Female Reproductive Pathology Flashcards
What is contained in the cortex and medulla of the ovaries
Medulla - blood vessels and nerves
Cortex - developing follicles
Stages of follicle development
Primordial follicle
Early primary follicle
Late primary follicle
Secondary follicle
Tertiary/graffiti follicle
Corpus luteum
Corpus albicans
Atretic follicle
Where do primordial follicles develop
Fetal ovary in 1st 5 months gestation
Primordial follicle characteristics
Oocyte surrounded by single layer squamous follicular cells
Remain at first meiotic division until puberty
Early primordial follicle characteristics
Central oocyte surrounded by single layer cuboidal follicular cells
Limited number triggered to develop at start of each menstrual cycle by FSH
Late primary follicle characteristics
Zona granuloma forms
Zona pellucida enlarges
Zona pellucida
Thin hard band of glycoproteins that separates the oocyte and follicular cells, proteins on sperm bind to specific glycoproteins
How does the zona granuloma forms
Follicular cells proliferate into stratified epithelium
Secondary follicle characteristics
Follicular antrum in granuloma layer
Increased zona granuloma layers
Thicker zona pellucida
Larger oocyte
The cal cells outside follicle
What does the follicular antrum contain
Fluid containing Hylauronan and proteoglycans
What do thecal cells produce
Oestrogen
Tertiary/graffian follicle characteristics
2n haploid oocyte
Follicular antrum makes up most of follicle
Secondary oocyte located eccentrically
Zona pellucida and corona radiate
When does a follicle become tertiary/ graffian
After 1st meiotic division before ovulation
Corpus luteum characteristics
Formed from remaining cells of granuloma and Theda interna after release of ovum
Blood clot in centre
Granuloma lutein surrounds clot
Theca lutein cells outside granuloma lutein
Corpus albicans characteristics
Fibrous material Formed from involution of corpus luteum
How long does the corpus luteum stay active after ovulation before becoming the corpus albicans
14 days - LH levels fall
What happens when the corpus luteum involves
Secretory cells degenerate and are phagocytoses by macrophages and replaced by fibrous material
What happens to primordial follicles that are stimulated to develop during menstrual cycle but don’t complete development
Atresia - degenerate to atretic follicles
What happens during atresia of primordial follicles
Granuloma cells undergo apoptosis and replaced by fibrous material
Oocyte degenerates
Basement membrane becomes glassy membrane
What does the basement membrane separate in follicles
Oocyte and granuloma cells
What happens to all but 1 primordial follicle
Atresia
Segments of oviduct
Infundibulum
Ampulla
Isthmus
Pars interstitialis
How does mucosa change as oviduct gets closer to uterus
Mucosa folds become smaller
Smooth muscle increases
2 types of epithelium in the oviduct and their functions
Ciliated - move ovum
Non ciliated secretory/ peg cells - release secretions that lubricate, nourish, and protect ovum
Layers of uterus
Endometrium - mucosal
Myometrium - muscular
Perimetrium - serosal
2 layers of endometrium
Stratum functionalis
Stratum basalis
Which layer of the uterus responds to oxytocin
Myometrium
Which layer of the endometrium expands, vascularises, and is sloughed off during the menstrual cycle
Stratum functionalis
Stages of the uterine cycle
Proliferation stage
Secretory phase
Menstrual pahse
Proliferative phase of uterine cycle
Growth of epithelium in stratum functionalis
Coiled densely packed glands and spiral arteries formed
Which hormone drives the proliferative phase of the uterine cycle
Oestrogen
What do glands in the endometrium contain during the proliferative phase of the uterine cycle
Nothing
When does the secretory phase of the uterine cycle begin
Ovulation
Secretory phase of the uterine cycle
Glands become more completely coiled
Max endometrium thickness
Secretions in lumina of glands containing glycogen and glycoproteins
Menstrual phase of uterine cycle
Spiral arteries constrict
Tissue becomes ischaemic and cells die
Stratum functionalis sloughed off
What causes the corpus luteum to degenerate
LH decrease
What hormones drive each stage of the uterine cycle
Proliferative - oestrogen
Secretory - progesterone
Menstrual - progesterone fall
2 parts of the cervix and their epitheliums
Endocervix - simple columnar
Ectocervix - stratified squamous
Transition point between endocervix and ectocervix
External os
Vagina epithelium
Stratified squamous w small degree keratisation
Layers of vagina
Stratified squamous epithelium
Thick dense irregular CT
Loose connective tissue containing many blood vessels and nerves
Layers of cervix
Epithelium
Collagenous and elastic connective tissues
What is checked in a PAP smear
dysplasia and pre cancerous cancers in cervix cells
Dysplastic cell characteristics
Reduced cytoplasm
Incr nuclear:cytoplasmic ratio
Differences between low grade and high grade intra epithelial lesions on PAP smears
Low - usually from HPV and resolve spontaneously
High - indicate cervical intraepithelial neoplasia or carcinoma in situ
What is cervical intraepithelial neoplasia classed into stages based on
Nuclei appearance - larger and darker in more severe
Basal cells - only in lower 1/3 of epithelium is low grade, in upper 2/3 indicates high grade
CIN I, II, and III
I - mild dysplasia, nuclear angulation, vacuolization
II - variation in cell and nuclei size, more layers of epithelium affected
III - changes of cell and nuclear size + abnormal mitoses in all epithelium layers
Endometrial cancer treatment
Hysterectomy
What hormone is linked to endometrial cancer
Excessive oestrogen
How does endometrial cancer appear
Polyploid masses projecting into endometrial cavity - irregular crowded glands lined by columnar epithelium w pseudostratified nuclei and mild atypical cytology
Most common uterine neoplasm
Leiomyoma/ fibroids
Most common leiomyoma location
Intramural
Leiomyoma histological characteristics
Very cellular
Look like normal smooth muscle
Are leiomyomas cancerous
No
Where can ovarian cancer originate from
Ovaries
Fallopian tubes
Peritoneum
Ligaments
Why are ovarian cancers often diagnosed late
Often asymptomatic
How does an ovarian cystadenoma appear microscopically and histologically
Multi cystic mass with fine papillary projection
Cyst lined w ciliated pseudostratified cuboidal or columnar epithelium
Where do germ cell tumours originate from
Primordial germ cells
What gland type is the breast a modified version of
Sweat gland
Gland types in the areola
Sebaceous
Sweat
Mammory
Glandular architecture of the breast
Secretory alveoli
Intralobular ducts
Interlobar oar ducts
Lactiferous ducts
What component of the secretory alveoli release milk
Cells in tubuloalveolar glands
Terminal duct lobular unit
Lobule + intrerlobular ducts
Drain into lactiferous duct
Cell types in TDLU
outer myoepithelial cells - contract to propel milk into duct
Inner epithelial cells
What bounds each TDLU
Basement membrane
Lactiferous duct epithelium
Columnar
Why does the majority of breast disease originate in the Lactiferous ducts
Cycling hormonal growth
High cell turnover
Lactiferous sinus
Dilation in areola that stores milk between breatfeeding
What happens to extra TLDUs formed bp during pregnancy after breast feeding finishes
Decr in size, don’t completely degenerate
How are breasts checked for microcalcifications
Mammogram
Fibrocystic changes
Fibrosis
Cysts
Usual duct hyperplasia
Adenosis
Apocrine metaplasia
Are fibrocystic changes more common in young or old women
Young
Sclerosis adenosis
Proliferating Glands/lobules squeezed together
Can look infiltraring but harmless
Myoepithelial cell layer between lobules
Apocrine metaplasia
Dilated acini lined by columnar cells with apocrine features, enlarged nuclei, and prominent nucleoli
Fibroadenoma
Biphasic benign tumour
What cells are proliferating in fibroadenomas
Ducts
Stroma
How do fibroadenomas appear histologically
Thin branching ducts in sparsely cellular pink stroma
Proliferating Stroma compresses ducts to slits
What happens to old fibroadenomas
Hyalinised and calcified
Ductal carcinoma in situ
Pre invasive lesion with atypical cells that grow within ducts and lobules
Hasn’t broken through basement membrane into breast tissue but has potential to
Are invasive ductal carcinomas or invasive lobular carcinomas more common
Invasive ductal carcinoma
Difference in malignant cells in invasive ductal and lobular carcinomas
Ductal - malignant cells attempt to form ducts
Lobular - malignant cells form single lines or single cells
