Gynecology . ifferent places may be seen great syncytial masses with large, variouslyformed protoplasm. Such a picture may correspond either to a placental restor to a benign form of chorio-epithelioma, or to an early stage of a malignantchorio-epithelioma. If radical operation is done there is a chance that the 320 GYNECOLOGY patient will be subjected to needless danger, with the loss of her pelvic organs,for there is no way of telling that the condition in the uterus is not perfectlyharmless. If one does not operate, and waits for later symptoms to develop,metastases may take place and it wi
Gynecology . ifferent places may be seen great syncytial masses with large, variouslyformed protoplasm. Such a picture may correspond either to a placental restor to a benign form of chorio-epithelioma, or to an early stage of a malignantchorio-epithelioma. If radical operation is done there is a chance that the 320 GYNECOLOGY patient will be subjected to needless danger, with the loss of her pelvic organs,for there is no way of telling that the condition in the uterus is not perfectlyharmless. If one does not operate, and waits for later symptoms to develop,metastases may take place and it will be too late to save the patient. More-over, one is confronted by the fact that a curetment sometimes turns a benignform of the disease into immediate and overwhelming malignancy, as is em-phatically pointed out by Hitschmann and Cristofoletti. Cases have beenreported where the initial curetings have been examined and pronounced bycompetent pathologists as malignant, and the extirpated uteri have later been. Fig. 120.— power. Most of the tissue consists of Langhans cells the nuclei of which do not stain asdeeply as those of the syncytium, and the cell outlines of which can usually be seen. Near the centerare two syncytial nuclei which are larger, irregular in shape, and stain deeply. Near the rightupper edge is a mitotic figure in a syncytial nucleus. found to be perfectly normal. Whichever course the surgeon adopts, he isrunning a risk, and he must depend to a certain extent on his surgical instinctto make the right decision. If the initial curetings show large or overwhelming numbers of groupedLanghans and syncytial cells, immediate radical operation is advisable, especi-ally if a hydatidiform mole has preceded. If the initial curetings show con-spicuous, though not numerous, characteristic cell collections, the case is re-garded with grave suspicion, and, if the symptoms have been preceded by amole, radical operation is seriously considered. If, ho
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