Virtual Microscopy	Choose another topic Cardiovascular Respiratory Renal and Urinary Tract Musculoskeletal Neuro(CNS and PNS) Gastrointestinal Reproductive Endocrine Hematopoiesis and Lymphoid Skin

Case 1

A 32 year old woman presented to a gynecologist for evaluation of irregular menses. She described a long standing history of unpredictable cycles. She reported occasional missed periods as well as episodes of heavy bleeding, which on one occasion required hospitilization. Her past medical history revealed menarche at age 14. She had never been pregnant. Family history was significant for a sister undergoing treatment for infertility.

Physical examination was significant for obestiy and hirsutism. There were no abnormalities noted on pelvic examination. A pelvic ultrasound demonstrated bilateral enlarged ovaries distorted by multiple small cysts. A serum (-HCG was negative. There was marked elevation of her serum luteinizing hormone (LH) with an increased LH/FSH ratio. She was diagnosed with polycystic ovarian disease.

Slides: [patient's ovary] [normal ovary (includes normal fallopian tube)]

1. Identify the following structures in the normal ovary (surface epithelium, stroma, follicles, corpus luteum, corpus albicans, blood vessels)
2. What are the microscopic differences in the structure of the ovarian follicles/ follicle development in polycystic ovaries versus normal ovaries (what is missing in the polycystic ovary)?
3. What aspects of the polycystic ovary are similar to the normal ovary?
4. What are the microscopic differences in the ovarian stroma in polycystic ovaries versus normal ovaries?

Case 1 (continued)

In the course of follow up for polycystic ovarian disease, our patient continued to experience excessive bleeding at unpredictable intervals. A repeat ultrasound showed a thickened endometrial stripe. An endometrial biopsy was performed which showed complex atypical endometrial hyperplasia.

Slides: [patient's endometrium] [normal proliferative endometrium] [normal secretory endometrium]

1. Identify the following structures in the normal uterus (endometrial glands, endometrial stroma, endometrial blood vessels, myometrium)
2. Contrast the histologic features of the hyperplastic endometrium with normal proliferative phase endometrium. What is different about the characteristics of the individual endometrial glands? What happens to the gland to stroma ratio?
3. Explain why patients with polycystic ovarian disease are at risk for the development of endometrial hyperplasia and carcinoma? What ovarian hormones play a role?
4. How does secretory endometrium differ from both normal proliferative endometrium and endometrial hyperplasia?
5. What histologic features distinguish early from late secretory phase endometrium?