Unit 7 - Female Reproductive System II

Question 1

what are the 4 anatomical subdivisions of the oviducts?

Answer 1

1. infundibulum - funnel shaped end where the oviduct lumen opens to the peritoneal cavity
   - fimbriae surround opening
2. ampulla - longest portion, and widest except for infundibulum
3. isthmus - straight part connecting ampulla and uterus
4. intramural part - passes through uterine wall

Question 2

what are the 3 layers of the oviduct wall?

Answer 2

1. inner mucosa
2. middle muscularis
3. outer serosa

Question 3

what comprises the inner mucosa of the oviduct?

Answer 3

1. mucosal folds - fill much of oviduct lumen to increase SA
   - most elaborate in ampulla, simplest in intramural part
2. mucosal epithelium - simple columnar epithelium
   - lines oviduct lumen and surfaces of fimbraie
   - ciliated and secretory cells
3. lamina propria - highly cellular, well-vascularized CT
   - has smooth muscle in finbriae for movement

Question 4

what are the cell types in mucosal epithelium of oviduct?

Answer 4

1. ciliated cells - pale eosinophilic cytoplasm, large euchromatic basal nucleus, prominent apical cilia, and darkly staining basal bodies at cilia bases
   - have motile cilia to sweep oocyte complex or fertilized embryo toward uterus
2. secretory (peg) cells - dark staining secretory products; apical surfaces protrude above epithelial surface
   - secretions nourish and protect gametes/embryos, and help sperm activation

Question 5

how do hormones affect mucosal epithelium of oviduct?

Answer 5

estrogen stimulates cilia elongation, increase secretions, and hypertrophy of both ciliated and secretory cells

Question 6

oviduct muscularis

Answer 6

smooth muscle and some CT

• thick, inner, circularly-oriented layer and thin, outer, longitudinally-oriented layer
• thickens and becomes better defined from infundibulum to isthmus
• contractions bend infundibulum closer to ovary
• sweeps fimbriae over ovary surface
• peristaltic contractions propel fertilized embryos toward uterus

Question 7

oviduct serosa

Answer 7

well-vascularized loose CT

• covered by simple squamous to cuboidal mesothelium
• provides blood and nerve supply to oviduct

Question 8

what happens if an ectopic pregnancy is not aborted?

Answer 8

developing placenta erodes thick lining of blood vessels in oviduct serosa
-growing fetus eventually ruptures oviduct, causing lethal hemorrhage

Question 9

anatomical overview of uterus

Answer 9

1. upper uterine body (“uterus”)
2. lower uterine body (“cervix)
3. inner endometrium, middle myometrium, outer perimetrium/epimetrium

Question 10

what are the layers of the endometrium?

Answer 10

1. stroma - CT of amorphous ground substance (some type III collagen, many fibroblasts)
2. simple columnar surface epithelium (mostly present)
3. uterine glands - simple, tubular glands lined by simple columnar secretory cells continuous w/ surface epithelium
4. spiral arteries (functionalis) and straight arteries (basalis)

Question 11

what are the 2 arteries of the endometrium?

Answer 11

1. spiral arteries - supply upper endometrium (functional layer = functionalis)
2. straight arteries - supply lower endometrium (basal layer = basalis)

Question 12

menstrual phase endometrium

Answer 12

progesterone loss after luteolysis causes constriction of spiral arteries and hypoxia of functionalis

• straight arteries and basalis are unaffected
• very short glands
• lacks surface epithelium

Question 13

proliferative phase endometrium

Answer 13

estrogen from growing ovarian follicles promotes proliferation of stromal and gland cells (mitotic profiles)

• surface epithelium regenerates from growing uterine gland secretory cells
• stroma thickens via replication of basalis fibroblasts and ECM production
• straight uterine glands lengthen
• spiral arteries grow into reformed functionalis and sprout arterioles

Question 14

secretory phase endometrium

Answer 14

progesterone from CL stimulates secretory cell hypertrophy and secretory activity, and promotes vascular changes

• coiling and dilation of uterine glands and secretion of glycogen-rich (apocrine) and glycoPRO-rich (merocrine) product
• thin-walled vascular lacunae develop and fill with blood
• -abundant blood flow to placenta

Question 15

endometriosis

Answer 15

presence of endometrial stromal and parenchymal cells outside uterus

• endometrium sloughed off during menses passes retrograde through oviducts, into peritoneal cavity (ovaries, outer surfaces of oviduct/uterus, broad ligament, colon, rectouterine pouch, rectal sheath)
• tissue is still hormone sensitive, undergoing cycles of growth and bleeding through menses
• pain (no longer cycle-dependent), inflammation, and adhesions between organ and peritoneal wall

Question 16

what is a chocolate cyst?

Answer 16

specific case of endometrial tissue invading ovary tunica albuginea
-brown due to accumulated blood

Question 17

myometrium

Answer 17

thickest layer of uterine wall

• bundles of smooth muscle are separated by CT
• organized into 3 partially interwoven, indistinct layers

Question 18

what happens to the myometrium in pregnancy?

Answer 18

smooth muscle cell hyperplasia and hypertrophy

• increased collagen prouction
• thicken/strengthen myometrium during pregnancy
• changes revert after pregnancy through smooth muscle cell apoptosis, atrophy, and removal of excess collagen

Question 19

what are uterine leiomyomas?

Answer 19

fibroids; 1:4 women

-benign smooth muscle tumors in myometrium

Question 20

perimetrium/epimetrium

Answer 20

• serosal where exposed to peritoneal cavity
• -loose CT, prominent blood vessels, covering of mesothelium
• -continuous with broad ligament (uterine mesentery)
• adventitial where not exposed
• loose CT that blends into surrounding tissues

Question 21

cervical mucosa

Answer 21

simple, columnar epithelium of mucous secretory cells

• long, non-coiled, branching tubular glands with wide lumens
• produce hormone-dependent consistency mucus that is not shed during menses

Question 22

what are Nabothian cysts?

Answer 22

result from occlusion of cervical gland ducts

• secretory product accumulates in plugged ducts
• not neoplastic, and usually resolve without intervention
• also found in endometrium, so not reliable to identify cervix

Question 23

cervical wall and during pregnancy?

Answer 23

dense CT with smaller amounts of smooth muscle

-during pregnancy, collagen and elastin fibers rearrange for birth

Question 24

external os

Answer 24

protrusion of cervix into superior part of vagina

-transformation zone is junction between cervix (simple, columnar) and vagina (stratified squamous

Question 25

what is the most frequent origin of cervical carcinomas?

Answer 25

external os

Question 26

what are Pap smears?

Answer 26

cytological examinations of transformation zone scrapings to detect cervical carcinomas - normal: squamous cells are uniform size with pyknotic nuclei - abnormal: heterogenous and euchromatic nuclei

Question 27

vaginal mucosa

Answer 27

statified, squamous, non-keratinized epithelium that accumulate glycogen in response to estrogen (fermented by bacteria to make acidic) - frequently infiltrated by lymphocytes and neutrophils - lamina propria is well vascularized and rich in elastic fibers (to muscularis), lymphocytes, and neutrophils - NO GLANDS

Question 28

vaginal muscular layer

Answer 28

smooth muscle fibers in 2 indistinct layers (inner circular and outer longitudinal)

Question 29

vaginal adventitia

Answer 29

elastic CT forms resiliant sheath around muscular layer

Question 30

nipple and areola

Answer 30

- highly pigmented skin that increases at puberty - long dermal papillae - radial and circumferential smooth muscle fibers in underlying dense, irregular CT allows erection - sebaceous, sweat, and modified mammary (Montgomery) glands underlie areola

Question 31

what empties at the nipple surface?

Answer 31

termini of lactiferous ducts (ductuli papillares)

Question 32

breast general histology

Answer 32

1. parenchyma - mammary glands (ducts and secretory elements) - Montgomery and compound tubuloalveolar glands 2. stroma - CT surrounding parenchyma

Question 33

what is a breast lobe?

Answer 33

largest unit of duct system (15-25 lobes in each breast) - drain into lactiferous duct and sinus at nipple - fibrous CT and white adipose separate lobes - lactiferous ducts subdivide within lobes to form interlobular (extralobular) ducts that end at breast lobules

Question 34

what is a breast lobule?

Answer 34

basic structural unit of duct system - intralobular ducts, secretory element in loose CT stroma - separated by dense irregular CT stroma (interlobular stroma) and adipocytes

Question 35

what is a terminal duct lobular unit? why is it clinically relevant?

Answer 35

a breast lobule plus its associated interlobular duct | -most common place where breast cancer arises

Question 36

breast development before puberty

Answer 36

for both genders - lactiferous sinuses near nipple - small, branching ducts

Question 37

breast development during puberty in girls

Answer 37

estrogen stimulates adipose and CT accumulation (determine size) -duct system elongates

Question 38

inactive adult breast - parenchyma - stroma - menstrual cycle changes

Answer 38

1. parenchyma - simple, cuboidal epithelium for ducts, with little/no secretory component - myoepithelial cells abundant in duct epithelium and basement membrane 2. stroma - loose CT within lobules (intralobular stroma) - dense irregular CT with adipocytes between lobules (interlobular stroma) 3. menstrual cycle changes - early in cycle: duct lumens reduced - ovulation - secretory cells increase in height, make some secretions

Question 39

breast during pregnancy (general) - parenchyma - stroma

Answer 39

- parenchyma grows due to estrogen, progesterone, prolactin, and placental lactogen - stroma decreases - -plasma cells, lymphocytes, eosinophils infiltrate intralobular stroma

Question 40

first half VS second half pregnancy breast

Answer 40

1. intralobular duct cells proliferate (strongly estrogen-dependent) with mitotic profiles - end buds (stratified, cuboidal epithelium) form at duct ends - duct cell cytoplasm is basophilic (prepare for PRO) 2. end buds hollow out to form alveoli (simple cuboidal with myoepithelial cells) - fat and PRO droplets accumulate in alveolar epithelium - -apocrine snouts appear on alveolar epithelial cell apical surfaces

Question 41

lactating breast

Answer 41

milk accumulates in alveoli as basophilic lumen secretions - alveolar epithelial cells are prominent basophilic cytoplasm, frequently large pale apical cytoplasmic lipid droplet that produces colostrum/milk - -alveoli that actively make milk and those that rest co-exist in same breast

Question 42

colostrum VS milk contents

Answer 42

C: higher PRO, vit A, Ab; lower lipid, CHO milk: merocrine PRO and apocrine lipid

Question 43

where do IgAs in milk come from?

Answer 43

made by plasma cells in intralobular stroma for passive immunity

Question 44

breasts in menopause

Answer 44

atrophy of breast parenchyma -alveoli disappear, ducts persist reduction of stroma -loss of fibroblasts, collagen, elastic fibers