Module 6 Female Reproductive and Mammary Flashcards
Action: Milk Production
Released from: Anterior Pituitary
Prolactin
Action: Milk ejection
Released from: Posterior pituitary
Oxytocin
Primary function of the breast is to provide milk to the newborn through the process of __, which is also known as milk production, is under the hormonal influence of PROLACTIN
LACTATION
During pregnancy, elevated levels of prolactin, estrogen, and progesterone all contributes to the development of the breast. However, during lactation, after parturition, there will be a sudden decrease in progesterone and estrogen leading to a marked level of __ which results to lactate change in production.
prolactin
separates the breast
Intermammary cleft
- Broadest and deepest part
- Despite varying sizes and shapes of the breast, base remains roughly the same among all individuals
- Between 2nd and 6th ribs
- Edge of the sternum to midaxillary line
BASE OF THE BREAST
Base of the Breast is in contact with deep fascia over
- Pectoralis major
- Serratus anterior
- External oblique
- Rectus abdominis
Breast Quadrants: Frequency distribution of different carcinomas of the breast
- Upper outer - 60% (where most cancer occur)
- Upper inner – 15%
- Lower outer – 15%
- Lower inner – 5%
o Also known as Tail of Spence
o Extension into the axilla
o May be visible as definite mass
AXILLARY TAIL
- Loose connective tissue plane between breast and deep pectoral fascia
- Allows the breast some degree of movement
- It is a potential space that allows some degree of movement
- It is independent from the deep fascia and the underlying muscles
RETROMAMMARY SPACE
- Tumor invasion of retromammary space
- Tumor adherence of breast base to deep fascia
- “Fixing” of the breast to Pectoralis major
“Fixed” Breast in Breast Carcinoma
- Also known as mammary papilla
- Round, raised area of modified skin with slightly convoluted epidermis
- Numerous sensory nerve endings
- Increased pigmentation during pregnancy
- At the tip: 15-20 openings of the lactiferous ducts arranged in a ring
NIPPLE
Lining epithelium of the Nipple
Stratified squamous keratinizing epithelium
Lactiferous ducts/sinus
Stratified cuboidal epithelium
Near the tip of the nipple (Lining epithelium)
Stratified squamous
Opening of the lactiferous ducts
Stratified squamous keratinizing
- Benign; usually bilateral, mostly umbilicated
- Failure of underlying mesenchymal tissue to proliferate and project the nipple outward
Congenital Nipple Inversion
Nipple inversion ≠ Nipple retraction
Inversion – entire nipple is pulled in
Retraction – only a part is drawn in
Umbilicated vs. invaginated nipples
Umbilicated – can be pulled out
Invaginated –cannot be extracted
- Hyperpigmented oval area of skin surrounding the nipple
- Thin skin with sebaceous glands
- Epidermis is continuous with lactiferous sinuses lining
- Sensory never endings: areola
AREOLA
- Areolar glands = Montgomery’s glands
- Modified sebaceous glands (oily secretion)
- Secretion lubricates and protects the areola and nipple: changes skin’s pH and discourages microbial growth
MONTGOMERY’S TUBERCLES
- May be associated with underlying breast carcinoma
- Eczematous skin changes in nipple and areola: erythema, scaling, burning, pruritus (itching) bleeding, ulceration, serosanguineous discharge
- Nipple: thickened, deformed and inverted
Paget’s Disease of the Breast
Blood Supply of the Breast
Branches of axillary and internal thoracic arteries
LYMPHATICS OF THE BREAST
- Axillary lymph nodes (75%)
- Parasternal nodes (where the medial quadrants also drain
- “Orange peel”
- Subcutaneous lymphatic obstruction
- Lymphatic dilatation and accumulation
- Skin edema and prominence of skin gland orifices
Peau d’orange in Breast Carcinoma
MAMMARY GLANDS
modified compound tubuloalveolar apocrine sweat glands
- each mammary gland consists 15-20 lobes
- Lobes are separated by dense CT septae
- These septae radiates from the nipple areolar complex like spoke fascia wheels
MAMMARY GLANDS
PARENCHYMA VS STROMA
Parenchyma – cells that serve the main function of the tissue/organ
Stroma – cells that support/provide structural scaffolding
- Also known as Ligament of Cooper
- Fibrous tissue septa extending from the deep fascia to the skin
- More prominent in the superior portion of the breast and they maintain the breast form and upright posture
- They are less effective when the patient lies at her back
SUSPENSORY LIGAMENTS
- Involvement of suspensory ligaments results in skin dimpling
Skin Dimpling in Breast Carcinoma
(Mammary Gland: Lobe)
Each lobe consists of:
Duct system = lactiferous ducts/sinus
Lobules = terminal duct lobular units (TDLU)
– cancer that arise from the cells of the ductal system
Ductal Carcinoma
– cancer that arise from the cells of the lobules
Lobular Carcinoma
- Involvement of ducts
- Nipple retraction is caused by the invasion of cancer cells in the mammary ducts
Nipple Retraction in Breast Carcinoma
- Functional unit of the breast
- Lobule epithelium is hormone sensitive and undergoes proliferation during pregnancy
- Lobes represent the parenchyma
TERMINAL DUCT LOBULAR UNIT (TDLU)
2 CELLS OF MAMMARY EPITHELIUM
- Glandular Epithelial Cells
2. Myoepithelial Cells
o Inner layer
o Low columnar-cuboidal epithelium
Glandular Epithelial Cells
o Outer layer o Clear cytoplasm o Contact basement membrane o Have epithelial cell and smooth muscle cell features o Contractile
Myoepithelial Cells
Stem cell function (Myoepithelium and Glandular Cells
a. Bipotent stem cells = mammary repopulating units (MRUs)
- Can give rise to two types of cell, myoepithelial cells or glandular cells
b. Unipotent stem cells – give rise to myoepithelial cells only
- Estrogen Receptor/Progesterone Receptor Positivity
- Tested on tissues removed by biopsy or surgery
- If a patient is ER/PR positive an option would be to undergo hormonal therapy
- Hormone-sensitive breast cancers may respond to hormonal agents like tamoxifen, anastrozole, exemestane
ER/PR Positivity
Adult Mammary Gland States
- Resting
- Active
- Lactating
- Atrophic/Postmenopausal
- Adult nonpregnant female
- Small ducts
- Few Lobules: undeveloped alveoli
- Abundant CT and adipose (which form the parts of the stroma)
RESTING/INACTIVE
Resting Mammary Gland: Changes During Menstrual Cycle
- Glandular epithelium in terminal ducts proliferate, enlarge, show early secretory activity
- Accumulation of fluid and GAGs in stroma → slight enlargement and discomfort
- Adult pregnant female
- Prominent vascular network
- Spider angioma
- Development of Montgomery’s tubercles
- Increased pigmentation
Active Mammary Gland
- Adult pregnant female
- Growth and proliferation of duct system
- Larger, more branched secretory units of each lobule
- Decreased adipose, connective but more collagen
- More cuboidal in nature
Active Mammary Gland
- Vacuolaction of glandular epithelial cells: lipid-rich secretion
- Stroma infiltration by lymphocytes and plasma cells
Active Mammary Gland
- adult lactating female
- Very large lumina of ducts and alveoli: filled with milk
- Fewer adipocytes, connective tissue, ducts are larger, each lumina is filled with milk, increased vacuolations, and more Montgomery’s tubercles
- More columnar in nature
Lactating Mammary Gland
Remember the trend in comparing the three mammary states:
- lobules become bigger and more developed as you go from resting to lactating
- stroma becomes lesser/ smaller
- Postmenopausal female
- Ducts regress (fewer but larger) – some transform into cysts
- Alveoli shrink, atrophy, resorbed
- Decreased CT and adipose tissue
- Parenchyma also shrink and regress (it appears to be very small
Atrophic Mammary Gland
Breast vs Prostate
BREAST
- lumen is filled with milk
- simple low columnar-cuboidal
PROSTATE
- lumen is filled with substances called Prostatic Concretion or Corpora Amylacea (present only in older males)
- lining is pseudostratified columnar
- Protein: casein, beta-lactoglobulin, alpha-lactalbumin, lactoferrin - 1 g/dL
- Protein is synthesized in the rough endoplasmic reticulum and transported by the golgi bodies outside through merocrine secretion
Merocrine secretion
- Lipid portion of the breast milk is through this secretion
- Lipid droplets coalesce with each other and will eventually tear up/get a portion of the cytoplasm.
- Lipid - 4-5 g/dL
Apocrine secretion
– 7 g/dL ( help draw water osmotically into protein secretory vesicles adding volume to the milk)
Lactose
- Secretion released first few days after birth
- Higher protein, vitamin A, sodium and chloride
- Lower lipid, carbohydrate, potassium
- Antibodies (secretory IgA)
Colostrum
Embryology (Breast)
Parenchyma: surface ectoderm
Stroma: dermal mesenchyme
6 weeks AOG: mammary (milk) lines = mammary line placode
Embryology (Breast) 2
- Mammary bud penetrates the mesenchyme.
- 15-20 solid mammary cords develop → later canalized; lactiferous ducts
- Mesenchyme gives rise to stroma
- Childhood mammary gland structure is rudimentary
- Pronounced enlargement of the male breast
- Estrogen
- Endogenous: occurs at puberty
- Exogenous: caused by drugs (ex. Spironolactone, alcohol, cimetide)
- Klinefelter’s syndrome (47, XXY)
Gynecomastia
- no breast development (absent breast and nipple)
Amastia
- no nipple over breast (mainly accessory breast)
Athelia
- nipple developed, no breast development
Amazia
- accessory breast along milk ridge
Polymastia
- supernumerary nipples
Polythelia
- consists of the paired ovaries and oviducts (or uterine tubes), the uterus, the vagina, and the external genitalia
- system produces the female gametes ( oocytes ), provides the environment for fertilization, and holds the embryo during its complete development through the fetal stage until birth
female reproductive system
- are almond-shaped bodies approximately 3 cm long,
1. 5 cm wide, and 1 cm thick. - Each is covered by a simple cuboidal epithelium, the surface (or germinal) epithelium, continuous with the mesothelium and overlying a layer of dense connective tissue capsule, the tunica albuginea, like that of the testis.
Ovaries
- Glandular, exocrine because it has glands,
cytogenic because the product is a cell which is the
oocyte, and endocrine in function because it produces
estrogen and progesterone.
Ovaries
2 Layers of the Ovaries
- Ovarian Cortex
2. Ovarian Medulla
- a region with a stroma of highly cellular connective tissue
and many ovarian follicles varying greatly in size after menarche
Ovarian Cortex
– main characteristic or structures found in the cortex.
– It is composed of oocyte and follicular cells
ovarian follicles
- is basically the primary oocyte; can be called as ovum or
egg cell. these cells are arrested in meiosis
oocyte
– flattened support cells that surrounds the primary oocyte
follicular cells
– composed of smooth muscle, collagen fibers, elastic fibers, lymphocyte, and fibroblast. The stroma of the ovarian cortex is denser than that of the medulla which is more or less composed of smooth muscle.
stroma
– innermost; continuous with the indentation in the middle called the hilum.
Ovarian Medulla
(Ovary)
– this is where the lymphatic vessels, blood vessels, and nerves exits and enters the ovary. It contains losse connective tissue and blood vessels
Hilum
In the first month of embryonic life, a small population of primordial germ cells migrates from the yolk sac to the gonadal primordia. There the cells divide and differentiate as __.
oogonia
In developing ovaries of a 2-month embryo, there are about
600,000 oogonia that produce more than 7 million by the
fifth month. Beginning in the third month, oogonia begin to
enter the prophase of the fi rst meiotic division but arrest after completing synapsis and recombination, without progressing to later stages of meiosis. These cells arrested
in meiosis are called __
primary oocytes
FOLLICULOGENESIS
- Release of FSH
- Growth of the oocyte
- Proliferation and changes in the follicular cells
- Proliferation and differentiation of the surrounding stroma
2 PHASES OF THE OVARIAN CYCLE
- Follicular – FSH, Estrogen
2. Luteal – LH, Progesterone, Estrogen
Each primary oocyte becomes surrounded by flattened
support cells called __ to form an ovarian follicle.
follicular cells
By the seventh month of development, most oogonia
have transformed into primary oocytes within follicles. Many
primary oocytes, however, are lost through a slow, continuous degenerative process called __, which continues through a woman’s reproductive life.
atresia
At puberty the ovaries contain about 300,000 oocytes. Because generally only one oocyte resumes meiosis with ovulation during each menstrual cycle (average duration, 28 days) and the reproductive life of a woman lasts about 30 to 40 years, only about __ are liberated from ovaries by ovulation. All others degenerate through atresia.
450 oocytes
An ovarian follicle consists of an oocyte surrounded by one or more layers of epithelial cells within a basal lamina. The follicles that are formed during fetal life—__—consist of a primary oocyte enveloped by a single layer of the flattened follicular cells. These follicles occur in the superficial ovarian cortex. The oocyte in the primordial follicle is spherical and about 25 μm in diameter, with a large nucleus containing chromosomes in the first meiotic prophase.
primordial follicles
The organelles tend to be concentrated near the nucleus and include numerous mitochondria, several Golgi complexes, and extensive RER. The basal lamina surrounds the follicular cells, marking a clear boundary between the follicle and the vascularized stroma.
primordial follicles
(Follicular Growth and Development)
Beginning in puberty with the release of __ from the pituitary, a small group of primordial follicles each month begins a process of follicular growth. This involves growth of the oocyte, proliferation and changes in the follicular cells, as well as proliferation and differentiation of the stromal fibroblasts around each follicle.
follicle-stimulating hormone (FSH)
(Follicular Growth and Development)
Selection of the __ that undergo growth and recruitment early in each cycle and of the dominant follicle destined to ovulate that month both involve complex hormonal balances and subtle differences among follicles in FSH receptor numbers, aromatase activity, estrogen synthesis, and other variables.
primordial follicles
When ovulation is not followed by the implantation of a fertilised ovum, the thickened mucosal lining, the endometrium, degenerates and a new ovulation cycle commences. In humans, the thickened endometrium
is shed in a period of bleeding known as __.
menstruation
(Embryology of the female genital tract)
Most of the structures of the female genital tract are derived from the paired __. These give rise to the right and left Fallopian tubes and fuse centrally to form the structures of the uterus, cervix and vagina.
Müllerian or paramesonephric ducts
(Embryology of the female genital tract)
Small embryological remnants of the Wolffian ducts may persist into adulthood and can be noted in sites such as the __ and in the lateral walls of the cervix.
paratubal tissue (or mesosalpinx)
(Embryology of the female genital tract)
The ovaries arise from the __ a thickening in the mesothelium high on the posterior wall of the peritoneal cavity.
genital ridge
The body of the ovary consists of spindle-shaped cells, fine collagen fibres and ground substance that together constitute the __. The stromal cells resemble fibroblasts, but some contain lipid droplets.
ovarian stroma
The superficial cortex is more fibrous than the deep cortex
and is often called the __. However, unlike the testis, this is not an anatomically distinct capsule.
tunica albuginea
On the surface of the ovary is an epithelial covering, misleadingly called __, which is a continuation of the peritoneum.
germinal epithelium
The central zone of the ovarian stroma, the medulla, is
highly vascular and contains __, which are morphologically very similar to Leydig cells of the testis.
hilus cells
During early fetal development, primordial germ cells
called __ migrate into the ovarian cortex where they
multiply by mitosis.
oogonia
__ which are composed of a primary oocyte surrounded by a single layer of flattened follicular cells. The primary oocyte has a large nucleus with dispersed finely granular chromatin, a prominent nucleolus and little cytoplasm.
primordial follicles
Its oocyte has greatly enlarged and the follicular cells have multiplied by mitosis and become cuboidal in shape. They are now known as __.
granulosa cells
A thick homogeneous layer of glycoprotein and acid proteoglycans, the __, develops between the oocyte and the follicular cells. Both cell types probably contribute to its formation.
zona pellucida
With further follicular development, the surrounding stromal cells begin to form an organised layer around the follicle called the __, separated from the granulosa cells by a basement membrane.
theca folliculi
__ are derived from the fibroblast-like cells of the ovarian stroma.
Theca cells
The primary follicle continues to enlarge and the granulosa cells continue to proliferate, forming a layer several cells thick called the __
zona granulosa
In humans, this mesothelial layer is low cuboidal rather than columnar. This layer is continuous with the mesothelial lining of the peritoneal cavity and was formerly known as the __, based upon the mistaken belief that these cells were the origin of the female germ cells
germinal epithelium
Fluid-filled spaces develop between the granulosa cells, and these begin to coalesce to form the follicular antrum. This is now known as a __.
secondary follicle
(Secondary follicle)
The zona granulosa continues to proliferate, and small
fluid-filled spaces appear within it. These fuse to form the
__, in which follicular fluid accumulates.
follicular antrum
(Secondary follicle)
At this stage, the oocyte has almost reached its full size and becomes situated eccentrically in a thickened area of the granulosa called the __.
cumulus oophorus
(Secondary follicle)
At the periphery of the follicle, the theca folliculi has
developed two layers:
- the theca interna - comprising several
layers of rounded cells - theca externa - less well-defined; consisting of spindle-shaped cells that merge with the surrounding stroma.
(Secondary follicle)
The cells of the __ have the features of typical
steroid-secreting cells and produce estrogen precursors (e.g. androstenedione), oestrogen and, in the preovulatory stage, progesterone. In the ovary, these steroid-secreting cells are often described as luteinised. Follicular hormones promote proliferation of the endometrium in readiness for the implantation of a fertilised ovum.
theca interna
(Secondary follicle)
The __ is composed of flattened stromal cells and has no endocrine function.
theca externa
(Secondary follicle)
The granulosa cells also produce hormones from the stage of antral formation onwards. Estrogen is produced from precursors secreted by the theca interna, as well as small amounts of intrafollicular FSH and, at ovulation, the FSH inhibitor __.
inhibin
(Graafian follicle)
Approaching maturity, further growth of the oocyte ceases and the first meiotic division is completed just before ovulation. At this stage, the oocyte becomes known as the __ and commences the second meiotic division.
secondary oocyte
(Graafian follicle)
The __, containing very little cytoplasm, remains inconspicuously within the zona pellucida. The follicular antrum enlarges markedly and the zona granulosa now forms a layer of even thickness around the periphery of the follicle.
first polar body
(Graafian follicle)
The __ diminishes, leaving the oocyte surrounded by a layer several cells thick, the corona radiata, which remains attached to the zona granulosa by thin bridges of cells. Before ovulation, these bridges break down and the oocyte, surrounded by the corona radiata, floats free inside the follicle.
cumulus oophorus
(Graafian follicle)
The surrounding __, consisting of plump
luteinised cells. By this stage, the follicle has reached between 1.5 and 2.5 cm in diameter and bulges under the ovarian surface. The overlying surface epithelial cells are flattened and atrophic and the thin intervening stroma becomes degenerate and avascular.
theca interna
(Graafian follicle)
At __, the mature follicle ruptures and the ovum,
made up of the secondary oocyte, zona pellucida and corona radiata, is expelled into the peritoneal cavity near the entrance to the Fallopian tube. The second meiotic division of the oocyte is not completed until after penetration of the ovum by a spermatozoon.
ovulation
Following ovulation, the ruptured follicle collapses and fills
with a blood clot to form the __, which has a brief career as an endocrine organ.
corpus luteum of menstruation
The __ is about the same size
as the antecedent ovulatory follicle (i.e. 1.5 to 2.5 cm). Under the influence of luteinising hormone (LH) secreted by the anterior pituitary, granulosa cells increase greatly in size and begin secretion of progesterone.
corpus luteum of menstruation
(corpus luteum of menstruation)
The granulosa cells acquire the characteristics of steroid-secreting cells and are now called __.
granulosa lutein cells
(corpus luteum of menstruation)
__ promotes the changes in the endometrium that make it ready for implantation of the embryo should fertilisation occur. Thus the cycles of production of oocytes and the preparation of the endometrium (the menstrual cycle) are coordinated by the same set of hormones.
Progesterone
(corpus luteum of menstruation)
The cells of the theca interna also increase somewhat in size and acquire similar cytoplasmic features to the luteinised granulosa cells. Although interrupted by ovulation, these cells (as well as the granulosa cells) continue to secrete oestrogens which are necessary to maintain the thickened uterine mucosa. These cells become known as __.
theca lutein cells
(corpus luteum of menstruation)
The basement membrane between the __ breaks down and these layers are invaded by capillaries and larger vessels from the theca externa to form a rich vascular network, characteristic of endocrine glands.
zona granulosa and the theca interna
(corpus luteum of menstruation)
Progesterone production by the corpus luteum is dependent on LH from the anterior pituitary, but rising progesterone levels inhibit LH production. Without the continuing stimulus of LH, the corpus luteum cannot be maintained and, 12 to 14 days after ovulation, it regresses, ultimately forming a functionless __
corpus albicans
Once the corpus luteum regresses, secretion of both oestrogen and progesterone ceases. Without these hormones, the endometrial lining of the uterus collapses, resulting in the onset of __.
menstruation
Implantation of a fertilised ovum in the uterine wall interrupts the integrated ovarian and menstrual cycles.
Corpus luteum of pregnancy
After implantation, a hormone called __ is secreted into the maternal circulation by the developing placenta; hCG has an analogous function to LH and maintains the function of the corpus luteum in secreting oestrogen and progesterone until about the 9th week of pregnancy.
human chorionic gonadotrophin (hCG)
After this time, the corpus luteum of pregnancy slowly regresses to form a functionless corpus albicans and the placenta takes over the major role of estrogen and progesterone secretion until __.
parturition
__ are common and arise from a wide variety of causes. Most common of all are follicular cysts, due to enlargement of normal follicles, and corpus luteum cysts, which result from a similar expansion of a normal corpus luteum.
Ovarian cysts
The __ may occur at any stage in the development of the ovum. By the sixth month of development, the fetal ovary contains several million primordial follicles yet, by the time of birth, only about half a million remain. Atresia continues until puberty and thereafter through the reproductive years. In addition, with each ovarian cycle approximately 20 follicles begin to mature, usually all but one becoming atretic at some stage before complete maturity.
process of follicular atresia (degeneration)
Advanced atresia is characterised by gross thickening of the basement membrane between the granulosa cells and the theca interna, forming the so-called __
glassy membrane
Atretic follicles are ultimately replaced completely by collagenous tissue known as the __
corpus fibrosum
The __ is the inactive fibrous tissue mass that forms following the involution of a corpus luteum. The secretory cells of the degenerate corpus luteum undergo autolysis and are phagocytosed by macrophages, a few of which, containing cytoplasmic haemosiderin pigment. The vascular supporting tissue regresses to form a relatively acellular collagenous scar containing a few fibroblasts.
corpus albicans
The __ consists of the Fallopian tubes, the uterus
and the vagina, all of which have the same basic structure,
consisting of a wall of smooth muscle with an inner mucosal
lining and an outer layer of loose supporting tissue.
genital tract
- (also called uterine tubes or oviducts) carry ova from the surface of the ovaries to the uterine cavity and are also the site of fertilisation by spermatozoa.
- is shaped like an elongated funnel and is divided anatomically into four parts
Fallopian tubes
At the time of ovulation, the __ moves so as to overlie the site of rupture of the Graafian follicle
infundibulum
In women of child-bearing age, the endometrial lining of the uterine cavity consists of a pseudostratified columnar ciliated epithelium forming numerous simple tubular glands, supported by the cellular __.
endometrial stroma
The cycle of changes in the endometrium proceeds
through three distinct phases:
- menstruation
- proliferation
- secretion
- This is the phase of endometrial shedding that only occurs if there is failure of fertilisation and/or implantation of the ovum.
- Progesterone production by the corpus luteum is inhibited by negative feedback on the anterior pituitary, thus suppressing LH release and leading to involution of the corpus luteum. In the absence of progesterone, the
endometrium cannot be maintained. Reactivation of
FSH secretion initiates a new cycle of follicular development and estrogen secretion. This, in turn, initiates a new cycle of proliferation of the endometrium from the endometrial remnants of the previous cycle.
menstrual phase
- The endometrial stroma proliferates, becoming thicker and richly vascularised. The simple tubular glands elongate to form numerous long, coiled glands that begin secretion coincident with ovulation.
- is initiated and sustained until ovulation by the increasing production of estrogens from developing ovarian follicles.
- continues until about the 14th day when ovulation occurs and the secretory phase begins.
proliferative phase
- Release of progesterone from the corpus luteum after ovulation promotes production of a copious, thick, glycogen-rich secretion by the endometrial glands.
- culminates at the onset of menstruation on about the 28th day.
secretory phase
The endometrium is divided into three histologically
and functionally distinct layers.
- Stratum basalis
- Stratum spongiosum
- Stratum compactum
The deepest or basal layer, the __, adjacent to the myometrium, undergoes little change during the menstrual cycle and is not shed during menstruation.
stratum basalis
The broad intermediate layer is characterised by a stroma with a spongy appearance and is called the ___.
stratum spongiosum
The thinner superficial layer, which has a compact stromal appearance, is known as the __.
stratum compactum
The compact and spongy layers exhibit dramatic changes throughout the cycle and both are shed during menstruation. These layers are jointly referred to as the __.
stratum functionalis
The arrangement of the arterial supply of the endometrium has important influences on the menstrual cycle. Branches of the uterine arteries pass through the myometrium and immediately divide into two different types of arteries, __.
straight arteries and spiral arteries
__ are short and pass a small distance into the endometrium, then bifurcate to form a plexus supplying the stratum basalis.
Straight arteries
- are long coiled and thick-walled and pass to the surface of the endometrium, giving off numerous branches which give rise to a capillary plexus around the glands and in the stratum compactum.
- are responsive to the hormonal changes of the menstrual cycle
Spiral arteries
The withdrawal of progesterone secretion at the end of the cycle causes the spiral arteries to constrict and this precipitates an ischaemic phase that immediately precedes __.
menstruation
__ of endometrial cells (apoptotic bodies) can be seen at the onset of menstruation. These cells have died by apoptosis
nuclear debris
- is composed of blood, necrotic epithelium and stroma. Normally, menstrual blood does not clot due to the
local release of inhibitory (anticoagulant) factors and its
expulsion is enhanced by uterine contractions. By day 3 to 4 of menstruation, most of the stratum functionalis has been shed and proliferation of the basal layer of the endometrium has begun again.
Menses
During the proliferative phase, there is a continuum of change that makes the precise dating of the cycle inaccurate in histological specimens. Lymphocytes and occasional lymphoid aggregates are a normal feature of late proliferative phase endometrium, but plasma cells are abnormal, indicating chronic infection.
endometritis
- marks the onset of the secretory phase, although
endometrial cell division continues for several days - the coiled appearance of the glands is now more pronounced and the endometrium approaches its maximum thickness.
Ovulation
Under the influence of progesterone, the glandular
epithelium is stimulated to synthesise glycogen. Initially, the
glycogen accumulates to form vacuoles in the basal aspect of the cells, thus displacing the nuclei towards the centre of the now tall columnar cells. This __ appears on day 16 and is the characteristic feature of early secretory endometrium.
basal vacuolation of the cells
__ is an important source of nutrition for the fertilised ovum.
Glycogen
- is characterised by a saw-tooth appearance of the glands, containing copious thick glycogen- and glycoprotein-rich secretions
late secretory phase
(secretory phase)
__ which are probably large granular lymphocytes, are found in the stroma at this stage. These changes in secretory phase endometrium make more precise dating possible on histological specimens than in the proliferative phase.
Endometrial stromal granulocytes
After the menopause, the cyclical production of oestrogen and progesterone from the ovaries ceases and the whole genital tract undergoes __. The endometrium is thin, consisting only of the stratum basalis, and the glands are sparse and inactive.
atrophy
- The main bulk of the uterus consists of smooth muscle, the __, which is composed of interlacing bundles of long slender fibres arranged in ill-defined layers.
- This contains bundles of fibres in transverse, longitudinal and oblique sections. Within the muscle, there is a rich network of arteries and veins which are supported by collagenous supporting tissue.
myometrium
During pregnancy, in response to increased levels of __, the myometrium increases greatly in size, mainly by increasing cell size (hypertrophy), although some increase in cell numbers (hyperplasia) due to cell division may also occur.
estrogens
At parturition, strong contractions of the myometrium are
reinforced by the action of the hormone __, secreted by the posterior pituitary. These contractions expel the fetus from the uterus and also constrict the blood supply to the placenta, thus precipitating its detachment from the uterine wall.
oxytocin
The __ protrudes into the upper vagina and contains the endocervical canal, linking the uterine cavity with the vagina.
uterine cervix
The function of the cervix
- to admit spermatozoa to the genital tract at the time when fertilisation is possible
- to protect the uterus and upper tract from bacterial invasion
- must be capable of great dilatation to permit the passage of the fetus during parturition.
__ is lined by a single layer of tall columnar mucus-secreting epithelial cells.
endocervical canal
Where the cervix is exposed to the more hostile environment of the vagina, the __, it is lined by thick stratified squamous epithelium as in the vagina and the vulva. The cells often have clear cytoplasm due to their high glycogen content.
ectocervix
The main bulk of the __ is composed of tough collagenous tissue containing a little smooth muscle. At the squamocolumnar junction, the cervical stroma is often
infiltrated with leucocytes, forming part of the defence against ingress of microorganisms.
cervix
the mucus-secreting epithelial lining of the endocervical canal is thrown into deep furrows and tunnels, giving the appearance in two dimensions of branched tubular glands, hence the rather inaccurate term __. The columnar mucus-secreting cells lining the ‘glands’.
endocervical glands
In the proliferative phase, rising levels of estrogen promote secretion of thin, watery mucus which permits the passage of spermatozoa into the uterus around the time of __.
ovulation
Following ovulation, the __ becomes highly viscid, forming a plug that inhibits the entry of microorganisms (and spermatozoa) from the vagina. This is particularly important should pregnancy occur.
cervical mucus
The __ is influenced by ovarian hormones, particularly oestrogens, which soften the tissues by reducing collagenous cross-linkages and increasing uptake of water by the ground substance.
cervical stroma
One effect of this is that the volume of the cervical stroma varies during each cycle, causing eversion of the columnar epithelium near the squamocolumnar junction and exposing it to the vaginal environment. This ectropion is known colloquially as __
cervical erosion
- most common tumor in women found in the smooth muscle. 98-99% BENIGN. Pwede siyang Makita sa lahat ng layers mg uterus.
Leimyoma
- The most common diagnostic and even therapeutic regimen that can detect any abnormalities in the reproductive organ of the female
Ultrasound of the cervix
- Hystero means uterus and salpingo means fallopian tube. We do this to see any obstruction in the cavity and lumen (uterus and fallopian tube). We do this to detect infertility. Since mahal na and dye, nowadays we use
__ wherein we inject a saline solution. We can use MRI and CT scan
HYSTEROSALPINGOGRAPHY
– herald of minimally invasive surgery. The smaller the incision the better. Uses scope, also can be diagnostic and therapeutic.
Laparoscopy
- The condition wherein there is an endometrial tissue outside the uterus.
- Most common cause of adhesion and infertility.
- Paano nagkakaroon? Because there is a backflow of menstrual blood to the fallopian tube then magdedeposit.
Endometriosis
- You scrape the wall of the endometrium. It can be a diagnostic and therapeutic. Nowadays ginagamitan na daw siya ng hystersocope para may guide
ENDOMETRIAL SAMPLING / D and C
- It is a diagnostic screening test. You do this when
the female is sexually active. 2 years after the female started to be. You will use spatula then scrape the lining of the cervix near the vagina. Yung bago ay yung gumagamit ng cytobrush. Screening test siya for CERVICAL CANCER.
PAPANICOLAU (PAP) SMEAR
The __,consists of a mucosal layer lined by stratified squamous epithelium, a layer of smooth muscle and an outer adventitial layer A. In the relaxed state, the vaginal wall collapses to obliterate the lumen, and the vaginal epithelium is thrown up into folds. The fibrous lamina propria contains many elastin fibres, has a rich plexus of small veins and is devoid of glands.
wall of the vagina
PAPANICOLAU (PAP) SMEAR Cells:
- Superficial
- Intermediate
- Parabasal/Basal
– estrogen, are flat with an irregular border and a light orange cytoplasm. These cells from under the influence of estrogen.
Superficial Cell
– progesterone, are flat with an irregular border and a blue cytoplasm. These cells from under the influence of progesterone. When you are in ovulatory phase or your
pregnant kase mataas ang progesterone
Intermediate Cell
– are oval with a large nucleus with prominent chromatin and blue cytoplasm. Parabasal cells in vaginal smear imply the absence of estrogen and progesterone influence.
Kapag menopausal ka naman
Parabasal/Basal Cell
VAGINA LAYERS:
o Tunica Mucosa – Stratified Squamous Non Keratinizing epithelium except at the opening kase nagkakaroon ng
keratinization lalo na kung sexually active
with elastic lamina propia
o Tunica Muscularis – consist of innercircular bundled and outer thicker longitudinal muscle. More collagen fibers
than elastic fibers.
o Tunica adventitia – it has dense connective tissue with rich elastic fibers.
__ is produced by the cervical glands. During sexual arousal, lubricating mucus is also produced by the vaginal vestibule, including the paired greater vestibular glands (of Bartholin), homologous to male bulbourethral glands
Mucus
Counterpart of bulbourethral glands of male and secretes mucin during sexual stimulation. Most common site of gonococci infection where they will be stored
Bartholin’s gland
- Contains hairs, lots of fats, sebaceous and sweat glands with lots of genital corpuscles.
- LE: Stratified Squamous Keratinized
Labia Majora
- Counterpart of penis, it has corpora cavernosa and corpora spongiosum, the main difference is that it is smaller and no urethra. Meron din siyang cavernous spaces filled with cavernous blood during sexual stimulation and becomes erectile tissue
Clitoris
