A 33-year-old nulligravid woman comes to the office for evaluation of infertility. She has never been pregnant despite years of unprotected intercourse with her husband. She also has a history of pelvic pain, which worsens with menses. The pain has persisted despite medical therapy and is suspected to be due to endometriosis. Exploratory laparoscopy is performed, and multiple flesh-colored nodules are present on the pelvic organs, along with thin, filmy adhesions. In addition to having endometrial glands with hemosiderin pigment, one of the biopsies contains simple cuboidal epithelial cells. Which of the following is the most likely site of the biopsy?

Question

A 33-year-old nulligravid woman comes to the office for evaluation of infertility.  She has never been pregnant despite years of unprotected intercourse with her husband.  She also has a history of pelvic pain, which worsens with menses.  The pain has persisted despite medical therapy and is suspected to be due to endometriosis.  Exploratory laparoscopy is performed, and multiple flesh-colored nodules are present on the pelvic organs, along with thin, filmy adhesions.  In addition to having endometrial glands with hemosiderin pigment, one of the biopsies contains simple cuboidal epithelial cells.  Which of the following is the most likely site of the biopsy?

Quizplus · Accepted Answer

11ec160b_391e_2204_9249_cb416620ab1f_MD0001_00 The normal uterine mucosa (endometrium) is composed of simple columnar epithelium (Choice B), tubular glands, and stroma (connective tissue). Endometriosis is an important cause of chronic pain and infertility and is due to endometrial cells implanted on various pelvic organs, most commonly the ovary, posterior cul-de-sac, broad ligaments, and uterosacral ligaments. Histopathologic findings include hemosiderin deposits and endometrial glands or stroma outside of the uterus. As the endometrial implants shed through the menstrual cycle, they can accumulate old blood which appears as "chocolate"-colored fluid inside an ovarian cyst (endometrioma). Implants throughout the pelvis and abdomen can also appear as flesh-colored nodules, powder burn patterns, or adhesive disease. The ovary is covered by simple cuboidal cells that divide and proliferate rapidly to repair ovarian surface defects from ovulation. Ectopic endometrial tissue may impair fertility by disrupting folliculogenesis, oocyte release, and oocyte fertilization. (Choices A, C, and F) Endometriosis involving the fallopian tubes is also common and can impair fertility by obstructing tubal transport. Implants on the cervix and vagina are rare. (Choice E) The peritoneum has simple squamous epithelium (mesothelium) and is continuous with the cuboidal epithelium of the ovarian surface. These structures are frequent sites of endometriotic implants. Educational objective: The uterine mucosa is covered by endometrium, and abnormal implantation of endometrial glands/stroma is referred to as endometriosis. The ovary is covered by a simple cuboidal epithelium involved in surface repair of defects from ovulation. Endometriosis commonly affects the ovary and results in infertility. __________ References: The developmental origin of cervical and vaginal epithelium and their clinical consequences: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/24977630) Human female reproductive tract epithelial cell culture. (http://www.ncbi.nlm.nih.gov/pubmed/23097117) Endometriosis - Morphology, Clinical Presentations and Molecular Pathology (http://www.ncbi.nlm.nih.gov/pubmed/21814398)

A 33-Year-Old Nulligravid Woman Comes to the Office for Evaluation