Female Reproductive Pathology Flashcards by Bel Luscombe

What is contained in the cortex and medulla of the ovaries

Medulla - blood vessels and nerves
Cortex - developing follicles

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Stages of follicle development

Primordial follicle
Early primary follicle
Late primary follicle
Secondary follicle
Tertiary/graffiti follicle
Corpus luteum
Corpus albicans
Atretic follicle

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Where do primordial follicles develop

Fetal ovary in 1st 5 months gestation

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Primordial follicle characteristics

Oocyte surrounded by single layer squamous follicular cells
Remain at first meiotic division until puberty

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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

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Late primary follicle characteristics

Zona granuloma forms
Zona pellucida enlarges

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Zona pellucida

Thin hard band of glycoproteins that separates the oocyte and follicular cells, proteins on sperm bind to specific glycoproteins

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How does the zona granuloma forms

Follicular cells proliferate into stratified epithelium

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Secondary follicle characteristics

Follicular antrum in granuloma layer
Increased zona granuloma layers
Thicker zona pellucida
Larger oocyte
The cal cells outside follicle

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What does the follicular antrum contain

Fluid containing Hylauronan and proteoglycans

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What do thecal cells produce

Oestrogen

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Tertiary/graffian follicle characteristics

2n haploid oocyte
Follicular antrum makes up most of follicle
Secondary oocyte located eccentrically
Zona pellucida and corona radiate

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When does a follicle become tertiary/ graffian

After 1st meiotic division before ovulation

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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

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Corpus albicans characteristics

Fibrous material Formed from involution of corpus luteum

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How long does the corpus luteum stay active after ovulation before becoming the corpus albicans

14 days - LH levels fall

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What happens when the corpus luteum involves

Secretory cells degenerate and are phagocytoses by macrophages and replaced by fibrous material

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What happens to primordial follicles that are stimulated to develop during menstrual cycle but don’t complete development

Atresia - degenerate to atretic follicles

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What happens during atresia of primordial follicles

Granuloma cells undergo apoptosis and replaced by fibrous material
Oocyte degenerates
Basement membrane becomes glassy membrane

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What does the basement membrane separate in follicles

Oocyte and granuloma cells

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What happens to all but 1 primordial follicle

Atresia

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Segments of oviduct

Infundibulum
Ampulla
Isthmus
Pars interstitialis

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How does mucosa change as oviduct gets closer to uterus

Mucosa folds become smaller
Smooth muscle increases

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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

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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

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