Module 8 Part 2 - Hormonal Changes Flashcards
Control of Ovulation
The LH surge brings about 4 major changes in the follicle:
- stops estrogen synthesis by follicular cells
- reinitiates meiosis in the oocyte of developing follicle
- triggers production of specific locally acting prostaglandins - induce ovulation by vascular changes
- causes differentiation of follicular cells - into luteal cells
Menstrual Cycle Phases
Menstrual phase - days 1-6
Proliferative phase - days 6-14
Secretory or Progestational phase - days 15-28
Menstrual Phase
Characterised by discharge of blood (day 1)
Large number of leukocytes found in menstrual flow
Usually lasts for up to 7 days - coinciding with the early ovarian follicular phase
After day 7 the influence of FSH and LH, resulting from the newly growing follicle which increases levels of estrogen
Cytology of Menstrual Phase
Desquamated endometrial cells
Blood
Polymorphonuclear leukocytes
Predominantly intermediate cells in clumps and folded cytoplasm
Proliferative Phase
Begins at cessation of the menstrual flow
Estrogen stimulates proliferation of epithelial cells, glands and blood vessels in endometrium
Lasts from end of menstruation to ovulation
Peak estrogen levels trigger the LH surge responsible for ovulation
Cytology of Proliferative Phase
Gradual disappearance of blood
Endometrial cells with small histiocytes up to day 12
Basophilic intermediate cells become replaced with mature, flat eosinophilic superficial cells
Cytology of Ovulation
Predominantly flat, superficial squamous cells
Nipple-like protrusions occasionally seen in endocervical cells
Thick cervical mucous forms fern-like crystalline structures
Secretory or Progestational Phase
Coincides with the ovarian luteal phase
Corpus luteum secretes large amounts of progesterone and estrogen
Progesterone acts on thickened endometrium to convert it to a richly vascularised glycogen filled tissue
Cytology of Secretory or Progestational Phase
Intermediate cells increase in numbers
Cytolysis occurs with lactobacilli and moth eaten cytoplasm and naked nuclei
Background of cytoplasmic debris
Increase in polymorphonuclear leukocytes
Cytology of Pregnancy
Mature squamous show glycogen deposits Clusters of intermediate cells Navicular cells Cytolysis Appearance of parabasal cells is usually a poor prognostic sign - may suggest fetal damage
Uncommon Pregnancy Findings
Syncytiotrophoblasts - large irregular, basophilic or eosinophilic with hyperchromatic, homogenous nuclei of uneven sizes
Cytotrophoblasts - can’t be recognised without immunostaining
Decidual cells - large mononucleated cells
Arias - Stella phenomenon
Cytology of Past Partum
No evidence of estrogen Atrophic smear pattern - predominance of parabasal cells especially in lactating women Return to normal cyclic patterns vary May find endometrial cells Polymorphonuclear leukocytes
Sampling Technique for Hormonal Indices
Smear from upper third of lateral vaginal wall Smear must be fixed immediately Smear to be PAP stained Count 300 cells Clinical data required Not a cervical or endocervical sample Not air dried smear Not a smear showing marked inflammation Not a smear with infection, squamous metaplasia
Cellular Indices for Hormonal Assessment
Estrogen markers:
1. KPI - Karyopyknotic index
- represents the ratio of superficial squamous cells to intermediate cells
2. EI - Eosinophilic index
- represents the ratio of mature eosinophilic cells to mature cyanophilic cells
Progesterone markers:
1. FCI - Folded cell index
- ratio of folded mature squamous cells to flat mature squamous cells
2. CCI - Crowded cells index
- ratio of mature cells in clusters of 4 or more to cells in clusters of 3 or less
MI - maturation index
- % of superficial, intermediate and parabasal cells present
MV - Maturation value
- specific numerical value to squamous cells
