1. Female Genital Tract I Case 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.

2. Identify the organs. Identify the labeled structures Describe the gross findings

3. A – Body of uterus B – Ovary C - 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

4. Identify the organ and structures. Describe the gross findings

5. Endometriosis-Ovary The 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

6. Describe the findings of this surgically resected ovary

7. Endometriosis-Ovary The surgical specimen consists of an ovary containing an endometrioma or "chocolate cyst"

8. .

9. Endometrial glands Collagen/scar tissue Endometrial tissue is present in a healed scar. Endometrial stroma with associated blood Hemosiderin pigment

11. Endometrial gland Endometrial stromal cells