T3 L1 &2 :Pathology of the Female Reproductive Tract 1 & 2

Question 1

what hormone secreted at puberty causes maturation of squamous epithelial cells and of which organ

Answer 1

Oestrogen

Vagina

Question 2

what is formed within mature squamous epithelial cells

Answer 2

Glycogen

Question 3

what is the purpose of glycogen in vaginal cells

Answer 3

Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)

Question 4

what is the function of Lactobacilli

Answer 4

Lactobacilli produce lactic acid keeping vaginal pH below 4.5

Question 5

describe the different components of the cervix

Answer 5

• Ectocervix
• Endocervix
• Transformation zone

Question 6

What type of cells are within the ectocervix

Answer 6

stratified squamous epithelium

Question 7

what type of cells are within the endocervix

Answer 7

Single layer of tall, mucin producing columnar cells

Question 8

what contributes to the large surface area of the endocervix

Answer 8

• Columnar epithelium lines tiny blind ending channels (‘clefts’)
• These radiate out from the endocervical canal into the surrounding stroma

Question 9

what type of epithelium is the ectocervix covered by

Answer 9

stratified squamous epithelium

Question 10

what type of epithelium is the endocervix covered by

Answer 10

columnar epithelium

Question 11

what is the junction between the endocervix and ectocervix called

Answer 11

‘squamo-columnar junction

Question 12

describe the formation of the transformation zone

Answer 12

• 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

Question 13

what is the endocervical columnar epithelium exposed to & what does this cause

Answer 13

Acidic vaginal environment

Reserve cells in this area proliferate and mature to form squamous epithelium: This process is called squamous metaplasia

Question 14

define metaplasia

Answer 14

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

Question 15

what happens after metaplasia occurs

Answer 15

• 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

Question 16

what is the myometrium

Answer 16

Bundles of smooth muscle, vasculature and nerves of the cervix

Question 17

when and what is the proliferative phase in the endometrium

Answer 17

-Before ovulation & has mitosis

1) Tubular glands
2) Specialised Stroma
3) Blood vessels

Question 18

what occurs in the secretory phase in the endometrium

Answer 18

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

Question 19

define neoplasia

Answer 19

‘new growth’ – abnormal, uncoordinated and excessive cell growth.

persists following withdrawal of stimulus and associated with genetic alterations

Question 20

what are neoplasms classified according to

Answer 20

Neoplasms are classified according to their behaviour and histogenesis

Behaviour:  Benign or Malignant

Histogenesis: Recognising the cell of origin

Question 21

describe benign neoplasms

Answer 21

Remains localised and doesn’t invade surrounding tissues

Generally grow slowly

Good resemblance of parent tissue

Question 22

give an example of a benign neoplasm

Answer 22

Leiomyoma of the myometrium‘ fibroid ’

It closely resembles parent tissue

Question 23

what are the 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

what are the clinical problems for benign neoplasms

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

Abnormal uterine bleeding, pain

Question 25

describe malignant neoplasms

Answer 25

-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

Question 26

how does malignant tissue appear to be

Answer 26

- loss of differentiation - loss of cellular cohesion - enlarged irregular dark nuclei - increased numbers of mitoses

Question 27

what are the 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

Terminology of neoplasms

Answer 28

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 29

What type of cell types can be

Answer 29

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

Question 30

Define Dysplasia and the type of lesions

Answer 30

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

Question 31

what is the UK and USA terminology for dysplasia

Answer 31

UK: Cervical intra-epithelial neoplasia (CIN) US: Squamous intra-epithelial lesion (SIL)

Question 32

what does the degree of the dysplasia predict

Answer 32

the likelihood of developing invasive malignancy Grade % progress to CIN3 % progress to SCC CIN1 11 1 CIN2 22 5 CIN3 - 40

Question 33

what are the typical types of dysplasia in different areas of the body

Answer 33

- squamous metaplasia of the cervical transformation zone - squamous metaplasia of the bronchial epithelium - glandular metaplasia of the distal oesophagus

Question 34

what is the difference between how dysplastic and normal surface cells appear

Answer 34

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

Question 35

what is the difference between dysplasia and carcinoma

Answer 35

is invasion through the basement membrane

Question 36

what does HPV infection cause

Answer 36

HPV infection causes CIN and cervical cancer

Question 37

what does the HPV infect

Answer 37

infect epithelium

Question 38

give some high risk HPV and low risk

Answer 38

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

Question 39

What are the prevention measures against the HPV infection

Answer 39

HPV vaccinations