T3 L1 and 2 Pathology of female reproductive tract Flashcards
What cells line the vulva and vagina?
Stratified squamous epithelium
What causes maturation of squamous epithelial cells in the vagina at puberty
Oestrogen that is secreted by the ovaries
What is a substrate for vaginal anaerobic organisms?
Glycogen in the cells shed from the surface
How is the vaginal pH maintained?
By lactobacilli which produce lactic acid
What is the vaginal pH?
<4.5
What is the ectocervix?
Also known as exocervix
Lower 1/3 of cervix
Stratified squamous epithelium
What is the endocervix?
Upper 2/3 of cervix
Single layer of tall, mucin producing columnar cells
Columnar epithelium line tiny blind-ending channels (clefts) which radiate out from endocervical canal into surrounding stroma
What is the squamo-columnar junction?
Junction between the ectocervix and the endocervix
What is the transformation zone?
Area of changing cells
Most common place on cervix for abnormal cells to develop
Describe the changes that occur during puberty in the cervix
Lips of cervix grow
Distal end of endocervix opens
Endocervical mucosa becomes exposed to vaginal environment
Why is the metaplastic squamous epithelium initially thin and delicate?
Lots of proliferation and maturation is incomplete
Why does metaplasia occur in the distal endocervical columnar epithelium?
It is exposed to acidic vaginal environment which it isn’t suited to
Reserve cells in this area proliferate and mature to form squamous epithelium
What is metaplasia?
Transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type
What is contained in the myometrium of the uterus?
Bundles of smooth muscle, vasculature and nerves
What happens to the endometrium in the proliferate phase before ovulation?
Tubular glands
Specialised stroma
Blood vessels
Mitoses in glands
What happens to the endometrium in the secretory phase?
Cork screw glands
Specialised stroma
Blood vessels
Secretions in glands
What is a neoplasia?
New growth
Abnormal, uncoordinated and excessive cell growth
Persists following withdrawal of the stimulus and is associated with genetic alterations
What are the histological features of neoplasms?
Classified by cell of origin
Determined by examining tissue under the microscope
Resemblance to parent tissue correlates with clinical behaviour
What is the terminology of neoplasia?
Neoplasms have suffix - oma
Malignant epithelial tumours are carcinomas
Carcinomas are named for the epithelial cell they resemble
What are adenocarcinomas?
Carcinomas of glandular epithelium
What are sarcomas?
Malignant stromal tumours
What are the features of benign neoplasms?
Remains localised
Doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue
What is a leiomyoma of the myometrium?
Benign neoplasm of smooth muscle
Localised
Slow growing
What are the consequences of benign neoplasms?
Pressure on adjacent tissue (bladder, rectosigmoid)
Obstruction of lumen of hollow organ (ureters, endocervix)
Hormone production
Transformation into malignant neoplasm
Symptoms for patient (abdominal uterine bleeding, pain)
Describe malignant neoplasms
Invade into surrounding tissues Spread to other sites via lymphatics to lymph nodes and blood vessels Grow relatively quickly Variable resemblance to parent tissue Looks different to normal tissue
How do malignant neoplasms look different to normal 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 hollow viscera Production of hormones Weight loss and debility Anxiety and pain
What is dysplasia?
Disordered growth and differentiation characterised by increased proliferation, atypia of cells and decreased differentiation
What is the difference between dysplasia and carcinomas?
Invasion through the basement membrane
Describe the pre-malignant state of malignant neoplasms
Accumulation of cells which look like malignant cells but don’t invade the basement membrane
Give examples of sites where dysplasia often occurs?
Squamous metaplasia of cervical transformation zone
Squamous metaplasia of bronchial epithelium
Glandular metaplasia of distal oesophagus
Describe how dysplastic cells are different to those at the surface of normal epithelium?
Higher ratio of nuclear size to cytoplasmic volume
Nuclei show some features associated with malignancy
What does HPV cause?
CIN and cervical cancer
How many types of HPV are there?
Over 130
Give examples of high risk HPV
16, 18
Give examples of low risk HPV
6, 11
How is HPV managed?
HPV vaccination
Population based screening - cervical sample cytology and HPV test
Colposcopy
Treatment of high grade dysplasia
Large loop excision of transformation zone
