Female Genital Tract ICase 2

• HISTORY: • Pt is a 27-year-old woman who presents with the inability to

conceive a child during the past five years. • PHYSICAL EXAM• Abdomen – normal bowel sounds, no masses or tenderness• 13.5 cm long parasagital scar in the left lower quadrant represents a

healed surgical incision. Several small nodules are felt below the scar (patient says her scar "hurts when I menstruate").

• Bimanual exam reveals slight tender nodularity in cul-de-sac, recto-vaginal septum and uterosacral ligaments.

• The uterus is retroverted and of normal size. • The right adnexa is tender but the left is not. • The rectal exam produces pain when the anterior wall is palpated.

Identify the organs.Identify the labeled structuresDescribe the gross findings

A – Body of uterusB – OvaryC - Cervix

The specimen lacks color because of formalin fixation. The surgical specimen consists of the uterus, ovaries, and fallopian tubes. The ovaries, especially the left one, are enlarged. The left ovary is dark red-brown with a finding consistent with the presence of blood. The tissue is distorted because of nests of hemorrhagic endometrium and fibrosis scattered in the visceral peritoneum. Diagnosis: Endometriosis

Identify the organ and structures.Describe the gross findings

Endometriosis-OvaryThe surgical specimen consists of sections of the ovaries.The left ovary contains blood ("chocolate cyst").The right ovary does not contain obvious blood.

A – Corpus Luteum

B – Endometriotic cyst of ovary

Describe the findings of this surgically resected ovary

Endometriosis-OvaryThe surgical specimen consists of an ovary containing an endometrioma or "chocolate cyst"

.

Endometrial glands

Collagen/scar tissue

Endometrial tissue is present in a healed scar.

Endometrial stroma with associatedblood

Hemosiderinpigment

Endometrial gland

Endometrial stromal cells