as to the time in which hydatiform changes in the stroma of the villi may be inaugurated. As illustrated in other instances in which isolated and small groups of villi were still implanted, the advent of degeneration of the stroma occurs, in part at least, before the villus is detached. Hence it is not merely a post-mortem or maceration change.


Another very interesting specimen of tubal implantation is No. 1771, received from Dr. H. M. N. Wynne, of the Johns Hopkins Hospital. The menstrual age of this specimen is 49 days, but its anatomic age, as based upon length according to Streeter's (1921) curve, is 37 days, thus showing a discrepancy of 12 days between the menstrual and anatomic ages. The embryonic length is only 12.5 mm., although with a menstrual age of 49 days it should be at least 18 mm. Upon examination, Streeter found the chorionic vesicle to contain a good deal of magma, some of which was still adherent to the embryo, as figure 148 (plate 14, Chap. X) shows. As has been repeatedly emphasized in the literature, the presence of this coagulum in itself probably indicates that the embryo died some time previously.


The wall of the tube is quite thin, as figure 138 shows, but the implantation is fairly well preserved around the whole perimeter of the specimen. The mucosa is destroyed throughout the greater extent of the section and the trophoblast is abundant, except in one rather degenerate and hemorrhagic area. The chorionic membrane is thin, but contains some vessels distended with blood. The stroma of many of the villi also contains vessels filled with blood, but the vessels in many others are very evidently in degeneration. The syncytium is scanty, and many of the villi are very plainly hydatiform, as seen in figures 137 and 139.


A third exceptionally fine specimen of tubal hydatiform mole is No. 2052, donated by Dr. C. L. Davis, of Washington, District of Columbia. Figure 140 shows a portion of the tube containing a hydatiform mole, some hydatiform villi of which protrude through an incision in the wall of the tube. The whole opening is filled with typical hydatiform villi which are noticeable with the unaided eye and . perfectly evident under an enlargement of 4 diameters. They present an extremely fine picture when seen with the binocular under a magnification of 10 to 20 diameters. Examination under a higher magnification shows that the preservation of the specimen is unusually good and that all the villi are markedly hydatiform. Trophoblastic proliferation is so marked that in some places it gives the appearance of decidual formation. Relatively little syncytium is present, but the trophoblast invades the muscularis in many places and a good deal of coagulum is present, most of it apparently having arisen from degeneration changes in the stroma of the mucosa and from similar changes in the trophoblast and the muscularis. The latter is moderately invaded by round cells. No remnant of the wall of the chorionic vesicle or of the amnion or embryo could be detected in the sections examined, both evidently having been absorbed completely, only some of the villi remaining behind ; or, the chorionic vesicle may have been aborted and these villi left implanted within the tube.


Some exceedingly fine hydatiform villous trees were found among the specimens in this group. Scaffoldings or frameworks formed by proliferating syncytium arising from the epithelium of the chorionic membrane also were seen. Since the syncytial buds were found far out on proliferations of trophoblast which capped the villi, and also in the center of trophoblastic nodules, the origin of the syncytium from the Langhans layer again would seem to be exceptionally well confirmed. In some cases a detached hydatiform villus was fastened by opposite extremities to two portions of the tube wall. It is well to remember, however, that one of these attachments probably was gained before the separation of the particular villus from the chorionic vesicle.


Of the 36 cases remaining in this group of chorionic vesicles without amnion, after deducting 8 (7 of which belong in group 1 and 1 which belongs in group 2), 50 per cent showed the presence of undoubted hydatiform degeneration, and in 1 additional case its existence was doubtful.


Since only a few specimens are contained in each of the last five groups, I shall treat them as one. Among 28 specimens remaining in these groups, 12, or 43 per cent, showed the presence of hydatiform degeneration, and 4 others were doubtful. From this percentage it is evident that the incidence of hydatiform degeneration among tubal specimens seems to increase rather than decrease with advancing age of the conceptus, as was emphasized in connection with the uterine specimens. This probably can be attributed to the fact that the specimens in the first group are composed of villi only, and that many of the empty chorionic vesicles in group 2 were detached from the wall of the tube by hemorrhage before hydatiform degeneration had developed sufficiently to enable me to recognize it. Moreover, it must be remembered that all tubal specimens, no matter in what group they are classified, are in fact young specimens, and since those falling in the latter groups succeeded in maintaining a foothold in spite of repeated hemorrhages, a large number of them might rightly be expected to show the presence of a hydatiform change.


The incidence of hydatiform degeneration in the 108 tubal pregnancies classed as pathologic is 45, or 41.7 per cent of the whole. This is a somewhat higher incidence than was obtained in the uterine abortuses classed as pathologic, and may be accounted for partly, or even wholly, by the greater incidence of young specimens in the tubal series. That the tubal specimens undoubtedly were younger follows from common knowledge regarding tubal pregnancies alone, but it also is shown by the average menstrual age, which was 43.4 days in 25 tubal as compared with 66.6 days in 51 uterine specimens. Moreover, 32 of the 48 tubal specimens of hydatiform degeneration, or 66.6 per cent, fall into the first two groups, thus again showing that the majority are small, young specimens. However, by comparing the percentage of hydatiform degeneration in the first five groups of the pathologic tubal and uterine cases composed of conceptuses of approximately the same age, the same difference in incidence is noticeable, it being almost twice as great in the tubal as in the uterine series.


Although the incidence of hydatiform degeneration among the pathologic tubal specimens is but slightly higher than that among the pathologic uterine specimens, the incidence of hydatiform degeneration in all tubal specimens contained among both the normal and pathologic is twice as high as that among the same classes of uterine specimens. This can be explained only partly by the fact that a larger proportion of the tubal specimens are young and pathologic. The pathologic tubal specimens form 70.5 per cent of 153 normal and pathologic tubal specimens found among the first 1,200 accessions, but the pathologic uterine specimens form only 33.6 per cent of the normal and pathologic uterine groups among the same accessions. But the real question remains, for the incidence of hydatiform degeneration among the specimens classed as pathologic was essentially the same in tube and uterus. Hence an increased incidence of 200 per cent in hydatiform degeneration in the tubes may be due to the less favorable nidus found there. If so, it throws a very significant light upon the probable cause of hydatiform degeneration, which would seem to lie in the conditions surrounding the implantation and early development rather than in the ova or spermatozoa themselves.


The conclusion, reached in a study of uterine specimens, that hydatiform degeneration is absolutely less, not more, frequent near the menopause is confirmed also by the study of the tubal specimens. The average age of 20 women in the tubal series was 33.9 years, as opposed to an average of 31 years obtained from 36 women in the uterine group. This age difference offers a tempting opportunity for generalization, and did the statistics include thousands of cases one might be willing to say that it points to a progressive change as cause, which begins in the uterus and finally reaches the tubes. But strangely enough, the average number of years of married life of 15 women in the tubal series is exactly the same as that of 29 women in the uterine series, or 7.1 years. This fact at once guards against a venturesome hypothesis, for it allows a no longer period for the supposed ascending change to reach the tubes than the uterus.


Eight of 20 women from the tubal series had borne one child, 4 had borne two, and 3 more than two, thus again more than confirming the statistical findings in the uterine series, which show that 9 of 33 women had borne once and 18 but twice. The parallelism between these statistics is striking indeed, especially if the small numbers be considered; 14 of 23 women, or 60.8 per cent, in the tubal series had aborted but once, as compared to 19 out of 44, or 46.3 per cent, in the uterine series, a fact which again points to the middle rather than to the end of the reproductive life of these women.

I do not know whether or not hydatiform degeneration in the tube also is relatively more common near the menopause, for I have not been able to obtain data on the relative frequency of tubal pregnancy in the different decades in the reproductive life of women. However, since by far the greater number of pregnancies usually occur early in this period, it probably would be safe to assume that most of the tubal pregnancies occur also at this time. Consequently, it might well follow that the ratio of tubal hydatiform degeneration to the number of pregnancies occurring in the later actually might be greater than that in the earlier decades.

Description of Plate

Plate 13

Mall Meyer1921 plate13.jpg

Fig. 135. A portion of a rather fibrous decidua. No. 874o. X300. (See Chap. VIII.)

Fig. 136. Hydatiform villi in section. No. 825. X45.

Fig. 137. Cross-section of tube and vesicle. No. 1771. X4.

Fig. 138. Cross-section of same, showing hydatiform villi. X2.

Fig. 139. Hydatiform villi from same, in section. X45.

Fig. 140. Hydatiform villi protruding through an incision in the tube wall. No. 2052. X2.


Plate 13: Fig. 135 | Fig. 136 | Fig. 137 | Fig. 138 | Fig. 139 | Fig. 140 | Chapter 8. Hydatiform Degeneration in Uterine Pregnancy


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Mall FP. and Meyer AW. Studies on abortuses: a survey of pathologic ova in the Carnegie Embryological Collection. (1921) Contrib. Embryol., Carnegie Inst. Wash. Publ. 275, 12: 1-364.

In this historic 1921 pathology paper, figures and plates of abnormal embryos are not suitable for young students.

1921 Carnegie Collection - Abnormal: Preface | 1 Collection origin | 2 Care and utilization | 3 Classification | 4 Pathologic analysis | 5 Size | 6 Sex incidence | 7 Localized anomalies | 8 Hydatiform uterine | 9 Hydatiform tubal | Chapter 10 Alleged superfetation | 11 Ovarian Pregnancy | 12 Lysis and resorption | 13 Postmortem intrauterine | 14 Hofbauer cells | 15 Villi | 16 Villous nodules | 17 Syphilitic changes | 18 Aspects | Bibliography | Figures | Contribution No.56 | Contributions Series | Embryology History

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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)