Pathology of the female reproductive tract

Question 1

Vulva and vagina tissue type

Answer 1

Stratified squamous epithelium

Question 2

Vagina change at puberty

Answer 2

Rise in oestrogen from ovary
- Matures squamous cells

Mature squamous cells secrete glycogen
- Glycogen is fermented by anaerobic bacteria–> lactobacilli

Lactobacilli- produce lactice acid
- pH <4.5

Question 3

Ectocervix tissue type

Answer 3

Stratified squamous epithelium.

Question 4

Endocervic structure

Answer 4

Simple columnar epithelium
- Secretes mucin

Blind ending channels/ clefts

• Increase surface area
• Radiate out of endocervical call into stroma.

Question 5

Squamo-columnar junction

Answer 5

Junction between ectocervix (stratified squamous) to columnar endocervix.

Question 6

Transformation zone

• Formation
• Structure

Answer 6

Distal end of the endocervix opens

• Trumpet shape
• Endocervical mucose becomes exposed to vaginal environment (acidic)

Forms metaplastic squamous change

Question 7

Squamous metaplasia

Answer 7

Some of the endocervix becomes exposed to the acidic vaginal environment
- Reserve cells proliferate into squamous epithelium

Adaptation copes with acidic environment

Question 8

Myometrium structure

Answer 8

Bundles of smooth muscle

Mixed with blood vessels and nerves

Question 9

Endometrium proliferative phase

Answer 9

Occurs before ovulation

Composed of

• Tubular glands
• Specialised stroma
• Blood vessels.

Due to proliferative phase- glands undergo mitosis

Question 10

Endometrium- Secretory phase

Answer 10

After ovulation
- Last 14 days

Tissue composed of

• Cork screw glands
• Specialised stroma
• Blood vessels.

Question 11

Metaplasia

Answer 11

Adaptive cell change from one type of mature differentiated cell type to another differentiated cell type.

Question 12

Benign neoplasm

• Behaviour
• Histogenesis

Answer 12

Neoplasm that is

• Localised, does not invade neighbouring tissue.
• Generally grow slowly
• Resembles parent tissue

Question 13

Leiomyoma

Answer 13

Benign neoplasm of the myometrium (fibroid)

Localised, grows slowly

Resembles myometrium histologically

Question 14

Consequences of benign neoplasm

Answer 14

Pressure on adjacent tissue

• Urinary frequency
• Constipation

Obstruction of hollow organ

• Urinary retention
• Endocervic block

Secretion of hormone
- Polycythemia

Transformation into malignancy

• Bleeding
• Pain

Question 15

Malignant neoplasm

• Behaviour
• Histology

Answer 15

Invade into surrounding tissues

Spread

• Lymphatics, into lymph nodes
• By blood, into other organs/ tissues

Grow relatively quickly

Variable resemblance to parent tissue

Question 16

4 main histological features of malignant neoplastic tissue

Answer 16

Loss of differentiation

Loss of cellular cohesion

Enlarged irregular dark nuclei

Increased number of mitosis- highly proliferative

Question 17

Consequences of malignant neoplasms [7]

Answer 17

Destruction of adjacent tissue

Metastasis

Blood loss- when there is ulceration

Obstruction- hollow viscera

Secretion of hormones

Weight loss

Anxiety/ pain

Question 18

Carcinoma

Answer 18

Malignant epithelial tumours

Question 19

Dysplasia

Answer 19

Disordered differentiation and growth of cells.

Atypic cells
Highly proliferative
Loss of differentiation

Question 20

Cervical intra-epithelial neoplasia (CIN)

Answer 20

Dysplasia of the cervix

Known as Squamous intra-epithelial lesion (SIL) in USA

Higher the grade, the most likely to progress into squamous cell carcinoma

Question 21

Sites of metaplasia in the body

Answer 21

Regions where dysplasia is most likely to occur.

Cervical transformation zone
- Squamous metaplasia

Bronchial epithelium
- Squamous metaplasia

Distal oesophagus
- Glandular metaplasia

Question 22

Normal constituents of a smear

Answer 22

Endocervical cells [columnar]

Squamous cells

Metaplastic cells

Normal cells will have small nucleus and larger cytoplasm.

Question 23

HPV and cervical cancer

Answer 23

HPV infection causes CIN

CIN has high risk of developing into cervical cancer

Question 24

HPV

• Description
• High and low risk.

Answer 24

Virus that infects the epithelium and keeps infection local to the site of contact.

High risk
- 16, 18–> Malignancy

Low risk
- 6, 11–> genital warts

Question 25

Management of HPV

Answer 25

Vaccination

Population based screening

Colposcopy

Large loop excision of the transformation zone
- Treats high grade dysplasia

Question 26

Epidemiology of cervical, endometrial cancer

Answer 26

Cervical- Mainly in developing world
- Incidence and mortality declining in Europe (vaccination, screening)

Endometrial- mainly in north america and Europe
- Incidence is increasing

Question 27

Birth cohort effect of cervical cancer incidence peaks

Answer 27

Incidence of cervical cancer peaks in 30s and 80s.

Groups of people experience different life exposures compared to those born before and after.

Women reaching sexual debut during WW1 and WW2 have high incidence and mortality of cervical cancer.