T3 L1 &2 :Pathology of the Female Reproductive Tract 1 & 2 Flashcards
what hormone secreted at puberty causes maturation of squamous epithelial cells and of which organ
Oestrogen
Vagina
what is formed within mature squamous epithelial cells
Glycogen
what is the purpose of glycogen in vaginal cells
Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)
what is the function of Lactobacilli
Lactobacilli produce lactic acid keeping vaginal pH below 4.5
describe the different components of the cervix
- Ectocervix
- Endocervix
- Transformation zone
What type of cells are within the ectocervix
stratified squamous epithelium
what type of cells are within the endocervix
Single layer of tall, mucin producing columnar cells
what contributes to the large surface area of the endocervix
- Columnar epithelium lines tiny blind ending channels (‘clefts’)
- These radiate out from the endocervical canal into the surrounding stroma
what type of epithelium is the ectocervix covered by
stratified squamous epithelium
what type of epithelium is the endocervix covered by
columnar epithelium
what is the junction between the endocervix and ectocervix called
‘squamo-columnar junction
describe 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 the vaginal environment
what is the endocervical columnar epithelium exposed to & what does this cause
Acidic vaginal environment
Reserve cells in this area proliferate and mature to form squamous epithelium: This process is called squamous metaplasia
define metaplasia
a transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type
what happens after metaplasia occurs
- At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation & maturation is incomplete)
- With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix
what is the myometrium
Bundles of smooth muscle, vasculature and nerves of the cervix
when and what is the proliferative phase in the endometrium
-Before ovulation & has mitosis
1) Tubular glands
2) Specialised Stroma
3) Blood vessels
what occurs in the secretory phase in the endometrium
1) Cork screw glands
2) Specialised stroma
3) Blood vessels
define neoplasia
‘new growth’ – abnormal, uncoordinated and excessive cell growth.
persists following withdrawal of stimulus and associated with genetic alterations
what are neoplasms classified according to
Neoplasms are classified according to their behaviour and histogenesis
Behaviour: Benign or Malignant Histogenesis: Recognising the cell of origin
describe benign neoplasms
Remains localised and doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue
give an example of a benign neoplasm
Leiomyoma of the myometrium‘ fibroid ’
It closely resembles parent tissue
what are the consequences of benign neoplasms
- Pressure on adjacent tissue
- Obstruction of lumen of a hollow organ
- Hormone production
- Transformation into a malignant neoplasm
- Symptoms for the patient
what are the clinical problems for benign neoplasms
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
Abnormal uterine bleeding, pain
describe 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
how does malignant tissue appear to be
- 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
- Anxiety and pain
Terminology of neoplasms
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
What type of cell types can be
Vulva squamous squamous cell carcinoma
Vagina squamous squamous cell carcinoma
Cervix squamous squamous cell carcinoma
glandular adenocarcinoma
Endometrium glandular adenocarcinoma
stroma stromal sarcoma
Myometrium sm muscle leiomyosarcoma
Define Dysplasia and the type of lesions
This state is termed dysplasia
disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation
(There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane)
Dysplastic lesions may (but don’t always) progress to invasive malignancy
Recognising dysplastic lesions allows early treatment before invasion occurs
what is the UK and USA terminology for dysplasia
UK: Cervical intra-epithelial neoplasia (CIN)
US: Squamous intra-epithelial lesion (SIL)
what does the degree of the dysplasia predict
the likelihood of developing invasive malignancy
Grade % progress to CIN3 % progress to SCC
CIN1 11 1
CIN2 22 5
CIN3 - 40
what are the typical types of dysplasia in different areas of the body
- squamous metaplasia of the cervical transformation zone
- squamous metaplasia of the bronchial epithelium
- glandular metaplasia of the distal oesophagus
what is the difference between how dysplastic and normal surface cells appear
Normal surface cells have a small nucleus and lots of cytoplasm
Dysplastic cells have a higher ratio of nuclear size to cytoplasmic volume, and the nuclei show the same features that we associate with malignancy
what is the difference between dysplasia and carcinoma
is invasion through the basement membrane
what does HPV infection cause
HPV infection causes CIN and cervical cancer
what does the HPV infect
infect epithelium
give some high risk HPV and low risk
High Risk HPV 16,18,31,33,35,39,45,51,52,56,58,59,68
Low Risk HPV
6,11,40,42,43,44,54,61,72,81
What are the prevention measures against the HPV infection
HPV vaccinations
