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External Genitalia
Functions:
production of female gametes reception of male gametes provision of a suitable environment for fertilization development of fetus and its expulsion nutrition of newborn
OVARY
flattened ovoid bodies suspended on either side of the uterus on the lateral wall of the pelvic cavity gland of double function: exocrine (cytogenic) endocrine Hilum: Vascular CT of the mesovarium becomes continuous with the ovarian stroma Germinal epithelium: a layer of cuboidal cells that replaces the peritoneal covering of the mesovarium a misnomer because it does NOT give rise to the primordial germ cells a specialization of the peritoneal mesothelium resting on a thin basal lamina
Ovary
Tunica albuginea: a layer of dense CT beneath the peritoneal mesothelium which increases in density with advancing age Has a cortex and a medulla
Ovary
GERM CELLS
Located in the ovarian follicles at cortical region of the ovary Germ cells: arise in the yolk sac and of endodermal in origin
a large nucleolus, well developed golgi apparatus, surrounded by numerous small mitochondria
Zona pellucida:
amorphous material deposited around the microvilli containing mucoprotein substance homogenous in fresh condition elaborated by the granulosa cells
Graffian Follicle
Granulosa cells:
stratified cuboidal epithelium with the basal layer of low columnar type resting on a prominent basal lamina cells are small with irregular cell outlines and uniform nuclei
Theca Externa
composed of concentrically arranged fibers & fusiform cells of ABSENT secretory function may have a significant role in post-ovulatory collapse of follicles
Ampulla: numerous elaborately branched folds Isthmus: short and rarely branched Interstitial part: Loxw folds Infundibulum: folds are continuous with the fringes
Oviduct
OVIDUCT
Lining Epithelium: Simple columnar epithelium; ciliated or nonciliated
Peg Cells: non-ciliated cells secreting glycoprotein into the lumen to provide nutrition to the ovum. Ciliated Cells:
Greatest at the region of infundibulum and least at the isthmus The cilia beat in the direction towards the uterus
Epithelial cells: undergoes cyclic changes along with the uterine mucosa True glands are absent and there is no true muscularis mucosae Tunica Muscularis: Inner circular or Spiral while Outer Longitudinal
in arrangement
UTERUS
thick walled, hollow pear-muscular organ, flattened in a dorsoventral direction Anatomical Divisions:
Upper expanded body or Corpus Uteri fundus (rounded, dome-shaped top) Isthmus (narrow transition between the corpus & cervix) cervix (narrow neck whose terminal portion projects to the vagina, i.e. portio vaginalis)
UTERUS
Histological Divisions:
Perimetrium or Serosa
Peritoneal layer of broad ligament covering the corpus & a portion of the cervix Composed of a single layer of mesothelial cells supported by a thin CT layer that is firmly adherent to the muscular layer Constant all throughout the cycle
Uterus
Muscularis or Myometrium
Shows changes only during pregnancy Massive coat of smooth muscle about 12 to 15 mm thick 3 layers:
Inner layer or sub-vascular stratum:
longitudinally arranged absent in the cervix
UTERUS
Outer layer or supra-vascular stratum: relatively thin composed of both circular and longitudinal fibers Longitudinal fibers becomes continuous with the longitudinal muscle coat of vagina
Fibers are shortest during the 1st week after menstruation & has the greatest length during the 4th week of the cycle During pregnancy, there is both an increase in muscle length and number. Cervix: has a firm consistency due to its dense fibrous nature
UTERUS
Mucosa or Endometrium
Undergoes all the changes that take place in the different phases of reproductive cycle Thin, pink, velvet-like membrane with perforations by the ostia of the uterine glands Intermenstrual phase
Lined by simple columnar epithelium, ciliated & non-ciliated cells Ciliated cells are located in discrete patches Non-ciliated cells exhibit secretory activity Epithelium rests on a delicate basement membrane and a considerably thick lamina propria with characteristic embryonal CT rich in fibroblasts
Normal Uterus
Non-pregnant Uterus
Pregnant Uterus
UTERUS
Two principal layers:
Stratum Functionalis
Thick superficial portion Supplied with coiled arteries Subdivisions: Stratum compactum or superficial dense portion Stratum spongiosum or deeper portion of looser texture
Stratum Basalis
Thin deeper portion of the lamina propria Contains uterine glands and a network of straight coursed capillaries that are independent from the blood vessels of the stratum functionalis The ONLY LAYER THAT REMAINS INTACT DURING MENSTRUATION
UTERUS
Vascular Architecture:
Uterine & Ovarian arteries arcuate arteries (middle third of uterine wall) radial arteries coiled or spiral arteries & basal arteries Coiled or Spiral arteries
Supplies most of the the mid portion & ALL of the superficial third of the endometrium Walls of these vessels are sensitive to the action of
hormones
UTERUS
Uterine Glands
Found in the lamina propria of the fundus & corpus of the uterus Slightly branched tubular glands extending to the entire thickness of the endometrium to the myometrium Lined by simple columnar ciliated epithelium Secretes a thin alkaline fluid to keep the uterine cavity moist
CERVIX
Lining Epithelium: tall columnar non-ciliated mucous secreting epithelium
at the level of internal os, ciliated cells are occasionally seen at the level of external os, an abrupt change to stratified squamous epithelium is seen that is similar to the vaginal epithelium
Tunica propria: less cellular than those of fundus and body; contains many collagen & elastic fibers & cervical glands
CERVIX
CERVICAL GLANDS
Large branched tubular glands lined by simple columnar mucous secreting cells that is affected by estrogen Branches of these glands are closed off from the lumen forming cyst-like dilatations filled with mucus, i.e. Nabothian cysts / follicles / ovules Spinnbarkait: property of cervical mucus that permits it to be drawn out in long strands; which is maximal at the time of ovulation
Cervix
CERVIX
Mucus:
change in the consistency of mucus from highly viscous state to a less viscous, more highly hydrated at the mid-cycle Microscopic patterns:
fern-like pattern -7th to 18th day of menstrual cycle By day 21, there is no fern or palm leaf pattern During pregnancy, there is a bladed or cellular appearance
menstruation and is thicker than the body of the uterus Plica palmitae or arbor vitae: numerous branching
folds of the cervical mucosa
CERVIX
Muscular Coat: thinner than that of the body of the uterus and fewer blood vessels present Fibrous Coat: Loose Areolar CT Portio Vaginalis:
stratified squamous epithelium rich in glycoprotein from a tall columnar epithelium of the endocervix Site of Cervical CA (Papanicolaou Smear: desquamated cells from the vagina and cervix are examined microscopically for CA detection)
STAGE
ENDOMETRIAL CYCLE
HIGHLIGHTS
follicular growth & estrogen secretion period varies greatly - thin endometrium - narrow tubular glands of straight course toward the basal layer epithelium is low columnar with round nuclei stromal cells are packed densely with small deep staining nuclei * in the superficial layer, these cells are packed loosely, rounded, vesicular, and has larger nuclei 2-3 days after ovulation, mitotic figures appear in the gland no lymphocytic infiltration - glandular hyperplasia glandular epithelium is taller & pseudostratified by ovulation - increase in stromal ground substance - thicker endometrium progestational stage active corpus luteum - endometrium thickness decrease d/t loss of fluid 3 zones become well-defined *basal zone (layer adjacent to myometrium) *Spongy zone (layer between the compact & basal layers) undergoes little histologic changes during menstruation mitosis in the glands present lacy labyrinth with scanty stroma between the tortuous glands (characteristic of the luteal phase) *Compact Zone (immediately beneath the endometrial surface) thickening of endometrial stroma (d/t edema) - glands are nearly straight & narrower in the compact & superficial layer with the lumen often filled with secretions - endometrium (5-mm thick) is extremely vascular, succulent & rich in glycogen - Stromal cells (fibroblasts, PMN, macrophages, lyphocytes & monocytes) undergo hypertrophic changes - appearance of spiral or coiled arteries becoming more tortuous & dilated)
Late
Secretory or
Luteal Early
Late
ENDOMETRIAL CYCLE
Pre-Menstrual or Ischemic interruption of coiled arteries
- 2-3 days before menstruation - regression of corpus luteum d/t decrease estrogen & progesterone levels - stromal infiltration by PMN or mononuclear WBC - disintegration of reticular framework of stroma in the superficial layer - decrease thickness of endometrium d/t loss of fluid & secretion (2 days) - functional layer is pale d/t: collapse of arteries & glands constriction of coiled arteries - vasoconstriction of arterioles & coiled arteries precedes the onset of menstrual bleeding superficial to 2/3 of mucosa becomes inadequately supplied
Menstrual
- external menstrual discharge: decrease in estrogen & progesterone endometrium undergoes involution & is partially destroyed bleeding maybe of either arterial or venous in origin upon hematoma formation, superficial endometrium is distended & ruptures necrosis shed coiled arteries relax, bear the surface, the vessel walls break and blood is added to the secretion hemorrhage stops when the coiled arteries vasocontrict again MENSTRUAL DISCHARGE -35 ml; does not clot d/t presence of fibrinolytic enzymes -whole functional layer is lost -basal layer remains intact -anovulatory type: cycle wherein bleeding is due to a non-production of a ripe follicle
18
Mitosis ceases
20
Few vacuoles
20 to 21
23 to 24
Predecidualization (increase in stromal cells, starts 1st in the region around spiral arteries)
Role of Prostaglandins:
Both endometrium & deciduas are enriched with arachidonic acid Initiation of parturition & maintenance of Labor Menstruation in non-pregnant Mechanism is by induction of vasoconstriciton
Menopause:
cessation of cyclic changes in the uterus atrophic mucosa, fewer and shorter uterine glands (may appear cystic), lamina propria changes to areolar type Increased amount of fibrous tissue in the muscular coat
Cytotrophoblast inner layer of cells with clearly defined cell boundaries Syncytiotrophoblast outer layer of mutinucleated protoplasmic mass
Forms the primitive villi which are epithelial cords extending out into the surrounding space Chorion:
Primitive embryonic CT comes in relation with trophoblast Chorionic or Secondary Villi: Embryonal CT with fetal blood vessels extending into the into the Villi
Chorion Leve: surface of the chorion degenerate by the 3rd month of pregnancy Fetal component: deeply embedded (chorion frondosum) chorionic plate: firm plate-like structure which is a portion of the chorion to which the villi are attached
Decidua Capsularis or reflexa - mucosa between the embryo & lumen of the uterus Decidua Parietalis or Vera remaining mucosa of body & fundus of uterus
endometrium increase in early part of pregnancy glands enlarge & become more tortuous Decidual cells: large & rounded endometrial stromal cells
may contain two or more nuclei (large with sparse chromatin & nucleoli) Vesicular cytoplasm containg glycogen rarely present by the end of pregnancy
PLACENTA
FETAL COMPONENT MATERNAL COMPONENT -chorionic plate -chorionic villi 2 types of Villi a. anchoring villi -pass from the chorionic plate to d. basalis b. free or floating villi Structure of a villus has a central core of mesenchymal tissue containing fetal blood vessels which are covered by trophoblasts. Hofbauer Cells: large cells with spherical nuclei found in the core of phagocytic function lined by typical endothelium
Placental Barrier: 1. Syncytial trophoblast separates the maternal circulation from the fetal circulation. 2. Composed of: a. cytotrophoblast in the 1st trimester b. basal lamina of the trophoblast c. wall of the fetal blood vessels (fetal CT, basal lamina of the fetal capillaries, & fetal endothelium) Placental Secretions: -human chorionic Gonadotropin *maintenance of corpus luteum of pregnancy -placental Lactogen *stimulates milk synthesis -progesterone & estrogen
Trophoblasts covering the villus cellular trophoblast (cytotrophoblast) 1.inner layer of cell mass (undifferentriated) 2. a.k.a. Langhans layer - consists of large, discrete pale cells - cytoplasm contains glycogen & vacuoles -desmosomes present Syncytial trophoblast (syncytiotrophoblast) 1.outer layer next to the spaces filled with maternal blood 2.dark layer of variable thickness showing numerous small dark nuclei 3.absent intercellular boundaries 4.microvilli present on the outer surface 5.dense cytoplasm (lysosomes & RER abundant) 6.Syncytial sprouts or knots: protuberances formed in the latter half of pregnancy as syncytiotrophoblasts aggregate 7.Fibrinoid: irregular masses of acidophilic homogenous substance present on the outer surface of the placenta
-decidua basalis *by the 4th month, it becomes loose in texture due to rich venous plexus -decidual cells prominent during 1st half of pregnancy: smaller decidual cells contain glycogen protective role in preventing trophoblast from penetrating into the myometrium (placenta acerata) secretory role: prostaglandins & prolactin -glandular epithelium is rich in glycogen & lipid droplets -Placenta Septa: projections formed as the deciduas is deeply eroded by the spiral arteries located opposite the anchoring villi
Umbilical Cord
VAGINA
hollow, musculo-fibrous organ, collapsed under ordinary conditions Histological Divisions:
Mucosa
Thrown into folds (rugae) and is lined by stratified squamous non-keratinizing epithelium Glycogen: accumulated by epithelium, particularly at the time of ovulation, thus appear vacuolated. Serves as a nutrient for male germ cell Fermented by bacteria converting it into lactic acid, which is important in maintaining a suitable type of bacterial flora in the vagina During estrogen phase of the cycle, the vaginal fluid is acidic (lower pH) than at other times Tunica Propria: loose areolar CT which has papillae that project towards the lining epithelium
Vagina
VAGINA
In the anterior wall, there are less papillae while in the posterior wall, there are numerous Contains abundant elastic fibers & WBC Dense plexus of small veins are found in the deeper portion Vaginal wall is devoid of glands. The mucus found in the lumen is derived from the glands of the cervix
Muscular Coat
Smooth Muscle : Outer layer is longitudinally arranged continuous with the myometrium while inner portion is circular Skeletal Muscle: present at the level of introitus or ostium which are fibers of the bulbocavernosus that acts as a sphincter
Vestibule:
Vaginal and urethral openings are lined by stratified squamous Skenes glands or glandulae vestibulares minores
Resemble the glands of Littre and contains mucous cells Located around the opening of the urethra and on the clitoris
MAMMARY GLANDS
specialized cutaneous glands located within the subcutaneous tissue a fully developed mammary gland is similar to that of the sebaceous glands (modified sweat gland) Before puberty: mammary glands are similar in both sexes, scanty fibrous stroma with few, short and narrow blind ducts After puberty: in the female
an increase in the CT stroma and accumulation of adipose developed ductal system beyond the rudimentary stage & several branches start to appear Cluster of cells soon appear to differentiate into true alveoli
Later months of pregnancy Breast Enlargement: hypertrophy of parenchymal cells distention of the alveoli with a eosinophilic secretion, colostrums Colostrum: secretion formed during the first few days after parturition Contains cellular debris, including cells of probable leukocytic origin, large fat globules, and more Immunoglobulins than milk Secretory Alveoli: Varies from tall epithelium to low columnar cells If tall: distal ends separated projecting into the lumen, with more organelles If short: smooth surface, granular-slightly acidophilic cytoplasm, few mitochondria Lumen is crowded with lipid droplets & fine granular material Apocrine in nature (partial disintegration) Milk Protein component: merocrine Secretion Fat component: Apocrine secretion CT stroma is greatly thinned Ducts are numerous Milk Let down: Oxytocin