Pathology of the female reproductive tract Flashcards
Outline the epithelium of the labia minora and vagina
Mucosa with stratified squamous epithelium
What happens at the vagina during puberty?
Ovary secretes oestrogen which 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 (dominated by lactobacilli).
Lactobacilli produce lactic acid keeping vaginal pH below 4.5.
What are the parts of the cervix?
Ectocervix: stratified squamous epithelium.
Endocervix: single layer of tall, mucin producing columnar cells. deceptively large surface area. columnar epithelium lines clefts which radiate out from endocervical canal into surrounding stroma.
Transformation zone.
Junction between ecto- and endocervix is the squamo-columnar junction.
Outline the formation of the transformation zone
During puberty the cervix changes shape
The lips of the cervix grow
The distal end of the endocervix opens
Endocervical mucosa becomes exposed to vaginal environment
Give an example of squamous metaplasia
The distal endocervical columnar epithelium is exposed to the acidic vaginal environment. It is not suited to this, so undergoes metaplasia.
Reserve cells in this area proliferate and mature to form squamous epithelium.
What are the features of the endometrium in the proliferative phase (before ovulation)?
Tubular glands, specialised stroma, blood vessels.
Mitoses in glands
What are the features of the endometrium in the secretory phase?
Cork screw glands, specialised stroma, blood vessels.
Secretions in glands.
What are the features of a leiomyoma of the myometrium (fibroid)?
Benign neoplasm of smooth muscle
Localised, slow growing
Closely resembles parent tissue
What are the consequences of benign neoplasms?
Pressure on adjacent tissue - bladder (frequency), rectosigmoid (constipation).
Obstruction of lumen of a hollow organ - adjacent to ureters, blocking endocervix.
Hormone production
Transformation into a malignant neoplasm
Symptoms for the patient - abnormal uterine bleeding, pain.
Outline the behaviour of malignant neoplasms?
Invade into surrounding tissues.
Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis).
Generally grow relatively quickly.
Variable resemblance to parent tissue.
What is the appearance of malignant neoplastic tissue?
loss of differentiation
loss of cellular cohesion
enlarged irregular dark nuclei
increased numbers of mitoses
What are the consequences of malignant neoplasms?
Destruction of adjacent tissue Metastasis Blood loss from ulcerated surfaces Obstruction of a hollow viscera Production of hormones Weight loss and debility
What are the malignant tumours of the female reproductive tract?
Vulva, vagina, cervix - squamous - squamous cell carcinoma
cervix - glandular - adenocarcinoma
Endometrium - glandular - adenocarcinoma
endometrium - stroma - stromal sarcoma
Myometrium - smooth muscle - leiomyosarcoma
What is dysplasia?
disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation
What are the properties of dysplasia?
‘pre-malignant’ state.
accumulation of cells which look somewhat like malignant cells but do not invade basement membrane (unlike carcinoma).
Dysplastic lesions may progress to invasive malignancy.
Recognising dysplastic lesions allows early treatment before invasion occurs.
Often occurs in sites where there is metaplasia
