Virtual Microscopy
 
  Virtual Microscopy > Reproductive > Uterine Pathology

Case 1: Review

There are morphologic changes that normally occur in the endometrium that mark different phases in the menstrual cycle. The changes that occur do so in an orderly fashion and allow one to “date” the endometrium and to assess hormonal status. The following examples illustrate some of these changes.

  1. proliferative endometrium
  2. early secretory endometrium
  3. late secretory endometrium
  4. menstrual endometrium

 

Case 2:

A 36-year-old woman represented to her gynecologist with recurrent dysmenorrhea and pelvic pain. On ultrasound, a small mass was noted in the right ovary. Laparoscopic surgery showed a hemorrhagic appearing mass attached to the right ovary [endometriosis gross]. Tissue was sampled and a diagnosis of endometriosis was made [endometriosis microscopic] [endometriosis microscopic]

  1. How can the gross appearance explain the patient’s symptoms?
  2. Describe the microscopic features of endometriosis? How are they similar or different than normal endometrial tissue?
  3. Be able to discuss potential explanations on how one can see endometrial-like tissue on the surface of the ovary.

 

Case 3:

A 42-year-old woman presented with several months of sporadic abdominal pain and an “abdominal mass”. A hysterectomy was performed [hysterectomy gross] [virtual slide of leiomyoma].

  1. Can you identify the lesion(s) in the gross photograph?
  2. Describe the microscopic features of leiomyoma. What is the cell of origin? How do they behave clincally?
  3. What histologic features distinguish leiomyosarcoma [leiomyosarcoma microscopic] [leiomyosarcoma microscopic] from leiomyoma?

 

Case 4:

A 68 year old post-menopausal female with a BMI of 34.2 presents to her family physician with a one month history of intermittent vaginal bleeding. She reports having a normal PAP at another medical institution 6 months ago. A transvaginal ultrasound shows a diffusely thickened endometrial stripe. After reviewing the results of an office endometrial biopsy and endocervical curettage (ECC), her doctor referred her to a local gynecologic oncologist.

  1. Identify areas of normal endometrial mucosa and myometrium. [Normal proliferative endometrium and myometrium]
  2. Describe histologic features of neoplastic endometrial tissue.[endometrial carcinoma]
  3. Be able to discuss general concept of carcinoma grading as applies to endometroid adenocarcinoma. Why is this important in pre-operative work-up?
  4. Discuss the reasoning behind doing both an endometrial biopsy and an ECC during the patient’s initial work-up and how the information from both may affect the surgical management as well as long-term prognosis.

 

Case 5:

A 52 year old female presents to her gynecologist with complaint of irregular vaginal bleeding and fatigue. A CBC showed microcytic anemia , and an endometrial biopsy showed complex hyperplasia without atypia. The anemia was treated with iron supplementation, and medroxyprogesterone acetate was started with subsequent resolution of her menstrual complaints.

  1. How does one recognize hyperplasia in the endometrium and what types are there? [endometrial hyperplasia]
  2. What is the significance of atypia in association with the hyperplasia type? [complex atypical hyperplasia of endometrium]
  3. What is the clinical significance of endometrial hyperplasia?
  4. How is hyperplasia treated differently from carcinoma?

 

Case 6:

A 70 year old female presents to the emergency room with vaginal bleeding. She states that she has never had hormone replacement therapy. Following a curettage, she is scheduled for radical hysterectomy.

  1. What type of tumor is present? [serous carcinoma]
  2. How does this tumor differ histologically from endometrioid carcinomas?
  3. Does this tumor carry a different prognosis than endometrioid carcinomas? If so, is it better or worse generally?

 

Show and Tell:

[endometrial polyp #1]

[endometrial polyp #2]

[chronic endometritis #1]

[chronic endometritis #2]

[decidua]