Pathology of the female reproductive tract 1

Question 1

Type of cell in vulva and vagina

Answer 1

Stratified squamous epithelium

Question 2

Vagina at puberty

Answer 2

Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells

Glycogen is formed within mature squamous epithelial cells

Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms

Lactobacilli produce lactic acid keeping vaginal pH below 4.5

Question 3

Parts of the cervix

Answer 3

Ectocervix

Endocervix

Transformation zone

Question 4

Ectocervix cells

Answer 4

Stratified squamous epithelium

Question 5

Endocervix cells

Answer 5

Single layer of tall, mucin producing columnar cells

Question 6

The endocervix surface area

Answer 6

Columnar epithelium lines tiny blind ending channels

These radiate out from the endocervical canal into the surrounding stroma

Question 7

Ectocervix covered by

Answer 7

Stratified squamous epithelium

Question 8

Endocervix is lined by

Answer 8

Columnar epithelium

Question 9

Junction between the endocervix and ectocervix is called

Answer 9

The squamo columnar junction

Question 10

Formation of the transformation zone

Answer 10

During puberty the cervix changes shaped

The lips of the cervix grow

The distal end of the endocervix opens

Endocervical mucosa becomes exposed to the vaginal environment

Question 11

Squamous metaplasia

Answer 11

The distal endocervical columnar epithelium is exposed to the acidic vaginal environment

Not suited to this so undergoes metaplasia

Reserve cells in this area proliferate and mature to form squamous epithelium

Question 12

Metaplasia definition

Answer 12

A transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

Question 13

Squamous metaplasia over time

Answer 13

At first the metaplastic squamous epithelium is thin and delicate

With time the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

Question 14

Myometrium

Answer 14

Bundles of smooth muscle, vasculature and nerves

Question 15

Endometrium in proliferation phase

Answer 15

(before ovulation)

1. Tubular glands
2. Specialised stroma
3. Blood vessels

Mitoses in glands

Question 16

Endometrium in secretory phase

Answer 16

1. Cork screw glands
2. Specialised stroma
3. Blood vessels

Secretion in glands

Question 17

Neoplasia

Answer 17

New growth- abnormal, uncoordinated and excessive cell growth

Persists following withdrawal of stimulus and associated with genetic alterations

Question 18

Nomenclature of neoplasms

Answer 18

Different neoplasms have different behaviour

Accurate . identification and naming therefore important for treating the patient

Question 19

Neoplasm behaviour

Answer 19

Benign or malignant

Question 20

Neoplasms histogenesis

Answer 20

Recognising the cell of origin

Question 21

Benign neoplasms

Answer 21

Remain localised and doesn’t invade surrounding tissues

Generally slowly

Good resemblance of parent tissue

Question 22

Leiomyoma of the myometrium

Answer 22

A benign neoplasms of smooth muscle

Localised

Slow growing

Closely resembles parent tissue

Question 23

Consequences of benign neoplasms

Answer 23

Pressure on adjacent tissue

Obstruction of lumen of a hollow organ

Hormone production

Transformation into a malignant neoplasm

Symptoms for the patient

Question 24

Benign neoplasms, clinical problems

Answer 24

Pressure on adjacent tissue
- bladder (frequency), rectosigmoid (constipation)

Obstruction to lumen of a hollow organ
- adjacent (ureters) blocking endocervix

Hormone production
- erythropoietin producing polycythaemia

Transformation into a malignant neoplasm
- probably malignancy arises de novo

Question 25

Behaviours of neoplasms: malignant

Answer 25

Invade into surrounding tissues Spread via lymphatics to lymph nodes and blood vessels to other sites Generally relatively quickly Variable resemblance to parent tissue

Question 26

Malignant neoplastic tissue looks different to normal tissue

Answer 26

Loss of differentiation Loss of cellular cohesion Enlarged irregular dark nuclei Increased number of mitoses

Question 27

Consequences of malignant neoplasms

Answer 27

Destruction of adjacent tissue Metastasis Blood loss from ulcerated surfaces Obstruction of a hollow viscera Production of hormones Weight loss and debility Anxiety and pain

Question 28

Histogenesis of neoplasms

Answer 28

Classified by cell of origin Determined by examining tissue under the microscope Resemblance to parent tissue correlates with clinical behaviour

Question 29

Terminology of neoplasia

Answer 29

Neoplasms have the suffix - oma Malignant epithelial tumours are carcinomas Carcinomas are named for the epithelial cell type which they resemble Carcinomas of glandular epithelium are called adenocarcinomas Malignant stromal tumours are sarcomas

Question 30

Malignant tumours of the vulva

Answer 30

Squamous Squamous cell carcinoma

Question 31

Malignant tumours of the vagina

Answer 31

Squamous Squamous cell carcinoma

Question 32

Malignant tumours of the cervix

Answer 32

Squamous - squamous cell carcinoma Glandular - adenocarcinoma

Question 33

Malignant tumours of the endometrium

Answer 33

Glandular - adenocarcinoma Stroma - stromal sarcoma

Question 34

Malignant tumours of the myometrium

Answer 34

Smooth muscle Leiomyosarcoma

Question 35

Dysplasia

Answer 35

Pre malignant state There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane Dysplastic lesions may progress to invasive malignancy Recognising dysplastic lesions allows early treatment before invasion occurs

Question 36

Dysplasia definition

Answer 36

Disordered growth and differentiation characterised by increased proliferation, atypia of cells and decreased differentiation

Question 37

Dysplasia at sites of metaplasia

Answer 37

Squamous metaplasia of the cervical transformation zone Squamous metaplasia of the bronchial epithelium Glandular metaplasia of the distal oesophagus

Question 38

Dysplastic cell nuclei

Answer 38

Have a higher ratio of nuclear size to cytoplasmic volume Nuclei show the same features that we associate with malignancy

Question 39

Difference between dysplasia and carcinoma

Answer 39

Invasion through the basement membrane

Question 40

Human papillomavirus

Answer 40

Infects epithelium Confined to local site of infection without viraemia Over 130 HPV types, some of which infect the anogenital mucosa Double stranded DNA virus 7.9Kbp

Question 41

HPV prevention/ treatment

Answer 41

HPV vaccination Population based screening - cervical sample cytology - cervical sample HPV test Colposcopy Treatment of high grade dysplasia Large loop excision of the transformation zone