REPRODUCTIVE II TUTORIAL

CASE 1 - Endometrium in different phases

Note:

Each of the following three kodachromes is from a hysterectomy specimen. Below are three factitious case histories. Match the slide with the history. Obviously, in an actual clinical setting, only an endometrial biopsy would be performed.

History A:

A 28 year-old woman, who was having periods of 4 to 7 days duration every 28 to 37 days, was being evaluated for infertility. Daily morning temperature measurements revealed no rise in basal body temperature. An endometrial biopsy was performed on the 27 day following the onset of her last menstrual period.

Slide 1.1: The slide shows a proliferative endometrium consistent with anovulatory cycles. The flat basal body temperature curve correlates with the failure of ovulation. Notice the pseudostratified nuclei in the glandular epithelial cells and the occasional mitotic figures. Distinguish the stratum basalis (from where regeneration occurs) from the proliferating stratum

History B:

A 32 year-old woman desired sterilization. She had complained of irregular periods during the last 6 months. During laparoscopic tubal ligation, a bulging, 2 cm diameter mass was noted on the left ovary. A depression lined by yellow tissue was present on the surface of this mass. A D&C was performed.

Slide 1.2: The slide shows an early secretory endometrium. Notice the tortuous glands and epithelial cells containing subnuclear vacuoles. What is the main content of the vacuoles? The 2 cm diameter ovarian mass with the central yellow depression is a corpus luteum.

History C:

A 52 year-old woman, who had had no periods for three years, began to experience intermittent vaginal bleeding. On pelvic exam, a small endocervical polyp protruded from the external os. A D&C was performed.

Slide 1.3: The slide shows an atrophic, postmenopausal endometrium. Some of the glands are cystically dilated, but they are lined by flat, atrophic-appearing epithelial cells. There is no evidence of hyperplasia or malignancy.