CASE 1

Note:

Each of the following three kodachromes is from a hysterectomy specimen. Below are three fictitious case histories. Describe how the history and the histologic findings are correlated.

History A:

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A 30 year-old woman had an abnormal Pap smear, followed by colposcopy and cervical biopsy showing invasive squamous cell carcinoma. A hysterectomy was performed.

History B:

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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.

History C:

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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.

CASE 2

History:

A 35 year-old woman complained of irregular periods and dysmenorrhea. The uterine corpus was thought to be diffusely enlarged on pelvic exam. A hysterectomy was performed. The uterus weighed 300 grams (normal: up to 225 grams). and the cut surface of the myometrium showed coarse trabeculations. The image is a section of the myometrium. Notice the multiple foci of endometrial-type glands within the smooth muscle. These glands are associated with endometrial-type stroma.

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Questions:

1. What is the diagnosis?
2. How is this process different from an invasive endometrial carcinoma?

CASE 3

History:

A 34 year-old woman complained of severe dsymenorrhea and irregular bowel movements. She had two children during her early twenties, but had been unable to conceive since then. At laparoscopy, multiple lesions are noted on the pelvic peritoneum, uterine serosa, left fallopian tube, and left ovary. A small 1 cm diamter mass is visible in the wall of the sigmoid colon.

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Questions:

1. What is the pathologic process?
2. What three histologic elements can be found in this condition?
3. What is the pathogenesis of this condition?
4. What can be done for this condition?
5. What do you tell the patient if she says that all her previous doctors told her that it was "all in your head"?

CASE 4

History:

A right adnexal mass was discovered in a 23 year-old woman, who was being evaluated for infertility. On abdominal x-ray, calcification was noted in the region of the right ovary. A CT scan revealed bilateral ovarian masses that were both cystic and solid. At laparotomy, the right ovary was 13 cm and the left ovary 7 cm in greatest dimension, and their external surfaces were smooth.

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Questions:

1. What is the diagnosis and prognosis?
2. What sorts of things can you find in this lesion?

CASE 5

History:

A 28 year-old white man noted mild, bilateral breast enlargement associated with slight breast tenderness. After two months, he began to experience a dull ache and a sensation of heaviness in the right testicle. His serum alpha-fetoprotein was elevated, and a pregnancy test was positive (but the quantitative HCG was not very high). The right testis was noted to be enlarged. An orchidectomy was performed.

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Questions:

1. What is the diagnosis?
2. Explain the laboratory test findings.
3. What is the most probable reason for the gynecomastia and breast tenderness?

CASE 6

History:

A 73 year-old woman, who had experienced her last menstrual period approximately nineteen years previously, developed intermittent vaginal bleeding. On pelvic examination, the cervix appeared normal. The uterus appeared to be somewhat enlarged, but it was difficult to assess because of her obesity. An abdominal ultrasound was performed and revealed an enlarged uterus, but no apparent adnexal masses, but the quality of the ultrasound study was limited by the patient's size.

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Questions:

1. What is the diagnosis?
2. What determines the prognosis?
3. What are risk factors for this disease?

CASE 7

History:

A 20-year-old woman was in the second trimester of her first pregnancy. She was having severe hyperemesis. Her physician found that on physical exam, she seemed to be large for dates, and no fetal heart tones were audible. A sonogram showed no fetus, only lots of echos (a "snowstorm" appearance). A quantitative beta-HCG was extremely high. A dilation and curretage (D&C) procedure was done.

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Questions:

1. What is the diagnosis?
2. How does this lesion arise?
3. What will you do to follow the patient?

CASE 8

History:

A 76-year-old man noted increased hesitancy with urination over the past few months. His physician palpated a firm nodule in the region of the prostate on physical examination. A urologist biopsied the prostate. His serum prostate specific antigen was 23.8 ng/mL. He underwent a radical prostatectomy.

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Questions:

1. What is the diagnosis?
2. Who gets this disease?
3. How important is histopathologic study of this disease?
4. What is the significance of the laboratory test finding?