Sem 2 - Repro

Question 1

Which of the following epithelial features are required for proper functioning of the Fallopian tubes? (2)

Answer 1

cilia, secretion

Question 2

pseudostratified columnar epithelium with stereocilia from?(2)

Answer 2

vas deferens, epididymis

Question 3

Name the different types of epithelium that line the different parts of the cervix.

Answer 3

The endocervical canal is lined by simple columnar mucus secreting epithelium which changes at the squamo-columnar junction into non-keratinising stratified squamous epithelium that covers the ectocervix.

Question 4

Explain how and why squamous metaplasia occurs in the cervix during the reproductive years. What name is given to the region where this change occurs? Is this a physiological or pathological process? (6 marks)

Answer 4

During the reproductive years, the squamo-columnar junction is at the external os. Under the influence of oestrogens, expansion of the cervical stroma occurs, resulting in eversion of the columnar endocervical epithelium near the os out onto the ectocervix. Here it is exposed to the more hostile vaginal environment and it undergoes metaplasia to the more protective stratified squamous epithelium.

This is a normal physiological process.

The region at the external os that spans the squamo-columnar junction and area where metaplasia occurs is known as the transformation zone.

Question 5

The squamous cells in the mid and upper epithelium of the cervix have clear cytoplasm. Why is this?

Answer 5

glycogen - doesnt stain in H&E

Question 6

What main tissues, cells, structures are in the cervical stroma? (3 marks)

Answer 6

The main components of the cervical stroma are fibrous connective tissue with elastin, smooth muscle and blood and lymphatic vessels. Lymphocytes and antigen presenting cells are located under the epithelium.

Question 7

Explain, with reasons, the pathological significance of the transformation zone (please don’t use abbreviations). What relevance does this have to taking a cervical smear?

Answer 7

The transformation zone is the region at the external os where squamous metaplasia occurs. HPV preferentially infects this metaplastic squamous epithelium. As a result of persistent HPV infection, this metaplastic squamous epithelium may become dysplastic and subsequently give rise to invasive squamous cell carcinoma.
It is thus also the region from where cervical smears should be taken such that HPV, premalignant and even malignant changes can be detected.

Question 8

Normal stratified squamous epithelium appears eosinophilic on low power. The severely dysplastic epithelium appears basophilic on low power. Why?

Answer 8

The dysplastic epithelium contains cells with much higher nuclear:cytoplasmic (N:C) ratios (i.e. relatively more nuclear material to stain with haematoxylin) than normal squamous cells. The nuclei may also be hyperchromatic.

Question 9

What are the histological features of HPV infection in the cervix?

Answer 9

presence of koilocytes: cells with areas of clear cytoplasm around large irregular nuclei in the upper epithelium.

Question 10

What are the histological features of CIN1?

Answer 10

CIN1 (or cervical intrapepithelial neoplasia 1) is characterised by the presence of mild nuclear atypia and disorganisation of cells in the lower third of the stratified squamous epithelium.

Question 11

What are the histological features of CIN2?

Answer 11

the presence of nuclear atypia (enlargement, hyperchromasia), immature maturation and disorganisaton (i.e. dysplasia) of cells in the lower 2 thirds of the stratified squamous epithelium.

Question 12

when describing a malignancy what should be included?

Answer 12

information about it being invasive, a description of the cells indicating their malignant nature (e.g. large pleomorphic nuclei, hyperchromatic nuclei, prominent nucleoli, etc.) and about the features of differentiation of the cells (e.g. gland formation, keratinization, etc.) to indicate the type of tumour. Other features that are relevant include whether or not there is necrosis, desmoplasia and inflammation.

Question 13

What is the natural history of carcinoma of the cervix?

Answer 13

The tumour invades locally into adjacent tissues such as uterus, vagina, bladder and rectum. It metastasises via lymphatics to local lymph nodes and via blood to distant sites such as liver and lung. Death may occur from extensive local invasion, from distant metastases, weight loss or pneumonia.

Question 14

what characteristics will normal superficial squamous cells demonstrate?

Answer 14

abundant cytoplasm with small uniform nuclei. (low N:C ratio).

Question 15

describe histologcally normal cervical epithelium? compare with cancerous?

Answer 15

Normal superficial squamous cells have abundant cytoplasm with small uniform nuclei. Cells from deeper down will have a larger uniform nucleus that takes up a greater proportion of the cell (they thus have a higher N:C ratio). Dysplastic and malignant cells will typically have a larger than normal nucleus (thus a higher than normal N:C ratio) and the nucleus will generally be irregular, hyperchromatic

Question 16

The presence of endocervical cells (as well as squamous cells) in the smear indicates that it is a satisfactory smear. Why?

Answer 16

The presence of endocervical cells as well as squamous cells indicates that the smear is from the transformation zone (which is from where it should be taken), which includes the squamocolumnar junction.

A smear from further out on the ectocervix will only contain squamous cells and may not contain the metaplastic squamous cells where HPV and dysplasia typically occur

Question 17

Why is it important for the patient if severely dysplastic cells from the epithelium cross the basement membrane

Answer 17

Once malignant cells invade through the basement membrane they can gain access to blood vessels or lymphatics and metastasise. Metastatic carcinomas are much more difficult to cure.

Question 18

what are the 2 components of the endometrium?

Answer 18

The endometrium comprises epithelium and stroma.

Question 19

what is a leiomyoma? where most common? describe histologically

Answer 19

benign smooth muscle lesions. common in uterus. Diagnostic features include that the lesion/s are well circumscribed, the cells show features of smooth muscle cells and the nuclei are small and uniform, with small or inconspicuous nucleoli, are not hyperchromatic, there are few/no mitoses and there is no necrosis

Question 20

whats a malingant leiomyoma called?

Answer 20

leoisarcoma

Question 21

Which cells (name 2) in the ovary produce oestrogen and oestrogen precursors during the proliferative phase?

Answer 21

the granulosa cells and cells of the theca interna

Question 22

What are the 3 main groups of primary neoplastic lesions of the ovary, and from which cells in the normal ovary are they believed to originate?

Answer 22

Primary ovarian neoplasms fall into one of 3 main groups: the germ cell tumours, derived from the germ cells or oocytes, tumours derived from stromal cells (sex cord -stromal tumours) and the epithelial tumours (most common) which are believed to originate from the surface mesothelium, which may undergo a metaplastic process to give rise to the epithelial tumours.