Week 2 - Female Genital Tract Flashcards
Ovary
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
Clinical Presentations of Ovaries
Swelling
Abdominal/ pelvic pain
Ascites
Elevated CA-125
Clinical Investigation of Ovaries
Abdominal US and CT scan
Laparoscopy and Peritoneal washing
Histology of Ovaries
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
Ovarian Follicles
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
Pathological Conditions of the Ovaries
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
Stages of Ovarian Carcinoma
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
Fallopian Tube
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
Fallopian Tube - Histology
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
Secretory Cells in the Fallopian Tubes
Non ciliated, and contain apical granules and produce tubular fluid
Progesterone increases their number while oestrogen increases their height and secretory activity
Uterus
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
Uterus - Histology
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
Uterus Clinical Presentations
DUB - menorrhagia, dysmenorrhoea, PMB
Palpable abdominal mass, pelvic pain
Reflected symptoms - urinary frequency, constipation
Uterus Pathology
Non neoplastic:
- DUB
- polyp
- infection
- POC
Neoplastic:
- endometrial hyperplasia
- endometrial carcinoma
- uterine smooth muscle tumours adenomyosis
Indications for Endometrial Biopsy
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
Endometrial Biopsies and Resections
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
Cervix
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
Clinical Cervix Presentations
Discharge
Bleeding - PCB, IMB, DUB, CB
Abnormal cervical screening test
Tumour at os
Cervix Clinical Investigations
Most preinvasive disease detected on CST
Significant abnormalities go for colposcopy
Ectocervix - Histology
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
Endocervix Histology
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
Transformation Zone Histology
Metaplastic cells derived by endocx reserve cells, found at the transition between glandular and squamous epithelia
Cervix Surgical Specimens
Colposcopic punch, loop or con
Resections
- conservative - e.g. trachelectomy (removal of cervix, upper vagina and LNd
- radical BSO
- pelvic exentoration
What are Endometrial Curretage’s Good For?
Any kind of endometrial hypertrophy/hyperplasia/adenocarcinoma
Placenta Histology and Transfer of Nutrients from Mother to Foetus
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
What does an absense of PAS + staining in the squamous epithelium of the cervix indicate?
Absense of oestrogen, possible menopause
What do these images indicate?
Top:
- proliferative phase endometrium
- extremely thick functionalis with elongation of endometrial glands
Bottom:
- secretory phase endometrium
- oedematous (whiter areas)
