Metabolic characteristics of polycystic ovary syndrome women and polycystic ovary syndrome-like, prenatally androgenized (PA) female monkeys worsen with age, with altered adipogenesis of sc abdominal adipose potentially contributing to age-related adverse effects on metabolism. This study examines whether adipocyte morphology and gene expression in sc abdominal adipose differ between late reproductive-aged PA female rhesus monkeys compared with age-matched controls (C). Subcutaneous abdominal adipose of both groups was obtained for histological imaging and mRNA determination of zinc finger protein 423 (Zfp423) as a marker of adipose stem cell commitment to preadipocytes, and CCAAT/enhancer binding protein (C/EBP)α/peroxisome proliferator-activated receptor (PPAR)δ as well as C/EBPα/PPARγ as respective markers of early- and late-stage differentiation of preadipocytes to adipocytes. In all females combined, serum testosterone (T) levels positively correlated with fasting serum levels of total free fatty acid (r(2) = 0.73, P < .002). PA females had a greater population of small adipocytes vs C (P < .001) in the presence of increased Zfp423 (P < .025 vs C females) and decreased C/EBPα (P < .003, vs C females) mRNA expression. Moreover, Zfp423 mRNA expression positively correlated with circulating total free fatty acid levels during iv glucose tolerance testing (P < .004, r(2) = 0.66), whereas C/EBPα mRNA expression negatively correlated with serum T levels (P < .02, r(2) = 0.43). Gene expression of PPARδ and PPARγ were comparable between groups (P = .723 and P = .18, respectively). Early-to-mid gestational T excess in female rhesus monkeys impairs adult preadipocyte differentiation to adipocytes in sc abdominal adipose and may constrain the ability of this adipose depot to safely store fat with age.

Differential uptake or utilization of lipid by CC and MGC occurs during oocyte maturation and steroidogenesis, respectively, with the amount of lipid present in ovarian cells a function of both the follicular microenvironment at the time of the oocyte retrieval and the capacity of these cells to accumulate lipid in vitro over time.

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Discussion: This case is presented to educate physicians on a possible manifestation of vascular insufficiency on endoscopy and to always keep it in mind when evaluating a patient presenting with severe abdominal pain. Vascular insufficiency can manifest itself in many ways, but in our case, different clues led us to the diagnosis from her physical exam, to the findings seen on CTA and to the results appreciated on EGD.[2478] Figure 1. Patchy blanching of the gastric mucosa with superficial erosions as demonstrated on EGD.

Figure 1. (A) EGD demonstrating a gastric submucosal lesion in the body of the stomach (B) EUS illustrating 37 3 33 mm multiseptated anechoic lesion with internal debris (C) EGD findings showing a gastric mass occupying the entire lumen of distal gastric body with two overlying umbilicated ulcerations over the mass measuring 7 mm and 2 cm in size. (D) EUS demonstrating hypoechoic round mass of mixed features in the body of the stomach measuring 43 mm 3 32 mm.