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The Function of the Decidual Cell

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The Function of the Decidual Cell the function of the decidual cell. 265 the function of the decidual cell. % W. E. Fothergill, M.A., B.Sc., M.D., Manchester. when stroma of the uterine mucous membrane, little to the eye o shape > faltered by pregnancy, presents 01 o\ a multitude of small cells, round 1?pt beyond ? and but little cell pro op , conspicuous nuclei ^ j?. of the uterine mu 'odified pregnancy, the stroma ?veatly by ce s a S ? different for many of the G P' appearance, Their are arSed and infinitely in shape. 1 they vary nuc e ' an(l with clear outline and . vesicular, ai ,vi?.e P . ^e their cell is abundant and gianu Ce> protoplasm of cas These are well seen in sections changes 1 m ^-on for m these *n oases of ectopic gestation, ofe^terusthe b) c uterine decidua goes on uncomplicated lQetal structures. the eonnec ^ has this of t; been maintained that enlargement of the uterine mucosa occurs only during gestation. d " ^ccdlsthat the so-called decidual cell" is according yp been rtrongyj, of This view, however, nas or?mC P^gnancy. ce Pposed; for cells from decidual indistinguishable morbid condit in the uterine mucosa in various is now ' membrane bv the formation of a decidual . s?nie to be from pregnancy possible, apart thateitieint t le this as it the fact remains, of fulC' may, ^ pfnsfant C6lls in of the Uterin6 mUC?Sa feat the stroma . ?? ??????? ? n ? ^le decidual cells in normal gestation wsaaat, my evp in work.work >>was called tQ the point while engaged moles and placenpathologi^l p UoK investigating fleshy the decidual cells^ awGd thafc> under certain circumstances, to an active in the changes play part i o foetus. pl?_ar deat . tissue retained in utero after the ? Thn011^ free from septa un7Vf retained placenta remains decidual is not separated by effusion the flts portion to attack and absorbahsorb decidual cells appear TVine wall'^e firs Z foetal of the placenta. They ? chot.?ea. portion the c o maternal epithelium covering the villi and , bl0ni0ll.lc more slowly they 111 ^e intervillous later and aZ* space; the villi. to attack the connective tissue cores of these conclusion? . the material upon which ha8 \va<, ?s*.of This c tained from cases of missed abortion. ?, ' loU(r , this an term weU known clinically in country, j i811 come into use ^ use in naming it has fac?^h.ich " French and goabioad.Jn abortion is now good ^ But' tWmissed clinical stan p tough reports of cases from the J-O- ED. MEn 5<*R_vitw sre ?VOL. V.?Ill 266 W. E. FOTHERGILL. numerous indeed, records of cases which have been submitted to of complete examination are very rare. To make clear the action the decidual cells in certain cases of missed abortion, I mention the following example:? Mrs. P., set. 35, had an ordinary menstrual and obstetric history* and always enjoyed good health, until, in November, menstruation sud- she denly ceased. She did not suffer from morning sickness, nor did notice khe enlargement of the breasts or any other sign of pregnancy. was slightly ailing in January, due to the fatigue of nursing two of her children through scarlet fever. Amenorrlioea remained f?r complete a seven months. In June she complained of some pelvic pain, and brownish discharge appeared. Upon examination, there was no suptf1* m pubic dulness; the uterus was longer and narrower than is usual pregnancy, but in size approached that of one three months pregnant, its position was normal; its consistency was firm, like that of a fibroid- a The cervix was not soft, and the external os admitted the tip of only a finger. The examination to set uterine contraction; fov " " appeared up fleshy mole was expelled a few hours later without much bleeding' Recovery was rapid and complete. of The mass expelled from the uterus consisted of the products conception compacted into an ovoid body 2f in. long, If in. thick) Fig. 1.?Fleshy mole. Uterine surface. and firm and tough to the touch. Its outer surface consisteu w*aS almost entirely of the maternal aspect of the placenta, which t*ie wrapped round so as to enfold the membranes. The cavity of 267 THE FUNCTION OF THE DECIDUAL CELL. ?yum was and was reached intact, by and amnion. decidual tissue and the united e.?ori0n 2fll'j shreddy amnu, J amniotic cavity contained ?tus, and cord been absoibenrf''!n? . Th? membranous portion having , the the an turned back, ovum been incised o , having sur- ? ijjie uterine jPecimen now presents the appearances ie . of *** of the ? formed placenta (see Fig. 1) of the scidual tissue and blood clot. surface deep placenta is thrown into bosses 01 e /evnfionse separated by bosses, and furrows. The amnion1 is stretched over these smoothly Trans- dlPs down between them into the furrows (see J% ; Fig. 2.?Fleshy mole, amniotic surface. from in thickness <-? varies verse s^ows that tlie placenta less than -10n being together a 1 in. t0 i? membranea and decidua cells and ^!e fibrin, decidual j* in. tlii"]-ln'' ^frcr?-sections show villi, a firm structure. ttle frpCi' ??d into to the uterine . compacted at angles a Pip. V J's a section cut right shows from of the figure sUrface' The lower part surface of P^centa. forms the maternal P?rtioi1 ?f fu ^ec^ua^ tissue which villi. The dark ^le f of three chorionic the Plac? are parts blood which fills ?rea8 ^ove from the maternal aren^' n' derived are surrounded the villi partly are ^tervij]6 It is seen that sPaces- of the chorionic epithelium deeicl?U^Ual tissue and that traces 268 W. E. FOTHERGILL. i10^ visible only where the villi are in contact with fibrin, and where the decidual cells are touching the villi. Decidual cells Decidual cells Fibrin Patch ofdecidua serotina Fig.Fig. 3.?Section3.?Section showingshowing thethe uterineuterine surfacesurface ofof thethe placenta.placenta. oiof DecidualDecidual cellscells areare seenseen spreadingspreading fromfrom thethe patchpatch originaloriginal decidua,decidua, removingremoving fcetalfcctal epitheliumepithelium fromfrom thethe villivilli andand organisingorganising fibrin.fibrin. su Fig. 4 is from a section cut at right angles to the amniotic face of the placenta. The upper portion of the figure shows Decidual < : Villus .>. ikxSBBmmmmSBBSW Fibrin Fig. 4.?Section De- Fig. 4.?Section showing foetal surface of thetlie placenta. cidual cells are seen fcetal cidual cells are seen removing the degenerated removing degenerated the epithelium from chorion and villus, also organising the fibrin. ^ amnion and the chorion united into one membrane by nioH of their connective tissue layers. The epithelium of the 01 a^garly remains almost unchanged, and appears as a single row THE FUNCTIONrrrnxr OF THE DECIDUAL CELL. 269 stained cells. seated The epithelium ^ repre- only by a few Nuclei. A darkly stem' somewhat villus is shown to nuclei like below, u reduced bC"l^jew that of the chorionic fib ? Seeu, and the jtoegS* remainder of the he witU decidual eeW \ . Judging by the size of the u Placental sp AUd the sta?b ^en development had reached ^ c^ear that the! ov (\ied the " patient was in ailing m J ary and that gained utcro dead for abou th Jle decidual ? During cells appear to liav yajed the foetal ? P .,, Placenta, and to ^ with which have chorionic ep j-uin c?nnective they came in contact,^str?7tsides b a certain tissue cores of the villi. 1?< maternal ce ',!Xercised what may be called a aino?^the d ^structures. p <?? ^ up0U Kow if, in certain morbid coinflUions the decidual a Phagocytic action fcetal is it l.e?r normal upon ep ^ not P?ceUshav^ function also is foetal with vv^h _ troy st?u they come into contact ? m :eWIhave With ^ . jammed all question W the sections of decidual tissu and made a h^ lesliest number of new ones possessio^p0 e and most healthy specimen To describe Material examined would be imp ^ -u 011e slior 1 ^ before give a , brief general accoun - ^ three figures trating inappearances observed. sections of the 0f the men1 1 ^ ^ie the healthy P ? decidual or el, tissue aiTing in maternal portio n seen as a la)e thickness, separated ^ chorion by 1 space ?utaining chorionic villi, most o cut transveise ? thc '.^tions have been ' ^00j in prepared wit i ^cient care, ma the g , spaces between the Such gjl0W few villi thePr?Pa^ though nUa.nycomparatively touch it Pene ^ and a consniderable numbc1 /less of their superficially, decidun,^ ^ circumference em W1 ere > ilU in 3^.theliuII1 is eithei Qr ig ^ ^ only 270 W. E. FOTHERGILL. ?f disease and the condition of the maternal blood between the viL 1 indicates that little change, if any, occurred in the placental ?re 16 sPecimen was expelled from the uterus, Thp vllHR b! t?0 blood space are complete, though small tn n 1Uf .ie?maternal the ^ blood vessels. The villi in contact with dppirhn n ? 011i epithelium. One embedded villus contain? n Wo lofnS ^irblood vessel. The surface of the decidua de raforf cel1 0lltlhies are lost, the cell protoplasm being fn^rl t fn 5 mass, somewhat deeply stained, in wh^1 soinp rtn-l-V0!}tmuousC' iluclei remain visible. Below the surface lai'rc hp'ilHiv healthy decidualri^ ?UC1G cells are seen. Fig. 5.?Decidua5.?Dccidua and villi, third month. B, maternal blood ; V, villus ; E, foetal epithelium ; D, decidual cell. Figs. 6 and 7 show the surface of the decidua in an ovui'1 over 4 months old, which was fresh and free from post-mortel1' change. In Fig. 6 two villi are seen cut longitudinally.
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