Pathology of the female reproductive tract Flashcards
What are some changes to the vagina during puberty
Oestrogen secreted by the ovary stimulates the maturation of squamous epithelial cells
glycogen is formed within mature squamous epithelial cells
glycogen in cells shed from the surface and anaerobically metabolised by lactobacilli to make lactic acid which keeps pH below 4.5
What are the 3 parts of the cervix from inside to outside
Endocervix, transformation zone and ectocervix
What cells line the ectocervix
covered by stratified squamous epithelium
What cells line the endocervix
Single-layer of tall, mucin making columnar cells.
How does the cervix change in puberty
The cervix changes shape, the lips grow, the distal end of the endocervix opens and the endocervical mucosa becomes exposed to the vaginal environment (transformation zone)
What happens to the transformation zone once exposed to the acidic vaginal environment
The distal endocervical columnar epithelium is exposed to the acidic vaginal environment which it is not suited for so they undergo metaplasia.
reserve cells proliferate and form squamous epithelium (squamous metaplasia)
What is metaplasia
The transformation of a mature differentiated cell type to another kind of mature differentiated cell type.
Outline the metaplastic squamous epithelium and its stages
At first, the metaplastic squamous epithelium is thin and delicate but with time (proliferation n maturation increase) it comes to be as strong and well-formed as that on the ectocervix
The endometrium changes appearance, what is the structure in the proliferative phase (before ovulation)
and then in the secretory phase
1) tubular glands
2) specialised stroma
3) blood vessels
secretory
1) cork screw glands
2) specialised stroma
3) blood vessels
What is neoplasia
‘new growth’- abnormal, uncoordinated and excessive cell growth.
persists following withdrawal of stimulus and associated with genetic alterations
What are the consequences of benign neoplasms
Pressure on adjacent tissue
obstruction of the lumen of a hollow organ
hormone production
transformation into a malignant neoplasm
symptoms for the patient
What are clinical problems of benign neoplasms
Pressure on adjacent tissues
-bladder (frequency),
rectosigmoid (constipation)
obstruction to the lumen of a hollow organ
-adjacent (ureters) blocking
endocervix
hormone production
-erythropoietin producing polycythaemia
transformation into a malignant neoplasm
- probably malignancy arises de novo
How do neoplasms behave
Malignant
- invade into surrounding tissues
- spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)
- generally grow relatively quickly
- variable resemblance to the parent tissue.
What are the consequences of malignant neoplasms
Destruction of adjacent tissue
metastasis
blood loss from ulcerated surfaces
obs of a hollow viscera
production of hormones
weight loss and debility
What is dysplasia or CIN (cervical intra-epithelial neoplasia)
Disordered growth & differentiation characterized by increased proliferation, atypia of cells & decreased differentiation
Where does dysplasia often occur
Often occurs in sites where there is metaplasia
- squamous metaplasia of the cervical transformation zone
- squamous of the bronchial epithelium
- glandular metaplasia of the distal oesophagus
How do we analyse cervical cells
Via a pap test, cervical ‘smear test’, cells are grabbed and studied.
normal surface cells have a small nucleus and lots of cytoplasms
dysplastic cells have a higher ratio to nuclear size and cytoplasmic volume.
What is the difference between dysplasia and carcinoma
The difference is the invasion through the basement membrane
What effect does HPV have on the cervix
HPV infection causes CIN and cervical cancer.
HPV infect epithelium and are confined to the local site of infection
Which high-risk HPV is associated with CIN
HPV 16, 18
Which low-risk HPV types are associated with anogenital warts
HPV 6, 11
What are some strats to prevent cervical cancer
HPV vax, HPV test and sample cytology, colposcopy, treatment of high-grade dysplasia and large loop excision of the transformation zone.
What is the endometrium
The inner layer, composed of glands in a specialised stroma with a specialised blood supply.
growth, maturation and regression of all 3 components is coordinated during each menstrual cycle.
Where is endometrial cancer predominantly located and what type of carcinoma is it
Endometrial cancer is predominantly in the glands therefore it is an adenocarcinoma.
