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*GIGU I > 36. Histology of Menstrual Cycle > Flashcards

36. Histology of Menstrual Cycle Flashcards

1
Q

What are the 2 simultaneous cycles associated with the menstrual cycle?

A

Ovarian cycle

Uterine cycle

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2
Q

During the ovarian cycle, several ovarian follicles, each housing a primary oocyte, undergo _______ in preparation for ovulation

During the uterine cycle, the ______ prepares for implantation. If fertilization does not occur, this part is shed and menstruation occurs

A

Folliculogenesis

Endometrium

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3
Q

What are the 4 functions of the paired uterine tubes (oviducts)?

A
  1. Catch ovulated secondary oocyte
  2. Nourish oocyte and sperm
  3. Provide fertilization microenvironment
  4. Transport embryo to uterus
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4
Q

Regions of the oviducts:

Proximal ______ with fimbriae

Long and thin-walled _____

Short and thick walled _______

______ portion which opens into the uterus

A

Infundibulum

Ampulla

Isthmus

Intramural

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5
Q

The ampulla and isthmus are lined by ______ that project into the lumen

A

Mucosal folds

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6
Q

What are the histological layers of the uterine tubes?

A

Mucosal layer
Smooth muscle layer
Serosa layer

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7
Q

The mucosal layer of the uterine tube is a _______ epithelium with an underlying lamina propria. It is lined with _____ cells that change under the influence of hormones throughout the menstrual cycle. There are also ________ cells which secrete nutrients for the egg during migration

A

Simple columnar; ciliated; nonciliated secretory cells (peg cells)

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8
Q

What changes occur in the ciliated cells of the mucosa of uterine tubes under the influence of estrogen vs. progesterone?

A

During folliculogenesis, estrogen is high, the ciliated cells enlarge, growing in height and producing cilia

During luteolysis, progesterone is high, the cells lost their cilia and decrease in height

[so CILIOGENESIS is ESTROGEN-DEPENDENT]

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9
Q

Describe the smooth muscle layer of the uterine tubes

A

Has inner circular-spiral layer and outer longitudinal layer

Function = peristaltic contraction (along with ciliary activity of epithelial cells) propel the oocyte/zygote toward uterus

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10
Q

3 layers of uterine wall and epithelium type

A

Endometrium = simple columnar w/simple tubular glands

Myometrium = poorly defined smooth muscle + stratum vasculare

Perimetrium = serosa covering posterior surface and part of anterior surface (rest is adventitia)

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11
Q

What 2 layers exist within the endometrium of the uterus?

A

Functional layer (stratum functionale) — lost during menstruation; supplied by spiral arteries

Basal layer (stratum basale) — retained during menstruation

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12
Q

The myometrium of the uterus has a central, circular layer that is thick with blood vessels, constituting the _____ ______. Outer and inner layers contain _____ and ______ arranged fibers

A

Stratum vasculare; longitudinally; obliquely

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13
Q

In terms of endometrium vasculature, _____ arteries supply the endometrium. These arteries have a _____ segment that supplies the basal layer, as well as a _____ segment supplying the functional layer which must stretch with endometrial growth

A

Arcuate; straight; coiled (spiral aa.)

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14
Q

What happens at the straight-coiled junction of arcuate arteries just before menstruation?

A

Contraction occurs at this junction, reducing blood flow leading to the destruction of the functional layer

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15
Q

What are the phases of the menstrual cycle?

A
  1. Menstrual phase
  2. Proliferative phase
  3. Secretory phase
  4. Ischemic phase
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16
Q

Describe glandular changes in the endometrium during the proliferative phase of the menstrual cycle

A

During the early proliferative period, the glands of the endometrium are short, straight, and narrow. The lamina propria is compacted.

During the midproliferative period, the glands are longer and straight. The epithelium is mitotically active. The LP is slightly edematous.

During the late proliferative period, mitotic activity is intesnse, the glands grow rapidly and become tortuous. The LP is more edematous

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17
Q

Describe glandular changes in the endometrium during the secretory phase of the menstrual cycle

A

During the midsecretory period, glycogen accumulates in the basal portion of the glandular epithelial cells. The glands have saw-tooth appearance. Cells of stroma surrounding spiral aa. enlarge and become decidual-like.

During the late secretory period, glycogen shifts to apical portion; glands have secretion in the lumen; stromal cells surrounding spiral aa. are mitotically active an indication of decidual change

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18
Q

During the ______ period, the upper region of the endometrial stroma contains numerous decidual cells. The spiral arteries contract.

A

Ischemic

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19
Q

The proliferative phase of the menstrual cycle lasts from days ___-____

______ proliferate and cover surface of endometrium

______ arteries elongate and become convoluted, extending from basal into functional layer

This phase is ______-dependent

A

5-14

Glands

Spiral

Estrogen

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20
Q

During the secretory phase of the menstrual cycle from days ___-____:

Glands are convoluted with “______” appearance

The ______ reaches maximum thickness

Spiral arteries continue to grow and extend into the functional layer, and there is considerable ______ infiltration in the stroma

These phase is dependent upon ____ and _____

A

15-28

Saw tooth

Endometrium

Leukocyte

Estrogen; progesterone

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21
Q

During the ischemic phase of the menstrual cycle which lasts about 1 day, there is regression of the _______

Reduction in blood supply causes intermittent ischemia and subsequent _____ of the functional endometrial layer

A

Corpus luteum; necrosis

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22
Q

During the menstrual phase of the menstrual cycle, which lasts ___-____ days:

The _______ has sloughed away as well as numerous RBCs and leukocytes. The ______ remains intact

A

1-4

Stratum functionalis; stratum basalis

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23
Q

During the premenstrual, or ischemic, stage:

Periodic contractions of the spiral artery, triggered by a reduction in ________, deprive the functional layer of oxygen. A breakdown of the spiral a. floods the ________ with blood

A

Progesterone; LP

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24
Q

During the ischemic stage of the menstrual cycle, the functional layer, consisting of glands and decidual-like cells, detaches and sheds into the uterine cavity. Why is the stratum basalis not affected?

A

Because basal straight arteries provide independent blood supply to this layer

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25
Q

If pregnancy takes place, ______ cells in the LP increase in size as they store lipids and glycogen

The ___________ occurs when functional layer is shed as [above answer] at parturition

A

Decidual

Decidual reaction

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26
Q

Decidual cells derive from the epithelial-like transformation of endometrial stromal cells (decidual reaction in preparation for embryo implantation). What are the primary functions of decidual cells?

A

Modulate trophoblast cell invasion

Provide nutrients to the developing embryo

Prevent immunologic rejection

Endocrine role in production of decidual prolactin which has a trophic effect on corpus luteum

27
Q

What vascular changes occur in the endometrium in response to embryo implantation?

A

Increase in permeability of endometrial blood vessels and angiogenesis

28
Q

Recruitment of what types of inflammatory cells occurs at implantation site?

A

Lymphocytes
Macrophages
Eosinophils

29
Q

In addition to decidual prolactin, decidual cells produce _____ and _____

A

Prostaglandins; relaxin

30
Q

_________ = condition in which clusters of endometrium become implanted outside the uterus, forming _______

A

Endometriosis; endometriomas

31
Q

What are common locations for endometriomas?

A 
Oviduct
Ovaries
Sigmoid/ascending colon
Broad and uterosacral ligaments
Pelvic peritoneal lining
32
Q

Tx for endometriosis

A

OCPs
Drugs to induce menopause
Laparoscopy/ablation or hysterectomy
IVF for fertility management

33
Q

Endometriosis can give rise to cysts, scar tissue, and peritoneal adhesions, as well as what other conditions relating to the menstrual cycle?

A

Dysmenorrhea
Menorrhagia
Menometrorrhagia
Infertility

34
Q

_____ = chronic pelvic pain occurring during menstruation

A

Dysmenorrhea

35
Q

Excessive bleeding during the menstrual period

A

Menorrhagia

36
Q

Bleeding between periods

A

Menometrorrhagia

37
Q

Endometriosis is commonly first diagnosed in patients who present with what concern?

A

Infertility

38
Q

The cervix communicates with the uterine cavity through the ______, which is characterized by folded mucosa with deep _____ that mimic mucous secreting tubular glands

A

Endocervix; crypts

39
Q

Cervical crypts increase the surface area of mucous producing _____ _____ cells. Height of crypts varies with time of the menstrual cycle and secretory activity. They can become occluded and dilated, forming ____ ______

A

Simple columnar

Nabothian cysts

40
Q

_______ of cervix contains collagen bundles, some smooth muscle, and abundant vasculature

A

Stroma

41
Q

Ectocervix = external segment of cervix, lined by ____ ____ epithelium

A

Stratified squamous epithelium (nonkeratinized)

[contrast with simple columnar of endocervix]

42
Q

_________ = important area in cervix where epithelium changes between endocervix and ectocervix

A

Transformation zone

43
Q

About 95% of cervical intraepithelial neoplasias originates within the _______ ______

A

Transformation zone

44
Q

What are the histological layers of the fibromuscular vagina?

A

Mucosal layer = nonkeratinized strat squamous
Muscularis layer = circular + longitudinal sm. m.
Adventitial layer = dense CT

45
Q

The mucosal layer of the vagina is kept moist by mucous from the uterine/endocervical glands and glands of ______ in the vestibule

A

Bartholins

46
Q

What cyclical changes occur in the histological staining of the vagina relative to ovulation?

A

Ovulation (estrogen) —> stratified epithelium is fully differentiated and stains acidophilic

After ovulation (progesterone) —> decrease in squamous cells, polygonal cells stain basophilic (also more neutrophils and lymphocytes)

47
Q

T/F: the vaginal wall lacks glands

A

True

48
Q

Vaginal smears provide rapid info on levels of ____ and _______, which makes them useful for monitoring hormonal status during pregnancy

A

Estrogen; progesterone

49
Q

The clitoris is located below the mons pubis and is equivalent to the penis, or ______ _____ tissue in the male.

It consists of erectile vascular tissue, with 2 ______, each surrounded by a fibrous collagenouos sheath.

It is partially covered by skin rich with sensory nerves and receptors, but lacks ______ and ______

A

Corpora cavernosa

Crura

Hair follicles; glands

50
Q

Dysplasia occurs at which region of the cervix?

A

Ectocervix

51
Q

Describe dysplasia of the ectocervix

A

Disorganized epithelial cells that slough off before reaching full stratified maturity

Can progress into carcinoma — in situ or invasive

52
Q

Ectocervical dysplasia or carcinoma are detected by what method?

A

Pap smear

53
Q

STI associated with majority of cervical cancer cases

A

HPV

54
Q

What cells are used to detect high-risk HPV strains?

A

Cervical cells

55
Q

There are 13 types of HPV — which 2 are known contributors to cervical cancer?

A

HPV 16 and HPV 18

56
Q

_____ _____ = observing normal/abnormal cells using staining

A

Diagnostic cytopathology

57
Q

Pap smear is a standard procedure for detection using papanicolaou stain

Eosin stains ______ cells pink or orange

Light green stains the cytoplasm of less differentiated cells close to the ____ ____

Hematoxylin stains ______ dark blue/purple

A

Superficial squamous

Basal lamina

Nuclei

58
Q

In a pap smear:

________ stimulate differentiation of superficial layers of the vagina (stratified squamous). With epithelium differentiation (estrogen) —> progesterone causes rapid _________ of the apical pink-orange stained squamous cells

The _________ stained polygonal cells of the intermediate layers remain and are seen in the smear

A

Estrogens; desquamation

Light green

59
Q

Describe histology of mons pubis

A

Keratinized stratified squamous with hair follicles covering subcutaneous fat overlying pubic symphysis

60
Q

Describe histology of labia majora

A

Extensions of the mons pubis at each side of the vaginal introitus; pigmented skin with hair follicles and glands (apocrine sweat and sebaceous) covering fat pad

61
Q

Describe histology of labia minora

A

Pigmented skin folds with abundant blood vessels, elastic fibers, and sebaceous glands

62
Q

_____ = limit between the internal and external genitalia consisting of thin fibrous membrane lining lower vagina

A

Hymen

63
Q

Describe histology of the hymen, differentiating external vs. internal surfaces

A

External surface = keratinized stratified squamous

Internal surface = nonkeratinizing stratified squamous

*GIGU I (67 decks)

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