Reproductive System Medical Histology PDF

PATHOLOGY-1 Reproductive System Medical Histology Associate Professor Vinod Gopalan Academic Manager/Convenor-Y2 MD...

PATHOLOGY-1 Reproductive System Medical Histology Associate Professor Vinod Gopalan Academic Manager/Convenor-Y2 MD DKHI Lead- Y2 MD Histopathology & Medical Education School of Medicine & Dentistry, GU VINOD GOPALAN, Pathology, School of Medicine, Griffith University MALE REPRODUCTIVE SYSTEM FUNCTION Testes are responsible for production of spermatozoa and secretion of male sex hormones (Eg- testosterone). The ‘duct’ system collects, stores and conduct spermatozoa from each testis. Exocrine glands, seminal vescicles and prostate gland secrete a nutritive and lubricating fluid- Seminal fluid. Semen, the fluid expelled during ejaculation, consists of seminal fluid and spermatozoa plus some duct lining cells. Bulbourethral glands in the penis secrete fluid which lubricates the urethra for the passage of semen during ejaculation. free from RBC and immune cells VINOD GOPALAN, Pathology, School of Medicine, Griffith University  TESTES Normal Testes fluid accumulation hydrocoele - in tunica vaginalis b/w more significant sertoli cells more obvious on microscope http://gpvec.unl.edu/bse/physical_exam/testicular_defects.htm Rete testis in middle, small network to move sperm cells A network of small tubes in the testicle that helps move sperm cells (male reproductive cells) from the testicle to the epididymis. Function- Transport, mix the sperm and fluid seminiferous tubule reabsorption not need much fluid for efficiency Leydig b/w Clinical Significance: Cysts secrete testosterone rete testis - normal anatomical features seminiferous tubules - spermatids absence - pathology Vinod Gopalan, Pathology, School of Medicine, Griffith University Images obtained from Blue Histology and radiologykey websites. SEMINIFEROUS TUBULES Germ cells- involves in spermatogenesis and spermiogenesis Non-germ cells- Sertoli cells which support and nourish the developing spermatozoa Leydig cells- Endocrine cells seen in the interstitial spaces (between the seminiferous tubules). These cells secrete androgens (Eg- Testosterone). These cells are found in female ovaries as well. most from germ cells - 80%; non-germ cell also possible SPERMATOGENESIS LH acts, GnRH support and nourish support main spermatogonia Frontiers in Cell and Developmental Biology 2:56 VINOD GOPALAN, Pathology, School of Medicine, Griffith University SPERMATOGENESIS M- Myofibroblasts St- Sertoli cells SA- Spermatogonia type A SB- Spermatogonia type B S1- Primary spermatocytes S3- Spermatids S4- Spermatozoa large cells mitosis to spermatocytes Newborn - descent of testis non-descended temperature control - production of sperm factors: malnutrition, alcoholism, drugs, radiation cryptorchidism germ cell proliferation/division - affected testosterone levels - not altered primary to secondary precocious puberty - early puberty elongated tumours of adrenal gland cell responsible - precocious Leydig cells, adrenal... alcohol affects quality of sperm VINOD GOPALAN, Pathology, School of Medicine, Griffith University TESTIS- NORMAL HISTOLOGY CLICK TO VIEW thick tunica albuginea rete testis seminiferous tubules epididymis seminoma - not see normal healthy architecture Key tissue/cellular components: Discuss its functional significances 1. Seminiferous tubules 2. Sertoli cells and spermatids 3. Leydig cells 4. Rete testis in middle 5. Tunica albuginea http://gpvec.unl.edu/bse/physical_exam/testicular_defects.htm Vinod Gopalan, Pathology, School of Medicine, Griffith University left normal - not completely out hydrocoele test +ve hydrocoele important diagnostic test SELF ASSESSMENT CLINICAL SIGNIFICANCES Leydig cell tumours- The MOST common clinical precocious puberty presentation would be________________? + testicular mass TRUE/FALSE 95% of testicular tumours arise from germ cells. True Two majour functions of the rete testis transport fluid reabsorption - more concentrated sperm include_______________&__________________ and mixing of spermatozoa TRUE/FALSE Seminoma arises from Sertoli cells False - from testicular germ cells Name two hormones which controls the secretory activity of Leydig cells LH, GnRH Leydig - often not noticed, often less symptomatic non-germ cell - cannot limit to age VINOD GOPALAN, Pathology, School of Medicine, Griffith University PROSTATE Prostate gland consist of glands embedded in a fibromuscular stroma. It has 4 zones of unequal size. Transition zone: Surrounds proximal prostatic urethra and has 5% glands. Location for hyperplasia. Central zone: Surrounds the ejaculatory ducts. 20% glands Peripheral zone: 70% glands. Location for 70-80% of the carcinomas Anterior fibromuscular stroma: No glands Vinod Gopalan, Pathology, School of Medicine, Griffith University  hyperplasia adenocarcinoma - glands outside urethra from glands to BPH fibromuscular stroma behind the transitional the most common for carcinomas less likely glands central b/w peripheral for DRE transitional look for nodular mass and peripheral PROSTATE PROSTATE- NORMAL HISTOLOGY CLICK TO VIEW proteins accumulate PERIPHERY sign of prostatic cancer glands with stromal tissue zone = BPH - hyperplasia transitional stroma and glands BPH cancer - stroma less, urethra more glands transitional Key tissue/cellular components: Discuss its functional significances 1. Prostatic glands & secretory cells 2. Fibromuscular stroma 3. Corpora amylacea 4. Prostatic urethra & transitional epithelium Vinod Gopalan, Pathology, School of Medicine, Griffith University Prostate-Specific Antigen (PSA) Test PSA is a protein produced by cells of the prostate gland. In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. They include instrumentation increase PSA masturbation, sex... ▪ Prostatitis ▪ Benign prostatic hyperplasia (BPH) Normal Test? Increased BPA - inflammation, infarct, ischaemia, infection There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered as normal. Therefore, a man with PSA level > 4.0 ng/mL would often recommend for further investigation such as a prostate biopsy. calcify with prostatic stones New England Journal of Medicine 2004;350(22):2239-2246. BUT- Studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer. not a definite factor elevated - more investigation Vinod Gopalan, Pathology, School of Medicine, Griffith University SELF ASSESSMENT PROSTATE TRUE OR FALSE Hyperplastic lesions are commonly seen in the False peripheral zones and carcinomas are commonly occur in the transitional zone transition from gland to stromal Prostate stroma contains both smooth muscle fibres and fibrous (collagen) tissues. True - fibromuscular stronger with smooth muscle Many prostate cancers are clinically insignificant and does not require any treatment True - bound in prostate for decades. may die from overtreatment Presence of corpora amylacea is diagnostic Seen in many tissues finding in benign hyperplasia False - not suggestive of pathology deposited even in ageing, healthy Vinod Gopalan, Pathology, School of Medicine, Griffith University FEMALE REPRODUCTIVE SYSTEM Female genitalia has 2 parts: External and Internal External female genitalia includes; ❑Labia majora; Labia minora; Clitoris. external, squamous, keratinised - part of skin ❑All are lined by keratinised stratified squamous epithelium. VINOD GOPALAN, Pathology, School of Medicine, Griffith University External female genitalia – Vulva External genitalia made of labia majora, labia minora and clitoris rete ridges are sign of healthy skin basal Stratified keratinised squamous epithelium matured a lot of glycogen in Bartholin’s gland / major vestibular gland cytoplasm Acini lined w/ mucus- secreting columnar epithelium Keratin layer Duct lined by transitional epithelium fine layer transitional epithelium in there, acini VINOD GOPALAN, Pathology, School of Medicine, Griffith University Pathology overview Epithelial disorders Bulbar overall epidermis before puberty, after menopause Lichen sclerosus: Thinning of epidermis, absence of rete ridges, dermal fibrosis and chronic inflammation. Clinically present as leukoplakia/papules. thicken overall skin Can progress to SCC. thin epidermis white patch rete ridges absent both can coexist Lichen simplex chronicus: Significant epithelial thickening (no atypia) with hyperkeratosis. Do not progress to SCC but some association been reported. Clinically present as leukoplakia (patches or plaques). small white papule in females - consider as differential biopsy to confirm Differentials: Dermatoses, psoriasis and lichen planus thicken skin Dermatitis Pruritis Infections (HPV, HSV) Suppurative lesions - N. gonorrhoea VINOD GOPALAN, Pathology, School of Medicine, Griffith University Pathology overview Cysts Skene’s gland- paraurethral gland Secretions- antimicrobial functions Prevent UTI Pathology- Infection & Cyst proximal glands - lubircate antimicrobial inferior to vagina obstruct to cyst formation periurethral glands https://en.wikipedia.org/wiki/Skene%27s_gland#/media/File:Skenes_gland.jpg secondary bacterial infection BARTHOLIN CYST: Obstruction of the duct by an inflammatory process Usually painless mass if not infected. Infection will leads to abscess formation Microscopy: Ductal squamous metaplasia/epithelium Vinod Gopalan, Pathology, School of Medicine, Griffith University Pathology overview Neoplasms multifocal relate to HPV Vulvar Intraepithelial Neoplasm (VIN): SCC- Vulva: Commonly present as areas of leucoplakia. Can have the same presentation Some cases- pigmented (melanin) as VIN. Vulvar Neoplasms: Two forms like a growth 1. High-risk HPV (type 16) related [multi-focal] ulcerative 2. Non-HPV related [unifocal] small area Vinod Gopalan, Pathology, School of Medicine, Griffith University Pathology overview Neoplasms Intra-epithelial neoplasm SCC intraepithelial - not see basal cells and mature cells squamous cell nest not have matured cells smaller nest skin naturally produce nests zone absent - malignant... nests, pearls Vinod Gopalan, Pathology, School of Medicine, Griffith University  Pathology overview Vulvar Intraepithelial Neoplasia Identify the key features Keratin layer need further examination for HPV Neoplasia Keratin layer lack of zonal difference reproductive hyperchromatic Neoplasia clue of pathology flattened VINOD GOPALAN, Pathology, School of Medicine, Griffith University External female genitalia -Clitoris ❑A fold of skin over the clitoris forms a "hood" homologous to the foreskin of the penis. ❑Epithelium is located far from the erectile tissue. ❑The clitoris is composed of only two columns of erectile tissue. blood fills in erection - space to fill in Clitoris (CS): Abundant, cavernous sinuses and the relatively thin tunica albuginea, surrounding and separating the two columns of erectile tissue. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Clitoris: clinical significance Epidermal cyst of the clitoris A- Cystic enlargement of clitoris B- Normal looking clitoris after excision of the cyst BJU International 2001 88(9cr), 984 normal after inflamed VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; into vagina, no keratin ❑Vagina: Stratified squamous non-keratinized epithelium Epidermal cyst - HPV or non-HPV - squamous or non-squamous ❑Cervix ❑Ectocervix: Stratified squamous non-keratinized epithelium ❑Endocervix: Psuedo-stratified columnar ciliated epithelium no keratin onward ❑Uterus: Simple columnar epithelium ❑Fallopian tubes: Simple columnar epithelium ❑Ovary: Simple cuboid epithelium VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; Vagina ❑There is no epithelial keratin layer, but the mucosa is protected by the acid environment resulting from bacterial growth on a glycogen substrate released from the mucosa. flattened as get older mucosa Vaginal wall consisting of three layers: the mucosa, muscularis and adventitia of the vagina mucosa needs protection The normal adult vaginal mucosa with a wrinkled appearance that is seen in women of reproductive years appears at the left. The cervix has been opened to reveal an endocervical canal. bacteria grow - lactobacillus adenocarcinomas and sarcomas can occur needs acidic pH VINOD GOPALAN, Pathology, School of Medicine, Griffith University Vagina: Histology KEY PATHOLOGIES ▪ Vaginitis more lubricating ▪ SCC lumen no keratin mature cells more obvious Stratified Squamous Epithelium glycogen more obvious mature Lamina propria basal zone VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; Cervix ❑ Normal cervix with a smooth, glistening mucosal surface. smooth, glistening round more common for ❑ The cervical os is small and nulliparous round, typical for a nulliparous woman. ❑ The os will have a fish-mouth shape after one or more pregnancies. ❑ Has 2 parts Ectocervix & ectocervix - outside similar to lining vagina Endocervix risk of malignancy non-keratinised after birth e.g. oesophagus + stomach fish mouth Barrett's oesophagus carcinoma endocervix - columnar VINOD GOPALAN, Pathology, School of Medicine, Griffith University Cervix: Histology Ectocervix Mature zone: Why does the cytoplasm appears clear/empty? What is the clinical significance? Clear cytoplasm indicates glycogenation. As cells mature, the nuclei get smaller and cytoplasm amount increases. Zonal difference - pap smear Matured squamous cells Basal cells Sub mucosa VINOD GOPALAN, Pathology, School of Medicine, Griffith University Cervix: Histology Squamocolumnar junction-Endocervix transition zone 90% of genital tract neoplasms ❑ The inner cervix (Endocervix) lined by pseudo stratified columnar epithelium. ❑The squamous epithelium changes to a tall columnar epithelium at the cervical os – squamocolumnar junction (Transformation zone). ❑The squamocolumnar junction, where these two meet, is the most important cytologic and colposcopic landmark, as this is where over 90% of lower genital tract neoplasia arises. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Cervix: Histology Ectocervix-SC junction- Endocervix Cervical mucus functions as a barrier or a transport medium to spermatozoa most common for HPV and cervical carcinomas Columnar epithelium Squamous epithelium Mucus secretion from the endocervical glands cancer also from endocervical glands VINOD GOPALAN, Pathology, School of Medicine, Griffith University  February 2017 Clinical Case Reports 5(4) Cervix: Pathology overview Endo-cervical polyp Cervical Dysplasia massive growth change of cellular morphology Clinical Presentation Abnormal vaginal bleeding in HPV related between menstrual periods. Two key pathological progression Usually present as a cervical 1. CIN mass. 2. Carcinoma Low risk HPV (6, 11)- Condyloma genital warts High risk HPV (16, 18)-CIN and Carcinoma higher risk - 16, 18 VINOD GOPALAN, Pathology, School of Medicine, Griffith University Cervix: Histology Clinical significance HPV related carcinogenesis starts with a precancerous lesion called squamous intra-epithelial lesion (SIL). intra-epithelial lesion starts Classification Systems for Premalignant Squamous Cervical lesions Dysplasia / Cervical Squamous Carcinoma in Intraepithelial Intraepithelial Situ Neoplasia Lesion Mild dysplasia CIN I Low-grade SIL low risk regress Moderate dysplasia CIN II High-grade SIL LSIL- 60% regress HSIL- 20% regress Severe dysplasia CIN III High-grade SIL high risk - severe dysplasia and carcinoma Carcinoma in situ CIN III High-grade SIL VINOD GOPALAN, Pathology, School of Medicine, Griffith University Cervix: Pathology overview ❑ Histology of the cervix is critical for the use of effective cytologic screening, colposcopy, and biopsy for the management and treatment of cervical neoplasia. histology for screening clear nest and pearl function as it should well differentiated Squamous cell carcinoma: Nests of neoplastic squamous cells are invaded through a chronically inflamed stroma. This cancer is well- differentiated, as evidenced by keratin pearls. other - poorly differentiated VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; Uterus Composed of outer perimetrium, middle muscular layer (myometrium) and the inner endometrium. outside VINOD GOPALAN, Pathology, School of Medicine, Griffith University Uterus; Endometrium ❑The endometrium consists of a simple columnar epithelium and an underlying thick connective tissue stroma. glands to adenocarcinoma polyps from stroma ❑The mucosa is invaginated to form many simple tubular uterine glands. lots of blood vessels in endometrium ❑The glands extend through the entire thickness of the stroma, which also carries spiral arteries. ❑Only the endometrial mucosa of the uterus takes part in the menstrual cycle. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Uterus; Endometrium The endometrium can be divided into two zones: ❑Functionalis -Thick, superficial (surface epithelium, lamina propria and glands) - Rich capillary net work (coiled arteries) more vertical glands -Sloughed at menstruation horizontal glands ❑Basalis : -Deep, narrow (lamina propria & glands) -Straight arteries -Regenerate functionalis layer at each menstrual cycle VINOD GOPALAN, Pathology, School of Medicine, Griffith University HISTOLOGICAL CHANGES IN ENDOMETRIAL GLANDS Uterine Phases Changes in Endometrial glands Proliferative phase Long, straight Secretary phase Saw tooth or serrated appearance Menstrual phase Rupture of endometrial glands and lack of epithelium locked out VINOD GOPALAN, Pathology, School of Medicine, Griffith University MATCH THE IMAGES WITH UTERINE PHASES Image A Image B Image C Uterine Phases IMAGES Proliferative phase A Secretary phase sawtooth C Menstrual phase B VINOD GOPALAN, Pathology, School of Medicine, Griffith University UTERUS: ENDOMETRIUM Pathology-Overview Adenomyosis- Condition in which the myometrium may contain islands of ectopic endometrium, which may give rise to pain and other menstrual disturbances. should not be seen in myometrium in myometrial tissue, in uterus Endometriosis: Condition in which ectopic endometrial tissue may be found in various other sites throughout the pelvis and sometimes the abdominal cavity. Note: In this case, it may respond to the normal cyclical hormonal changes giving rise to bleeding into the tissues and consequent fibrosis. outside uterus e.g. near fallopian tube see bluish nodules Classic vesicular implants of endometriosis on the pelvic sidewall Images obtained from- http://www.acfs2000.com/basic_services /endometriosis.html Blue-black implants of endometriosis and resulting adhesions next to the uterus and involving the fallopian tube Active endometriosis on the edge of the liver and diaphragm Vinod Gopalan, Pathology, School of Medicine, Griffith University UTERUS: ENDOMETRIUM Pathology-Overview small tissue regurgitation theory - into fallopian tube and out metastases theory - into blood vessels or lymphatics, benign Endometriosis: metaplastic theory - stem cells converted into endometrial tissue, gland stem cell theory - stem cells to endometrial gland Einstein. 2012;10(1):39-43 common locations https://au.pinterest.com/pin/47076758581206036/ Clinical presentation: infertility, dysmenorrhea, pelvic pain, cyclic pain. Vinod Gopalan, Pathology, School of Medicine, Griffith University UTERUS: ENDOMETRIUM Pathology-Overview Adenomyosis of myometrium Endometriosis of Fallopian tube stroma very purple in fallopian tube Endometrial glands G and stroma S may be found outwith the endometrium itself. If the ectopic endometrium is found embedded deep within the myometrium M, the condition is known as adenomyosis; similar deposits at other sites are known as endometriosis. Vinod Gopalan, Pathology, School of Medicine, Griffith University UTERUS: ENDOMETRIUM Pathology-Overview 1. Endometrial hyperplasia 2. Endometrial polyp 3. Endometrial carcinoma fallopian tubes http://www.pubcan.org/syndrome.php?id=13&subject=sites VINOD GOPALAN, Pathology, School of Medicine, Griffith University Uterus: Endometrium Pathology-Overview all proliferating back to back, no stroma b/w normal here polyp - most common at fundus Endometrial adenocarcinoma (left) and polyp (right) Endometrial adenocarcinoma Two distinct histological types Endometrial polyp located in the fundus. 1. Endometrioid carcinoma This uterus has been opened anteriorly 2. Serous carcinoma (more aggressive, p53 mutation) through cervix and into the endometrial in uterus - aggressive cavity. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Uterus; myometrium ❑Thickest layer of uterus ❑Composed of 3 layers (very difficult to see in most preparations) -inner longitudinal -middle circular -outer longitudinal ❑Pregnancy: undergoes hyperplasia & hypertrophy VINOD GOPALAN, Pathology, School of Medicine, Griffith University Uterus; myometrium longitudinal across circular around middle circular, outer longitudinal Longitudinal muscle fibers; Circular muscle fibers VINOD GOPALAN, Pathology, School of Medicine, Griffith University  Uterus: Myometrium Pathology-Overview elongated nuclei Leiomyoma (Fibroids) Leiomyoma (Fibroids) m = multiple, mensturating Grey to white tumours, with a characteristic whorled appearance on cut section. Mostly occur multiple and usually occur in pre-menopausal women. fibroids Leiomyosarcoma: s = senior, single Arise from mesenchymal cells of the myometrium malignant Always solitary and most often occur in post-menopausal women. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; OVARY ❑The surface of the ovary is covered by a single layer of cuboidal epithelium, also called germinal epithelium. ❑Ovary is divided into an outer cortex and an inner medulla. all follicles blood vessels and connective tissues ❑The cortex consists of a very cellular connective tissue stroma in which the ovarian follicles are embedded. ❑The medulla is composed of loose connective tissue, which contains blood vessels and nerves. Vinod Gopalan, Pathology, School of Medicine, Griffith University Internal female genitalia; OVARY POLYCYSTIC OVARIAN SYNDROME (PCOS) is a complex endocrine disorder characterized by hyperandrogenism, menstrual abnormalities, polycystic ovaries, chronic anovulation, and decreased fertility plenty of cysts in ovaries Polycystic ovary- The cystically dilated follicles located mainly in the cortex, and the secondary follicles directly under the surface. Vinod Gopalan, Pathology, School of Medicine, Griffith University Internal female genitalia; OVARY Inclusion cyst Follicular cyst Non-neoplastic ovarian cysts 1. Inclusion cyst: Derived from entrapped portions of the ovarian surface epithelium. 2. Follicular cyst: Cysts lined by granulosa cells. seen in PCOS 3. Luteal cyst: Derived from corpus luteum that has not undergone the normal transition to a corpus albicans. transition not there Luteal cyst Ep- Cuboid epithelium G- Granulosa cells L- Luteal cells from corpus luteum Vinod Gopalan, Pathology, School of Medicine, Griffith University Pathology overview OVARY Teratoma Common component of mixed germ cell tumours. Tumours consisting of fetal-type tissues such as cartilage, poorly differentiated epithelial structures and primitive mesenchyme. Ovarian teratomas are almost always benign in contrast to testicular teratomas which shows malignant features from mixed germ cells neurological ovary Benign Malignant immature cells testis mostly benign, mature tissues 1: Cells from an eye; 2: Brain tissue; 3: Cartilage; 4: Skin http://alistairdove.com/blog/2010/9/14/its-not-a-tumour-oh-wait-it-is-a-tumour.html Vinod Gopalan, Pathology, School of Medicine, Griffith University Pathology overview OVARY large cyst hair and teeth well differentiated benign VINOD GOPALAN, Pathology, School of Medicine, Griffith University Internal female genitalia; Fallopian tube (oviduct) ❑Histologically, the oviduct consists of a mucosa and a muscularis. meet sperm and oocyte into uterus VINOD GOPALAN, Pathology, School of Medicine, Griffith University Fallopian tube: Histology The mucosa is formed by a ciliated & secretory columnar epithelium with lamina propria. The number of ciliated cells and secretory cells varies along the different parts of oviduct. The muscularis consists of an inner circular muscle layer and an outer longitudinal layer. contraction important need fine movement of sperm Peristaltic muscle action seems to be more important for the transport of sperm and oocyte than the action of the cilia. multiple foldings VINOD GOPALAN, Pathology, School of Medicine, Griffith University Fallopian tube: Histology The mucosa : ❑2 types of cells. Secretory (non ciliated) cells and Ciliated cells ❑Secretory activity varies during the menstrual cycle, and secretory cells are also referred to as peg-cells. functional ❑Some of the secreted substances are thought to nourish the oocyte and the very early embryo. in fallopian tube VINOD GOPALAN, Pathology, School of Medicine, Griffith University Fallopian tube: Histology Infundibulum The infundibulum contains many finger-like projections called fimbriae. During ovulation, the fimbriae get close to the ovary and help to sweep the ovum that is released into the abdominal cavity. fimbriae and lumen infundibulum - finger-like Fimbriae VINOD GOPALAN, Pathology, School of Medicine, Griffith University Fallopian tube: Histology Ampulla ❑ Contains mucosal folds, or plicae which divide the lumen of the ampulla into a very complex shape. ❑Fertilization usually takes place in the ampulla. move and contract Mucosal folds or plicae lumen Muscularis VINOD GOPALAN, Pathology, School of Medicine, Griffith University Fallopian tube: Histology Isthmus ❑As the oviduct approaches the uterus, the mucosal folds become less prominent and muscularis layer will be thicker. ❑The mucosa is smooth, and the inner diameter of the duct is very small. like a small duct, folds less obvious VINOD GOPALAN, Pathology, School of Medicine, Griffith University FALLOPIAN TUBE: CLINICAL SIGNIFICANCE Common sites of ectopic pregnancy TUBAL PREGNANCY The Fallopian tube is the most frequent location for ectopic implantation of the fertilised ovum, resulting in ectopic pregnancy; other much rarer sites include the abdominal cavity and the ovary. complications, tubal pregnancy The most common cause of tubal ectopic pregnancy is obstruction of the lumen, usually caused by infection, endometriosis and intra-abdominal adhesions. However, about 50% occur in normal Fallopian tubes. Vinod Gopalan, Pathology, School of Medicine, Griffith University FALLOPIAN TUBE: CLINICAL SIGNIFICANCE ectopic pregnancy ruptured mucosal folds Fallopian tube: Ectopic pregnancy amniotic layer haemorrhagic chorionic villi Ectopic pregnancy in a fallopian tube that was excised. This is a medical emergency because of the sudden rupture with hemoperitoneum. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Female reproductive system: Breast ❑Breast can be considered a modified skin appendage in Mammalians producing milk for the nourishment of the newborn. ❑The milk is discharged from a collection of 10-20 large ducts opening through pores in the nipple during lactation. ❑Each large duct, also called lactiferous duct, branches out deep into the breast tissue forming what is called a breast lobe. ❑ A breast consists of about 10-20 inter-anastomosing lobes separated from each other by varying amounts of fibro-adipose tissue. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Female reproductive system: Breast fat cell necrosis Lactiferous sinus lobules- produce secretions, project out VINOD GOPALAN, Pathology, School of Medicine, Griffith University Breast: Histology-Lobules (4X) adipose strona ❑ Each lobule consists of terminal ductules and acini. acini secretions adipose stroma duct lobules to pathology intralobular stroma lighter - fibroadenoma interlobular stroma darker Courtesy to PATHPEDIA Cross section of a sub-segmental duct (arrow) giving rise to multiple “Terminal duct lobular units (arrowheads)” embedded in dense stroma. VINOD GOPALAN, Pathology, School of Medicine, Griffith University  Breast: Histology- Lactiferous ducts (40X) contractile myoepithelial layer luminal epithelial layer to lumen Courtesy to PATHPEDIA Higher magnification of the lactiferous-segmental duct shows an inner luminal epithelial layer of cuboidal to columnar cells and an outer myoepithelial contractile layer. VINOD GOPALAN, Pathology, School of Medicine, Griffith University Breast: Histology more stromal tissue for shape more lobules in lactating hyper-engorged Non-lactating breast (never pregnant before) Lactating breast non-obese more stromal, less fibrous male and females less adipose stromal less in elderly, more adipose for shape VINOD GOPALAN, Pathology, School of Medicine, Griffith University Breast: Pathology- Overview HISTOLOGICAL STRUCTURES IN BREAST ▪ Ducts- Epithelium ▪ Lobules- Epithelium ▪ Adipose tissues ▪ Stromal tissues ▪ Blood vessels type of adenomas blood vessels VINOD GOPALAN, Pathology, School of Medicine, Griffith University Robbins- Textbook of Pathology  SELF ASSESSMENT http://www.magicalmaths.org/download-free-self-peer-assessment-for-learning-images-afl/ VINOD GOPALAN, Pathology, School of Medicine, Griffith University SELF ASSESSMENT- 1 Identify the physiological phase of this endometrial gland a) Secretory phase A saw tooth b) Proliferative phase c) Menstruation phase VINOD GOPALAN, Pathology, School of Medicine, Griffith University SELF ASSESSMENT- 2 Label the slide contract Tissue- Breast myoepithelial cells secretory cells secrete fluids VINOD GOPALAN, Pathology, School of Medicine, Griffith University  fibrous tissue - interlobular SELF ASSESSMENT- 3 lobules ductules Label the slide Tissue- Breast fibrous tissue - interlobular fibroadenomas most common in breast - benign how healthy breast tissue should look no infiltration normal, healthy Adipose tissue VINOD GOPALAN, Pathology, School of Medicine, Griffith University SELF ASSESSMENT- 4 FGT Biopsy: Identify Tissue of origin keratin on top abnormal rete ridges flat thicken skin leukoplakia A- Ecto-cervix C- Vulva C E-SC Junction in cervix B- Endo-cervix D- Vagina Vinod Gopalan, Pathology, School of Medicine, Griffith University SELF ASSESSMENT- 5 A 27 year old underwent routine Pap smear examination and revealed presence of atypical squamous cells. Biopsy of this lesion is shown below. What is the most likely diagnosis not normal matured basal and mature not enough mature basal pleomorphic infections, zone the same A; Cervicitis inflammatory B; Cervical Intraepithelial neoplasia B C; Squamous cell carcinoma D; Normal squamous cell mucosa no nest Vinod Gopalan, Pathology, School of Medicine, Griffith University  THANK YOU Email: [email protected] Vinod Gopalan, Pathology, School of Medicine, Griffith University