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Saline infusion sonography of a normal endometrial cavity.


Transvaginal sonogram in the sagittal plane of a uterine cervix. An endocervical cyst is seen posterior to the thin, echogenic endocervical canal.


Transvaginal sonogram in the sagittal plane of a characteristic trilaminar proliferative endometrium. Calipers demonstrate proper measurement of the “double-layer” thickness made of the alternating hyper-hypo-hyperechogenic lines.


Asherman syndrome. Transvaginal saline infusion sonography demonstrates echogenic intrauterine synechiae.


Candidal infection. A. Thick white discharge, labial erythema, and edema are seen with candidiasis. (Used with permission from Dr. William Griffith.) B. Candida albicans in a potassium hydroxide preparation. Serpentine pseudohyphae are seen. (Reproduced with permission from Hansfield HH: Vaginal infections. In Color Atlas and Synopsis of Sexually Transmitted Diseases. New York, McGraw-Hill, 2001, p 169.)


The Tanner stages of female breast and pubic hair development.


Lichen sclerosus before and after treatment. A. Findings include thin, parchment-like skin on the labia majora, ecchymoses on the labia minora and majora, and mild disease on the perianal skin. Involvement of both the vulva and perinal skin gives a figure-of-eight shape to affected areas. B. Skin texture and ecchymoses improved following treatment. (Used with permission from Dr. Mary Jane Pearson.)


Normal GnRH neuron migration and the pathogenesis of Kallmann syndrome. A. During normal development, olfactory neurons arising in the olfactory epithelium extend their axons through the cribriform plate of the ethmoid bone to reach the olfactory bulb. Here, these axons synapse with dendrites of mitral cells, whose axons form the olfactory tract. Mitral cells secrete anosmin-1, which is the protein product of the KAL1 gene. This protein is necessary to direct the olfactory axons to their correct location in the olfactory bulb. The GnRH-secreting neurons use this axonal path to migrate from the olfactory placode to the hypothalamus. B. Patients with Kallmann syndrome due to a KAL1 mutation lack anosmin-1 expression. As a result, the axons of the olfactory neurons cannot interact properly with mitral cells, and their migration ends between the cribriform plate and olfactory bulb. As GnRH neuronal migration is dependent on this axonal trail, the GnRH secretion pathway likewise ends at this location. (Reproduced with permission from Rugarli E, Ballabio A: ...

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