1. Female Genital Tract I, Case 4 A 38-year-old woman undergoes a routine, annual gynecologic examination. She menstruates every 28-31 days for 2-4 days. She experienced three or four episodes of metrorrhagia in the previous year, but no hypermenorrhea. Bimanual exam reveals an asymmetrically enlarged uterus. The uterus is the size of a 2-3 month gestation and is freely movable. The uterus contains multiple nodules of varying size which are not tender.

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

3. The surgical specimen consists of the whole uterus and adenexa. The uterus is opened along the anterior midline. The fundus contains a large leiomyoma (bisected) which is sharply delineated from the adjacent, normal pink myometrium. The leiomyoma is white and is composed of interlacing bundles of muscle. A – Leiomyoma B – Fallopian Tube C – Endometrial Cavity D - Cervix

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

5. Leiomyoma - Uterus The surgical specimen consists of the uterus with a sumucosal leiomyoma. The benign neoplasm is white and protrudes into the endometrial cavity. Blood clots are in the endometrial cavity. A – Leiomyoma B – Blood clot C – Endocervical canal

6. Identify the organ Identify the structures Describe the gross findings

7. Leiomyoma - Uterus The surgical specimen consists of the uterus with a subserosal leiomyoma arising in the fundus. A – Leiomyoma B – Fallopian Tube C - Ovary D – Body of Uterus E - Cervix

8. Describe the histologic findings

9. The microscopic section of the uterine wall reveals a leiomyoma sharply delineated from the adjacent normal but compressed myometrium. The neoplasm is composed of whorled pattern of smooth muscle cell bundles A – Normal myometrium B – Interface C - Leiomyoma