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Endocrine And Reproductive System Class > Female Reproductive System 2 > Flashcards

Female Reproductive System 2 Flashcards

1
Q

Describe the myometrium, after parturition vs during pregnancy

A

 Interlacing bands of smooth muscle fibers
• Three poorly defined layers
• Functional syncytium – contract under the influence of oxytocin at parturition

 During pregnancy
• Smooth muscle hypertrophy (x10) and hyperplasia
• Increase in collagen fibers
• Uterine walls thin – stretch

 After parturition
• Some muscle fibers degenerate; uterus returns to near
original size
• Collagen degraded by enzymes
• Myometrium slightly thicker
• Uterine cavity larger than before
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2
Q

What is uterine Leiomyoma/fibroid?

A 
• Smooth muscular fibers arranged in whorls
• Fibrous stroma
• Well defined margin 
• Types:
- Submucosal 
- Intramural
- Subserous
- Pedunculated
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3
Q

What are the uterine changes related to implantation ?

A

• Implantation window 6th – 10th day after ovulation
• Embryo releases human chorionic gonadotropic hormone (hCG)
- Maintains corpus luteum
 Continued progesterone secretion
• Endometrium
- Endometrial (decidual) cells
 Large, round, pale, glycogen rich cytoplasm
- Glands
 More dilated and coiled in
early pregnancy
 Later: thin and flattened

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4
Q

Explain the structure and function of placenta

A

• Temporary organ of pregnancycontains both fetal and maternal tissue
• Function:maintaindevelopingfetus
o Secrete hormones: e.g., hCG, hPL, progesterone, relaxin, leptin
o Growth factors:
 Insulin like growth factor I &II
 Epithelial growth factor
o Site of Exchange: gases, metabolites, nutrients & waste
• Structure

Fetal side:
 Chorion
 Smooth and shiny (amnion – innermost membrane)

Maternal side:
 Decidua basalis—>(basal plate) modified endometrium over implantation site
 Fleshy looking
 15-25 cotyledons—>bulges counted after parturition

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5
Q

What are the parts of the placenta?

A

Chorion: derived from trophoblast layers and extraembryonic mesenchyme

• Trophoblast
o Internal layer—>Cytotrophoblast
 Mitotically active
o External layer—>Syncytiotrophoblast (secretes hormones, e.g., hCG)
 Basophilic multinucleate cytoplasmic mass
 Erosive: converts endometrium to decidua
• Proliferation of chorionchorionic villi
o Primary, Secondary, Tertiary
o Anchoring villi: extend into decidua basalis
o Floating villi: free in intervillous space, bathed with maternal blood
o Intervillous space: maternal blood

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6
Q

What is the primary chorionic villi?

A
  1. Primary chorionic villi: ― Day 11-13
    ― Finger-like extensions in maternal decidua
    ― Cytotrophoblast penetrate blood filled
    spaces of syncytiotrophoblast
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7
Q

What is the secondary chorionic villi?

A 
2. Secondary chorionic villi
― ~ Day 16
― Primary villi invaded by loose CT from
extraembryonic mesoderm
 E.g., fibroblasts, phagocytic cells (Hofbauer)
― Inner layer of cytotrophoblast
― Outer layer of syncytiotrophoblast
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8
Q

What is the Tertiary villi?

A 
3. Tertiary villi
― Form by end of week 3
― Smaller profiles in cross sections
― Blood vessels develop in extraembryonic
mesoderm
    Umbilical vessel branches
― Outer syncytiotrophoblast layer
Early Pregnancy
• Large edematous villi
• Few blood vessels
• Many CT cells
• Continuous cytotrophoblast layer
• Thick syncytiotrophoblast
Late Pregnancy
• More fetal blood vessels
• Less cells, placental macrophages
• Cytotrophoblast appears discontinuous
• Aggregates of syncytiotrophoblast nuclei: Syncytial
    knots
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9
Q

What are the components of the placenta?

A 
Exchange occurs through the placental barrier
• Components (thinnest portion): 
― ME: Maternal RBC in IV space
 ― Syn: Syncytiotrophoblast
 N: cell nucleus
― Thin cytotrophoblast layer
― TBL: Basal lamina of trophoblast
― CT: Mesenchyme connective tissue

― EBL: Basal lamina of umbilical vessel
― FEn: Umbilical endothelium
― FE: Fetal erythrocyte Which villus?
• Thins out at ~4th month - excha

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10
Q

Describe the structure function of the cervix

A

Connects uterine and vaginal cavities.
• Functions:
o Permits/restrict passage of spermatozoa
o Allows passage of fetus at parturition
o Protects upper genital tract from bacterial infection
• Regions:
1. Cervical canal (Endocervix)
− Internal os: communicates with uterine cavity
2. Ectocervix: projects into vaginal cavity
− External os: communicates with vagina
3. Transformational Zone (TZ)

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11
Q

Describe the basic histology of the cervix

A

Basic histology
o Mucosa: varies from simple columnar to stratified
squamous epithelium

o Dense fibrous connective tissue wall with some smooth muscle
 Lysis causes softening of cervix at parturition

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12
Q

What is the cervical canal/endocervix(CC)?

A

− Mucosa varies from other parts of the uterus
 Large, simple branched tubular glands (Gl)
 No spiral arteries
 Little/no variation in thickness during cycle
 Not shedding in menses

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13
Q

What are the components of the cervix?

A

• Simple columnar epithelium (SCE)
o Invaginates to form mucus secreting cervical glands
-Glandular secretions undergo cyclic changes in the menstrual cycle
1. Midcycle Ovarian activity?
― 10x increase in mucus production
― Thin, watery to allow sperm passage
2. Other times: viscus plug—>protective

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14
Q

What is the ectocervix like?

A

― Stratified squamous epithelium (SSEp) as
in the vagina or vulva. Why?
― Cells have large glycogen storespale
staining
― No glands
― Epithelial cells constantly shed into vagina

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15
Q

Describe the transformation zone of the cervix (T zone)?

A

Transformation zone (T zone)
― Junction between ectocervix and cervical
canal
 Reproductive years: just outside external os
 Prepubertal + Postmenopausal: cervical canal
― Abrupt change from endocervical to ectocervical mucosa
 Squamocolumnar junction

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16
Q

Describe the pathology of the cervix

A

Mucosal Glands
• Openings can become occluded
o Retention of mucus secretions - dilated
o Formation of Nabothian cysts
Epithelial Cells
• Transitional Zone*
o Cervical stroma hormone sensitive
 Estrogen—>expansion—>Ectropion
 Metaplasia (normal - reproductive age)
 Columnar—>Stratified squamous
o Chronic/persistent cervical infection—>
metaplasia
o Development site of precancerous lesions
o Cervical cytology used as screen for lesions

17
Q

How is human papilloma virus relevant to cervical pathology?

A

• Low risk HPV
o Affect mature cells
o Genital warts and mild cervical dysplasia
• High risk (Types 16 &18*)
o Affect stem cells
o Severe dysplasiacancer: cervix, vagina, vulva, anus, penis
• Infection:
o Most self resolving
o 5-10% persist (viral DNA integrates into stem cells)
o Dysplasia 20-30 years later

18
Q

HPV affects…

A

Stratified squamous epithelium

19
Q

How can we screen for cervical pathology?

A

• Direct visualization – speculum exam, colposcopy

• Cytology – Papanicolaou (Pap) Test
o Scarpe surface cells: brush, spatula
o Cervicitis, dysplasia, cervical carcinoma o HPV DNA testing

20
Q

What are the layers of the vagina?

A

Fibromuscular canal organized in 3 layers:
1. Mucosal layer:
―Transverse folds or rugae
― Non keratinized stratified squamous epithelium ―Lamina propria:
 Superficial: Loose connective tissue papillae
 Deep: Fibrous CT, elastic fibers, thin-walled veins. *
 No glands (lubrication: cervical and vestibular glands)

  1. Smooth muscle layer: 2 indistinct layers ―Inner circular
    ― Outer longitudinal: continuous with longitudinal layer of uterus ―Some Striated muscle fibers may be present
3. Adventitial layer:
―Inner Dense connective tissue 
   Elastic fibers
―Outer loose connective tissue 
    Neurovasculature
21
Q

What are the clinical correlations of the vagina?

A

Vaginal mucosa undergoes cyclic changes during the menstrual cycle
• Follicular phaseepithelial cells produce and store glycogen.
o Which hormone? Endometrial activity?
• Desquamation of cells releases glycogen into lumen
• Glycogen converted to lactic acid by lactobacillus acidophilus o Bacteria - normal flora
o Make vaginal fluid pH more acidic (~4)
o More acidic near midcycle
• Clinical correlate : Acidic pH prevents infection
o Yeast overgrowth post antibiotics, other infectionsvulvovaginitis
• Empty looking apical cellsglycogen extraction in tissue processing

22
Q

Describe the structure of the mammary glands

A 
Modifiedapocrinesweatglands
• Glandular elements arranged radially around the
nipple—>irregular lobes
o 15-25 lobes per breast
    Subdivided into lobules

• Duct: Compound – drains lobules
o Epithelium varies:
 Stratified squamous keratinized–simple cuboidal
o Terminates in Lactiferous duct
 Forms lactiferous sinus just before nipple

• Secretoryunit(lobules):Tubuloalveolar
• Suspensory/ Cooper’s ligament – fibrous bands
(connect with dermis)
• Histology varies with sex, age and physiological state

23
Q

What are the main cells in the mammary glands?

A 
1. Glandular Epithelial Cells
―Secretory cells in acinar glands (active lactating glands)
―Prolactin induces secretion of milk 
 Lipids: Apocrine secretion
 Proteins: Merocrine secretion
 Antibodies (IgA)
 From which cells?
  1. Myoepithelial cells (MEp)
    ―*Secretory portions, large ducts
    ―Between epithelial cell and basal lamina
    ―Contract under oxytocin (suckling)
     Force milk from the alveoli into the duct system —>ejection
24
Q

Describe the ductules of the mammary glands

A
  • Lactiferous ducts drain lobules
  • Lobule = Terminal duct lobular unit (TDLU)
  1. Secretory unit
    I. Inactive: terminal ductules
    II. Active: alevoli/ acini
  2. Intralobular collecting duct
  3. Intralobular stroma
    ― Loose connective tissue ― Hormone sensitive
    • Interlobular dense connective tissue o Abundant adipose tissue

• Cells:
o Line secretory and ductal portions

o Glandular Epithelial cells
 Inner: face luminal surface

o Myoepithelial cells
 Outer: toward basal surface

25
Q

What are the hormonal functions of the mammary gland?

A

• Puberty
o Estrogen & Progesterone Source?
 Development of mesenchymal cells
 Interlobular adiposeBreast enlargement
 Ducts extend, branch into developing stroma

• Pregnancy
o Glands complete maturation
o Estrogen & Progesterone Sources?
 Massive TDLU increase
 High progesterone: inhibit milk production
o Other hormones: prolactin, hPL
• Lactation
o  Estrogen and progesterone Why?
o Prolactin (?? pituitary)
 Induce milk secretion after birth
o Oxytocin (?? pituitary)
 Stimulate milk ejection
26
Q

Describe the inactive mammary gland in prepuberty

A
  • Presence of lobes and lobules
  • Not well developed
  • Stroma&raquo_space;> glands
  • Mostly ductal elements
  • Prepubertal —> Few adipocytes
  • After puberty—>Increased adipocytes
  • Postmenopausal—>general atrophy, (only ducts – male breast)
27
Q

Describe the inactive mammary gland after puberty

A

• Complete ductal architecture by adulthood
• Stroma&raquo_space; glands
• Ducts: simple cuboidal epithelium
o Cell height varies throughout menstrual cycle

  1. Follicular phase (lactiferous ducts) Hormone?
    ― Terminal ductules (TD): cords, cuboidal cells, narrow lumen ― Stroma: Less dense
  2. Luteal phase (alveoli) Hormone?
    ― TD: cell height, lumen present, some secretions ― Stroma: fluid accumulates (some edema)
    ― Abrupt Involution + apoptosis leading up to menses
28
Q

Describe the active mammary gland in the proliferative stage

A

• Estrogen, progesterone, human placental lactogen (hPL): o First Trimester: cell proliferation
o Second Trimester: non-uniform development o Third Trimester: ducts + glands well developed

• Secretory Unit

  1. TD: elongate and branch
  2. TD: differentiate into alveoli (breast enlargement)
  3. Alveoli: maturation begins

• Epithelial Cells:
1. (All): Proliferate and differentiate
2. (Glandular): vary in shape: flat – low columnar
3. (Glandular): cuboidal, basal nuclei, around central lumen
― Secretory vesicles, lipid droplets (Breast enlargement)

• Stroma:

  1. 2nd Trim: Plasma cell (IgA), lymphocyte, eosinophil infiltration
  2. 3rd Trim: Proliferation declines (decreased CT & adipose)
29
Q

Describe the active mammary gland in the lactating stage

A

• Mostly glandular tissue&raquo_space; Stroma
• Alveoli:
o Well developed
o Prominent lumen with Secretions

• Epithelial cells (Alveoli):
o Apical cytoplasm: Large lipid droplets, secretory vesicles o Actively secrete lipids and milk proteins

• Lobular stroma
o Infiltrated by plasma cells (arrows)
o Decrease in adipose and connective tissue
• Large lactiferous(excretory)ducts
• Cessation: gland atrophy, regression to inactive state

30
Q

What is the clinical significance of breast cancer?

A

Most common cancer in women (U.S.)

Most common type is ductal

Malignant cells proliferate
o Can breach BM, invade stroma

Loss of normal tissue architecture

Cell morphology depends on Grade
o Low (~normal)/ High (pleomorphic)
Necrosis, abnormal Calcifications

 Nipple retraction: Cooper’s ligam

Endocrine And Reproductive System Class (36 decks)

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