Pathology of the Female Reproductive Tract 1

Question 1

Microscopic Anatomy

• Normal anatomy informs pathology
• Microscopic changes in cells and tissues are translated into … …
• … originate from cellular components of tissues

Answer 1

• Normal anatomy informs pathology
• Microscopic changes in cells and tissues are translated into clinical disease
• Neoplasms originate from cellular components of tissues

Question 2

Vulva and Vagina

• L Majora skin with … follicles and … glands
• L minora and vagina - Mucosa with … … epithelium

Answer 2

• L Majora skin w hair follicles and sweat glands
• L minora and vagina Mucosa with stratified squamous epithelium

Question 3

Vagina at puberty

• … secreted by the ovary stimulates maturation of … epithelial cells
• Glycogen is formed within … … epithelial cells
• Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by …)
  
  • … produce lactic acid keeping vaginal pH below …

Answer 3

• Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells
• Glycogen is formed within mature squamous epithelial cells
• Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)
  
  • Lactobacilli produce lactic acid keeping vaginal pH below 4.5

Question 4

Cervix

• ..cervix
• ..cervix
• … zone

Answer 4

• Ectocervix
• Endocervix
• Transformation zone

Question 5

Cervix (Diagram)

Answer 5

Question 6

Ectocervix

• Covered by … … epithelium

Answer 6

• Covered by stratified squamous epithelium

Question 7

Endocervix

• Single layer of tall, … producing … cells

Answer 7

• ​Single layer of tall, mucin producing columnar cells

Question 8

The endocervix has a deceptively large surface area

• … epithelium lines tiny blind ending channels (‘…’)
• These radiate out from the endocervical canal into the surrounding …

Answer 8

• Columnar epithelium lines tiny blind ending channels (‘clefts’)
• These radiate out from the endocervical canal into the surrounding stroma

Question 9

Cervix

• _​_The ectocervix is covered by … … epithelium
• The endocervix is lined by … epithelium
• The junction between the two is called the ‘…-… junction

Answer 9

• The ectocervix is covered by stratified squamous epithelium
• The endocervix is lined by columnar epithelium
• The junction between the two is called the ‘squamo-columnar junction

Question 10

Formation of the transformation zone

• During puberty the cervix changes …
• The … of the cervix grow
• The … end of the endocervix opens
• Endocervical … becomes exposed to the vaginal environment

Answer 10

• During puberty the cervix changes shape
• The lips of the cervix grow
• The distal end of the endocervix opens
• Endocervical mucosa becomes exposed to the vaginal environment

Question 11

The transformation zone

Answer 11

Question 12

Cervix

• The distal endocervical … epithelium is exposed to the … vaginal environment
• It is not suited to this, so undergoes an adaptive change called …
• Reserve cells in this area proliferate and mature to form … epithelium: This process is called … …

Answer 12

• The distal endocervical columnar epithelium is exposed to the acidic vaginal environment
• It is not suited to this, so undergoes an adaptive change called metaplasia
• Reserve cells in this area proliferate and mature to form squamous epithelium: This process is called squamous metaplasia

Question 13

Metaplasia =

Answer 13

a transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

Question 14

The cervical transformation zone

Answer 14

Question 15

Squamous Metaplasia - Cervix

• At first, the metaplastic squamous epithelium is … and … (lots of … & maturation is incomplete)
• With time, the metaplastic epithelium comes to be as strong and well formed as that on the …

Answer 15

• At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation & maturation is incomplete)
• With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

Question 16

Where is the uterus?

Answer 16

Question 17

Mid sagittal section of the …

Answer 17

body of the uterus

Question 18

What is the myometrium?

Answer 18

The myometrium is the middle layer of the uterine wall

Question 19

What is the endometrium?

Answer 19

The endometrium is the innermost lining layer of the uterus

Question 20

Endometrium - 3 components (proliferative phase - before ovulation)

• … glands
• Specialised …
• … vessels

Answer 20

• Tubular glands
• Specialised stroma
• Blood vessels

Question 21

Endometrium - 3 components - Secretory Phase

• … … glands
• Specialised …
• … vessels

Answer 21

• Cork screw glands
• Specialised stroma
• Blood vessels

Question 22

Neoplasia:

• meaning ‘new growth’ – …, … and … cell growth
• persists following .. of stimulus and associated with … alterations

Answer 22

• meaning ‘new growth’ – abnormal, uncoordinated and excessive cell growth
• persists following withdrawal of stimulus and associated with genetic alterations

Question 23

Nomenclature of Neoplasms

• Different neoplasms have different …
• Accurate … and naming therefore important for treating the patient

Answer 23

• Different neoplasms have different behaviour
• Accurate identification and naming therefore important for treating the patient

Question 24

Neoplasms are classified according to their behaviour and histogenesis

• Behaviour: … or …
• Histogenesis: Recognising the … of …

Answer 24

• Behaviour: Benign or Malignant
• Histogenesis: Recognising the cell of origin

Question 25

_Behaviour of Neoplasms - Benign_ * Remains ... and doesn’t ... surrounding tissues * Generally grow ... * Good ... of parent tissue

Answer 25

* Remains **localised** and doesn’t **invade** surrounding tissues * Generally grow **slowly** * Good **resemblance** of parent tissue

Question 26

_Example of a benign neoplasm of smooth muscle of myometrium_

Answer 26

Question 27

_Leiomyoma of the myometrium_ * closely resembles ... tissue

Answer 27

* closely resembles **parent** tissue

Question 28

_Consequences of benign neoplasms_ * ... on adjacent tissue * ... of ... of a hollow organ * ... production * Transformation into a ... neoplasm * ... for the patient

Answer 28

* **Pressure** on adjacent tissue * **Obstruction** of **lumen** of a hollow organ * **Hormone** production * Transformation into a **malignant** neoplasm * **Symptoms** for the patient

Question 29

_Benign neoplasms - clinical problems_ * Pressure on adjacent tissue * Bladder (**...**) Rectosigmoid (**...**) * Obstruction to lumen of a hollow organ * Adjacent (...) Blocking endocervix * Hormone production * ? ... producing polycythaemia * Transformation into a ... neoplasm * Probably malignancy arises de novo * Abnormal uterine ..., ...

Answer 29

* Pressure on adjacent tissue * Bladder (**frequency)** Rectosigmoid (**constipation**) * Obstruction to lumen of a hollow organ * Adjacent (**ureters**) Blocking endocervix * Hormone production * ? **Erythropoietin** producing polycythaemia * Transformation into a **malignant** neoplasm * Probably malignancy arises de novo * Abnormal uterine **bleeding, pain**

Question 30

_Behaviour of Neoplasms - Malignant_ * Invade into ... tissues * Spread via ... to ... ... and ... vessels to other sites (...) * Generally grow relatively ... * ... resemblance to parent tissue

Answer 30

* Invade into **surrounding** tissues * Spread via **lymphatics** to **lymph nodes** and **blood** vessels to other sites (**metastasis**) * Generally grow **relatively** **quickly** * **Variable** resemblance to parent tissue

Question 31

_Malignant neoplastic tissue looks different to normal tissue._ * loss of ... * loss of cellular ... * enlarged irregular ... nuclei * increased numbers of ...

Answer 31

* loss of **differentiation** * loss of cellular **cohesion** * enlarged irregular **dark** nuclei * increased numbers of **mitoses**

Question 32

... tissue vs ... ...

Answer 32

normal tissue vs a malignant neoplasm

Question 33

_Consequences of malignant neoplasms_ * Destruction of ... tissue * M... * Blood loss from ... surfaces * Obstruction of a ... viscera * Production of ... * ... loss and debility

Answer 33

* Destruction of **adjacent** tissue * **Metastasis** * Blood loss from **ulcerated** surfaces * Obstruction of a **hollow** viscera * Production of **hormones** * **Weight** loss and debility

Question 34

_Histogenesis of neoplasms_ * ... by cell of origin * Determined by examining tissue under the ... * Resemblance to parent tissue correlates with ... behaviour

Answer 34

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

Question 35

_Terminology of neoplasia_ * Neoplasms have the suffix – ... * Malignant epithelial tumours are ... * These are named for the ... cell type which they resemble * ... of glandular epithelium are called ... * Malignant stromal tumours are ...

Answer 35

* Neoplasms have the suffix – **oma** * Malignant epithelial tumours are **carcinomas** * **Carcinomas** are named for the **epithelial** cell type which they resemble * Carcinomas of glandular epithelium are called **adenocarcinomas** * Malignant stromal tumours are **sarcomas**

Question 36

Malignant stromal tumours are ...

Answer 36

Malignant stromal tumours are **sarcomas**

Question 37

Carcinomas of glandular epithelium are called **...**

Answer 37

Carcinomas of glandular epithelium are called **adenocarcinomas**

Question 38

Malignant epithelial tumours are ...

Answer 38

Malignant epithelial tumours are **carcinomas**

Question 39

Overview of Benign Vs Malignant

Answer 39

Question 40

_Malignant tumours of female reproductive tract_

Answer 40

Question 41

_Malignant tumours of female reproductive tract_ * **Vulva** -\> squamous -\> squamous cell ... * **Vagina** -\> squamous -\> squamous cell ... * **Cervix** -\> squamous -\> squamous cell ... * glandular -\> ... * **Endometrium** -\> glandular -\> ... * stroma -\> stromal ... * **Myometrium** -\> sm muscle -\> ...

Answer 41

* **Vulva** -\> squamous -\> squamous cell **carcinoma** * **Vagina** -\> squamous -\> squamous cell **carcinoma** * **Cervix** -\> squamous -\> squamous cell **carcinoma** * glandular -\> **adenocarcinoma** * **Endometrium** -\> glandular -\> **adenocarcinoma** * stroma -\> stromal **sarcoma** * **Myometrium** -\> sm muscle -\> **leiomyosarcoma**