T3 L1 and 2 Pathology of female reproductive tract

Question 1

What cells line the vulva and vagina?

Answer 1

Stratified squamous epithelium

Question 2

What causes maturation of squamous epithelial cells in the vagina at puberty

Answer 2

Oestrogen that is secreted by the ovaries

Question 3

What is a substrate for vaginal anaerobic organisms?

Answer 3

Glycogen in the cells shed from the surface

Question 4

How is the vaginal pH maintained?

Answer 4

By lactobacilli which produce lactic acid

Question 5

What is the vaginal pH?

Answer 5

<4.5

Question 6

What is the ectocervix?

Answer 6

Also known as exocervix
Lower 1/3 of cervix
Stratified squamous epithelium

Question 7

What is the endocervix?

Answer 7

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

Question 8

What is the squamo-columnar junction?

Answer 8

Junction between the ectocervix and the endocervix

Question 9

What is the transformation zone?

Answer 9

Area of changing cells

Most common place on cervix for abnormal cells to develop

Question 10

Describe the changes that occur during puberty in the cervix

Answer 10

Lips of cervix grow
Distal end of endocervix opens
Endocervical mucosa becomes exposed to vaginal environment

Question 11

Why is the metaplastic squamous epithelium initially thin and delicate?

Answer 11

Lots of proliferation and maturation is incomplete

Question 12

Why does metaplasia occur in the distal endocervical columnar epithelium?

Answer 12

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

Question 13

What is metaplasia?

Answer 13

Transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

Question 14

What is contained in the myometrium of the uterus?

Answer 14

Bundles of smooth muscle, vasculature and nerves

Question 15

What happens to the endometrium in the proliferate phase before ovulation?

Answer 15

Tubular glands
Specialised stroma
Blood vessels
Mitoses in glands

Question 16

What happens to the endometrium in the secretory phase?

Answer 16

Cork screw glands
Specialised stroma
Blood vessels
Secretions in glands

Question 17

What is a neoplasia?

Answer 17

New growth
Abnormal, uncoordinated and excessive cell growth
Persists following withdrawal of the stimulus and is associated with genetic alterations

Question 18

What are the histological features of neoplasms?

Answer 18

Classified by cell of origin
Determined by examining tissue under the microscope
Resemblance to parent tissue correlates with clinical behaviour

Question 19

What is the terminology of neoplasia?

Answer 19

Neoplasms have suffix - oma
Malignant epithelial tumours are carcinomas
Carcinomas are named for the epithelial cell they resemble

Question 20

What are adenocarcinomas?

Answer 20

Carcinomas of glandular epithelium

Question 21

What are sarcomas?

Answer 21

Malignant stromal tumours

Question 22

What are the features of benign neoplasms?

Answer 22

Remains localised
Doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue

Question 23

What is a leiomyoma of the myometrium?

Answer 23

Benign neoplasm of smooth muscle
Localised
Slow growing

Question 24

What are the consequences of benign neoplasms?

Answer 24

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)

Question 25

Describe malignant neoplasms

Answer 25

``` 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 ```

Question 26

How do malignant neoplasms look different to normal tissue?

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 hollow viscera Production of hormones Weight loss and debility Anxiety and pain ```

Question 28

What is dysplasia?

Answer 28

Disordered growth and differentiation characterised by increased proliferation, atypia of cells and decreased differentiation

Question 29

What is the difference between dysplasia and carcinomas?

Answer 29

Invasion through the basement membrane

Question 30

Describe the pre-malignant state of malignant neoplasms

Answer 30

Accumulation of cells which look like malignant cells but don't invade the basement membrane

Question 31

Give examples of sites where dysplasia often occurs?

Answer 31

Squamous metaplasia of cervical transformation zone Squamous metaplasia of bronchial epithelium Glandular metaplasia of distal oesophagus

Question 32

Describe how dysplastic cells are different to those at the surface of normal epithelium?

Answer 32

Higher ratio of nuclear size to cytoplasmic volume | Nuclei show some features associated with malignancy

Question 33

What does HPV cause?

Answer 33

CIN and cervical cancer

Question 34

How many types of HPV are there?

Answer 34

Over 130

Question 35

Give examples of high risk HPV

Answer 35

16, 18

Question 36

Give examples of low risk HPV

Answer 36

6, 11

Question 37

How is HPV managed?

Answer 37

HPV vaccination Population based screening - cervical sample cytology and HPV test Colposcopy Treatment of high grade dysplasia Large loop excision of transformation zone