L1 - Pathology of female repro tract 1

Question 1

VULVA AND VAGINA

i) which labia has hair follicles and sweat glands?
ii) which type of epithelium does the labia minora and vaginal mucosa have? what structure also has this kind of epithelium?

iii) label areas A and B
- why does area C appear white?

Answer 1

i) labia majora

ii) labia minora and vagina has stratified squamous epithelium
- also found in the skin

iii) A - strat squamous epithelium
B - stroma
C - white space due to glycogen wash out

Question 2

VAGINA AT PUBERTY

i) what effect does oestrogen secreted from the ovary have on squamous epithelial cells?
ii) what substance is formed within mature squamous epithelial cells? where are mature cells found?
iii) what is a substrate for vaginal anaerobic organisms? which organism of the most common?
iv) how is vaginal pH kept low?

Answer 2

i) oestrogen causes ep cells to mature
ii) glycogen is found within mature ep cells and these are found most superficially (migrate up as they mature)

iii) glycogen is a substrate for vaginal anaerobic organisms
- most common is lactobacilli

iv) lactobacilli produce lactic acid which keeps pH low (below 4.5)

Question 3

THE CERVIX

i) label diagram areas A-D
- which cell type is found in A and B?

ii) as an epithelial cell moves up and matures what happens to its nuclei and cytoplasm?
iii) what do the cells of the endocervix produce? is this a single or multi layer of cells?
iv) how is endocervical surface area increased? what does this allow?
v) what is the junction between the endo and ectocervix cells called?

Answer 3

i) A = endocervix, B = transformation zone, C = ectocervix, D = endocervical canal
- ectocervix = stratified squamous epithelia
- endocervix = columnar epithelia

ii) as ep cell moves up it loses nuclei and increases cytoplasm

iii) endocervical columnar cells produce mucin
- single tall layer of cells

iv) columnar epithelia line clefts that radiate from the endocervical canal
- can produce large volumes of mucus

v) squamo-columnar junction

Question 4

ENDO AND ECTOCERVIX

i) which area is labelled A? what type of cells are found here
ii) which area is labelled B? which type of cells are found here?

Answer 4

i) A = ectocervix = stratified squamous epithelia
ii) B = endocervix = columnar epithelia

Question 5

THE TRANSFORMATION ZONE OF THE CERVIX

i) name two changes that the cervix goes through during puberty? (what happens to the lips and what happens to the distal end?)
ii) what happens to the endocervical mucosa once these changes have happened? what cell change does this trigger?
iii) what do cells of the TZ start off as? what do they become?
iv) what happens to reserve cells in the endocervical column? what type of epithelia do they form? what is this process known as?

Answer 5

i) lips of cervix grow and the distal end of the endocervix opens

ii) the endocervical mucosa then becomes exposed to the vaginal environment
- then undergoes metaplasia

iii) cells of TZ start off as columnar epithelia of the endocervix
- become squamous epithelium w

iv) reserve cells in the endocervical column proliferate and mature and form squamous epithelium
- squamous metaplasia

Question 6

METAPLASIA AND THE CERVICAL TRANSFORMATION ZONE

i) define metaplasia
ii) what type of cells are found in the TZ? is this strong or delicate initially? how much proliferation is there?
iii) over time what happens to the epithelium in the TZ?

Answer 6

i) transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell

ii) metaplastic squamous epithelia
- initially this is thin and delicate with lots of prolif and little maturation

iii) over time the epithelium becomes strong and looks the same as that on the ectocervix

Question 7

THE UTERUS

i) label diagram A-D
ii) which type of cells are found in the myometrium? how are these arranged?

Answer 7

i) A = fundus, B = myometrium, C = endometrium,
D = endometrial cavity

ii) bundles of smooth muscle cells

Question 8

THE ENDOMETRIUM

i) what phase occurs before ovulation? what are the three components seen in this phase?
ii) what is seen in glands in this phase?
iii) what phase occurs post ovulation? what are the three components seen in this phase? what is seen in glands?
iv) which phase is A and B?

Answer 8

i) pre ovulation = proliferative phase
- tubular glands, specialised stroma and blood vessels

ii) see mitoses in glands in the proliferative phase

iii) secretory phase post ovulation
- see cork screw glands, specialised stroma and blood vessels
- secretion from glands

iv) A - proliferative and B - secretory

Question 9

NEOPLASMS & BENIGN NEOPLASMS

i) define neoplasia
ii) what two things are neoplasms classified by? what does each mean?
iii) how does a benign neoplasm behave? (3) give an example
iv) name four consequences of benign neoplasms
v) give four clinical problems that can be associated with benign neoplasms

Answer 9

i) new growth that is abnormal, un co-ordinated and excessive

ii) classified by behaviour and histogenesis
- behaviour = benign or malignant
- histogenesis = recognising cell of origin

iii) benign remain localised/dont invade surr tissues
- generally slow growing
- good resemblance of parent tissue
EG leiomyoma of myometrium aka fibroid

iv) consequences = pressure on adj tissue, obstruc of lumen of a hollow organ, hormone production, transformation into malignancy, symptoms for patient

v) pressure on adj tissue - inc bladder freq or rectosigmoid block (constipation)
- obstruction of lumen - to ureters or block of endocervix
- hormone production - EPO > polycythaemia
- abnormal uterine bleeding and pain

Question 10

MALIGNANT NEOPLASMS

i) give three characteristics of malignant neoplasms
ii) which two routes may they spread by?
iii) give four ways in which neoplastic tissue looks different to normal tissue
iv) how may architecture be altered under the microscope?
v) give four consequences of malignancy

Answer 10

i) invade surrounding tissue, grow quickly, variable resemblance to parent tissue

ii) can spread by lymphatics > LNs
or by blood vessels > distant metastatic sites

iii) loss of differentiation, loss of cellular cohesion, enlarged irreg dark nuclei, increased number of mitoses
iv) reduced cell architecture
v) destruction of adjacent tissue, mets, blood loss from ulcerated surface, obstruction, hormone production, weight loss

Question 11

NEOPLASIA

i) what is histogensis the classification of a neoplasm by? how is this determined?
ii) what does resemblance to parent tissue correlate with?
iii) what suffix do neoplasms have?
iv) what is the general name for malignant epithelial tumours? what are tumours of glandular epithelium called?
v) what are malignant stromal tumours called?
vi) what is a malignant tumour of striated muscle called?
vii) which type of malignant tumour can be found in vulva/vagina/cervix?

Answer 11

i) classification by cell of origin
- determined by examining tissue under the microscope

ii) resemblance to parents tissue correlates with clinical behaviour
iii) neoplasms = oma

iv) epithelial tumours = carcinoma
- glandular ep tumour = adenocarcinoma

v) stroma tumours = sarcoma
vi) striated muscle malignancy = RMS
vii) squamous cell carcinoma