Week 2 - Female Genital Tract

Question 1

Ovary

Answer 1

Paired structures lying in the R&L iliac fossae attached to the posterior aspect to the broad ligaments
Reproductive age-3cm in diameter
External surface smooth or convoluted
Contains an outer cortex and inner medulla including cystic follicles, corpora lutea and corpora albicantia
Covered by a layer of peritoneum called the mesovarium

Question 2

Clinical Presentations of Ovaries

Answer 2

Swelling
Abdominal/ pelvic pain
Ascites
Elevated CA-125

Question 3

Clinical Investigation of Ovaries

Answer 3

Abdominal US and CT scan
Laparoscopy and Peritoneal washing

Question 4

Histology of Ovaries

Answer 4

The ovaries are covered by surface epithelium which is a modified mesothelium also referred to as the germinal epithelium
- flat to cuboidal mesothelial type cell which appear to actively participate in ovulatory rupture and the repair process
Has a peripheral cortex and central medulla, where numerous blood vessels, nerves and lymphatics are found
- cortex contains fibrocytes with collagen and reticular fibres
- medulla is dense irregular CT that is continuous with the mesovarium ligament

Question 5

Ovarian Follicles

Answer 5

Numerous ovarian follicles seen in cortex
The most numerous are primordial follicles - located in the periphery of the cortex and inferior to the tunica albuginea
- smallest and simplest follicle in structure and are surrounded by a single layer of squamous follicular cells
- contain immature and small primary oocyte, which gradually increase in size as the follicles develop into primary, secondary and mature follicles
- prior to ovulation of the mature follicle, all developing follicles contain primary oocytes

Question 6

Pathological Conditions of the Ovaries

Answer 6

Simple cyst: thin walled without solid areas-follicular, corpus luteum, cystadenomas
Complex cysts: with or without solid component. Non neoplastic endometriotic , benign neoplasm - dermoid, borderline or malignant
Solid tumours: Benign fibroma, Brenner tumours or carcinomas, primary and metastatic-wide range

Question 7

Stages of Ovarian Carcinoma

Answer 7

Stage 1: tumour confined to the corpus uteri
Stage 2: tumour invades cervical stroma, but does not extend beyond the uterus
Stage 3: Local and/or regional spread of the tumour
Stage 4: tumour invades bladder and/or bowel mucosa and/or distant metastasis

Question 8

Fallopian Tube

Answer 8

Extend from the uterine cornu to the medial pole of the ovary
4 segments - intramural portion, isthmus, ampulla and
infundibulum
Infundibulum is fimbriated and opens into the pelvic cavity
Histology: mucosa, sub mucosa, muscularis and serosa covered by mesothelial cells

Question 9

Fallopian Tube - Histology

Answer 9

The mucosa of the ampulla exhibits complex mucosal folds that form an irregular lumen with deep grooves between the folds
- mucosa consists of a single layer of ciliated columnar cells, most abundant in the infundibulum and ampulla, with E2 increasing the production of cilia
Mucosa overlies the LP with an inner circular muscularis and an outer longitudinal muscularis layer
The interstitial CT is abundant between the muscularis layers with numerous arterioles and venules

Question 10

Secretory Cells in the Fallopian Tubes

Answer 10

Non ciliated, and contain apical granules and produce tubular fluid
Progesterone increases their number while oestrogen increases their height and secretory activity

Question 11

Uterus

Answer 11

The body of the uterus comprises the (superior) corpus and the (inferior) cervix
Part above the fallopian tube = fundus
The lower portion merging with the cervix = isthmus
Endometrium comprises glands and stroma on a wall of myometrial smooth muscle

Question 12

Uterus - Histology

Answer 12

Surface of endometrium is lined by a simple columnar epithelium that overlies a thick LP
Tubular uterine glands seen in LP with simple columnar epithelium
Walls of the uterus demonstrate the inner endometrium, separated by the functionalis layer and basalis layer
- middle smooth muscle = myometrium
- outer serous membrane = perimetrium

Question 13

Uterus Clinical Presentations

Answer 13

DUB - menorrhagia, dysmenorrhoea, PMB
Palpable abdominal mass, pelvic pain
Reflected symptoms - urinary frequency, constipation

Question 14

Uterus Pathology

Answer 14

Non neoplastic:
- DUB
- polyp
- infection
- POC
Neoplastic:
- endometrial hyperplasia
- endometrial carcinoma
- uterine smooth muscle tumours adenomyosis

Question 15

Indications for Endometrial Biopsy

Answer 15

Abnormal uterine bleeding
Postmenopausal bleeding
Cancer screening (e.g., hereditary nonpolyposis colorectal cancer)
Detection of precancerous hyperplasia and atypia
Endometrial dating (proliferative, secretory, ovulation)
Follow-up of previously diagnosed endometrial hyperplasia
Evaluation of uterine response to hormone therapy
Evaluation of patient with one year of amenorrhea

Question 16

Endometrial Biopsies and Resections

Answer 16

Biopsies
- Dilatation and curettage (D&C)
- Novak curette
- Pipelle
- TruTest-brush
Resections
- hysterectomy either TAH or subtotal
- radical resections may include part of the vagina and the parametrium

Question 17

Cervix

Answer 17

Joined to the body of the uterus
Part lies within the vagina surrounded by the fornix
Ectocervix covered by NKSq epithelium
Endocervix a single layer of mucin secreting cells, commences at the transformation zone

Question 18

Clinical Cervix Presentations

Answer 18

Discharge
Bleeding - PCB, IMB, DUB, CB
Abnormal cervical screening test
Tumour at os

Question 19

Cervix Clinical Investigations

Answer 19

Most preinvasive disease detected on CST
Significant abnormalities go for colposcopy

Question 20

Ectocervix - Histology

Answer 20

Stratified nonkeratinising squamous epithelium
Basal cells at the deepest layer, these have dense chromatin, uniform oval nuclei, usually orientated perpendicular to BM with scant cytoplasm
Parabasal cells - located above the basal cells, with more cytoplasm than basal cells and may have multiple cell layers
Intermediate cells - abundant cytoplasm, usually pink or clear due to glycogen accumulation
Superficial cells - these have small round central nuclei, abundant pink or clear cytoplasm, flat cells that are usually orientated to BM

Question 21

Endocervix Histology

Answer 21

Demonstrates a single layer of mucinous columnar cells with apical mucin
Mucin has a pale blue appearance in H&E stained sections, with PAS/AB apical mucin stains intense blue/purple due to the presence of acid type mucin
Ciliated cells can be found and are usually assoc with tuboendometrioid metaplasia
Inconspicuous underlying reserve cell layer - forms infoldings clefts and glands of variable shape

Question 22

Transformation Zone Histology

Answer 22

Metaplastic cells derived by endocx reserve cells, found at the transition between glandular and squamous epithelia

Question 23

Cervix Surgical Specimens

Answer 23

Colposcopic punch, loop or con
Resections
- conservative - e.g. trachelectomy (removal of cervix, upper vagina and LNd
- radical BSO
- pelvic exentoration

Question 24

What are Endometrial Curretage’s Good For?

Answer 24

Any kind of endometrial hypertrophy/hyperplasia/adenocarcinoma

Question 25

Placenta Histology and Transfer of Nutrients from Mother to Foetus

Answer 25

The villi invade into the decidua which is derived from the maternal endometrial lining
This invasion by the villi into the deciduam enables exchange of nutrients etc. from the mother to the foetus
They get the nutrients etc. through the lacuna

Question 26

What does an absense of PAS + staining in the squamous epithelium of the cervix indicate?

Answer 26

Absense of oestrogen, possible menopause

Question 27

What do these images indicate?

Answer 27

Top:
- proliferative phase endometrium
- extremely thick functionalis with elongation of endometrial glands
Bottom:
- secretory phase endometrium
- oedematous (whiter areas)