WEEK 12W - FEMALE REPRODUCTIVE SYSTEM 2024 PDF

HUMAN REPRODUCTIVE SYSTEMS CCheung 1 HUMAN REPRODUCTIVE SYSTEM https://www.vectorstock.com/royalty-free-vector/human-reproductive-system-anatomical-banner-vector-24947367 CCheung...

HUMAN REPRODUCTIVE SYSTEMS CCheung 1 HUMAN REPRODUCTIVE SYSTEM https://www.vectorstock.com/royalty-free-vector/human-reproductive-system-anatomical-banner-vector-24947367 CCheung 2  ANATOMICAL HOMOLOGUES MALE REPRODUCTIVE FEMALE REPRODUCTIVE Anatomical Anatomical Scrotum Labia majora Ventral surface of the Labia minora penis Vestibular or Bartholin’s Bulbourethtral glands glands Penile shaft Clitoris Glans (head) penis Glans Foreskin Prepuce (hood) Sex organs Sex organs Testes Ovaries Sex cells (gametes) Sex cells (gametes) Sperms Ova (ovum) CCheung 3 CCheung 4 FEMALE REPRODUCTIVE SYSTEM https://www.vectorstock.com/royalty-free-vector/male-and-female-reproductive-realistic-human-body-vector-34121909 CCheung 5 COMMON SPECIMEN TYPES Breast tissue https://www.mdpi.com/2075-4418/13/18/3015 https://fity.club/lists/b/bone-cancer-diagram/ https://vitrovivo.com/product/breast-cancer-hups-02004t-adjacent-normal-tissue/ https://www.pathologyoutlines.com/topic/breastmalignanttreatmenteffect.html CCheung 6 COMMON SPECIMEN TYPES Placenta https://www.alignable.com/phoenix-az/reference-medicine/liquid-biopsy-sets CCheung 7 OBJECTIVES 1. Characterize the different components of the female reproductive system. 2. Describe the histological features of the ovary, uterus, fallopian tube and cervix. 3. Describe the development of the follicles and the progression of the corpus luteum. 4. Describe phases of the uterine cycle. 5. Describe the importance of the squamo- columnar junction 6. Describe the histological features of the glands– vestibular glands and Bartholin’s glands. 7. Describe the histological features of the nipple, areola and the breast in various phases of activity. 8. Describe the histological features of the placenta and umbilical cord. 9. Be able to describe the delivery of nutrients and oxygen to the embryo based on the structure of the placenta. CCheung 8 FRONTAL ASPECT CCheung 9 SAGITTAL SECTION CCheung 10  FUNTIONS Production of female gametes (ova) by process of oogenesis. Reception of male gametes, spermatozoa. Provision of suitable environment for fertilization. Provision of an environment for development of fetus. Expulsion of the developed fetus to the external environment. Nutrition of newborn. CCheung 11  BROAD LIGAMENT Mesometrium The mesentery of the uterus; the largest portion of the broad ligament. Mesosalpinx The mesentery of the fallopian tube. Mesovarium The mesentery of the ovaries. https://link.springer.com/chapter/10.1007/978-3-030-31989-2_15 CCheung 12  GROSS ANATOMY OF OVARIES AND ACCESSORY ORGANS Left and right components. Attached to the uterus by the ovarian ligament. Ovarian blood vessels are housed in the suspensory ligament of the ovary. https://basicmedicalkey.com/the-female-genital-tract-2/ CCheung 13  MICROANATOMY OF THE OVARIES Simple cuboidal Flat, ovoid shape. Tunica albuginea 3-5 cm long. Epithelium: Simple cuboidal. Ovarian stroma Beneath epithelium is Tunica albuginea – a fibrous tissue but not a distinct capsule. Cortex – peripheral zone. Medulla – central zone. CCheung 14 https://embryology.med.unsw.edu.au/embryology/images/2/2e/Ovary_Histology_-_tunica_albuginea.jpg  OVARIAN CORTEX Ovarian stroma (cortex) Whorled pattern Spindle shaped cells + smooth muscles Lipid droplets Fine collagen fiber + ground substance Tunica albuginea – fibrous superficial cortex. Ovarian follicles with gametes at various stages of development. Post-ovulatory structures Corpus luteum Corpus albicans CCheung 15  OVARIAN CORTEX Monkey ovarian cortex with Ovarian cortex with Human ovarian cortex with developing follicles primordial follicle no follicles visible CCheung 16 Vincent van Gogh brush stroke using impasto CCheung 17 https://twitter.com/SantaCruzBio/status/644276643553382404  OVARIAN MEDULLA Blood vessels + nerves. Contains Hilus cells (comparable to Leydig cells). Blood vessels Ovarian artery + ovarian branches of uterine artery anastomose in mesovarium and broad ligament. https://link.springer.com/article/10.1007/s00580-017-2472-9 CCheung 18  STAGES OF FOLLICULAR DEVELOPMENT 1. Oogonium (germ cell) 2. Primary oocyte in Primordial follicles 3. Primary follicle 4. Secondary follicle 5. Graafian follicle – containing secondary oocyte CCheung 19 https://basicmedicalkey.com/female-reproductive-system-7/ Primordial follicles in the ovary of a 25 y.o. female CCheung 20  FOLLICULAR ATRESIA Can occur at any stage in development. Six months in utero: several millions of primordial follicles. At birth: 500,000 left. Sexual maturity: only ~500 will be ovulated. CCheung 21  OVULATION 2º oocyte and the degenerating ovarian surface are disgorged in the peritoneal cavity near the entrance of the fallopian tube. Causes mid-cycle bleeding and abdominal comfort. Ruptured follicle Ovulation Corpus luteum Involution Corpus albicans CCheung 22  https://www.sciencedirect.com/science/article/abs/pii/B9780323449427000480 CCheung 23  POST-OVULATORY STRUCTURES BC CA: Corpus albicans CL: Corpus luteum BC: Blood clot CL Cortex CA Medulla BC CA https://wellcomecollection.org/works/ktmrbaur CCheung 24 1: Ovary 2: Ovarian follicles 3: Ligament 4: Fallopian tub 5: Ligament https://embryology.med.unsw.edu.au/embryology/images/8/80/Human_ovary_-_corpus_luteum_21.jpg CCheung 25  LUTEINIZATION Regulated by luteinizing hormone (LH). Luteinizing hormone from the anterior pituitary gland convert the follicle remnants to an endocrine structure, the CORPUS LUTEUM. The blood clot undergoes progressive re-organization and fibrosis over the following weeks. Granulosa cells become Granulosa lutein cells (GLC) Secreting progesterone For preparation of the endometrium of the uterus Theca interna cells become Theca lutein cells (TLC) Secreting estrogen For maintenance of thickness of uterine mucosa CCheung 26  LUTEINIZATION GRANULOSA LUTEIN THECA LUTEIN CELLS CELLS (GLC) (TLC) Large, pale-staining, Smaller cells with spherical nuclei with 1 densely staining or 2 nucleoli. cytoplasm. Eosinophilic cytoplasm Ovoid nucleus with one with lipid droplets. nucleolus. Derived from the Derived from the theca granulosa cells. internal cells. CCheung 27  GRANULOSA LUTEIN CELLS THECA LUTEIN CELLS https://basicmedicalkey.com/female-reproductive-system-7/ CCheung 28  CORPUS LUTEUM IF PREGNANT NOT PREGNANT Corpus luteum will continue Corpus luteum will to exist as an endocrine disintegrate. structure up to the third Lutein cells (TLC and GLC) month of pregnancy. will stop secreting estrogen Regulated by Human and progesterone, chorionic respectively. gonadotropin (hCG) secreted by placenta. Very large corpus luteum. Granulosa lutein cells contain hyaline-eosinophilic inclusion bodies – enlarge and calcify as pregnancy progresses. Corpus luteum will deteriorate at the second CL – corpus luteum trimester of pregnancy. Ft – fallopian tube CCheung 29 https://basicmedicalkey.com/female-reproductive-system-7/  CORPUS ALBICANS Inactive fibrous tissue mass. Formation after involution of the corpus luteum. The degenerate cells of corpus luteum undergo autolysis and phagocytosed by macrophages. Increases in number with age. Regression occurs without a trace. CCheung 30  OVARY mScope slide: OVARY -1 mScope slide: OVARY -2 CCheung 31 mScope slide: OVARY -1 CCheung 32 mScope slide: OVARY -3 CCheung 33 OVARY AND FALLOPIAN TUBE CCheung 34 OVARY AND FALLOPIAN TUBE YOUNG MENOPAUSAL POST – MENOPAUSAL https://basicmedicalkey.com/the-female-genital-tract-2/ CCheung 35  DERMOID CYSTS https://vixxenesque.livejournal.com/18833.html https://www.sciencedirect.com/science/article/pii/S1751731118003403 https://medicoapps.org/m-dermoid-cyst/ CCheung 36 THE GENITAL TRACT FALLOPIAN TUBES UTERUS CERVIX VAGINA CCheung 37  FEMALE GENITAL TRACT Cyclical changes under hormonal influence. Basic structure: Wall – smooth muscles (spiral arrangement) Inner – mucosal lining Outer- LOCT (serous lining) CCheung 38 FALLOPIAN TUBES (OVIDUCTS) CCheung 39  ANATOMY OF THE FALLOPIAN TUBE (OVIDUCT) ~4” long tubes on the upper free end of the broad ligament. Carry ova from surface of ovaries. Site of tubal ligation. 4 anatomical divisions: Infundibulum - funnel shaped; surrounds the ovary; has fringelike projections called fimbriae. Ampulla - dilated middle part; fertilization occurs here. Isthmus - smallest diameter; secretory function. Interstitial - connects fallopian tube with the uterus. CCheung 40  ANATOMY OF THE FALLOPIAN TUBE (OVIDUCT) CCheung 41  CELL TYPES IN THE FALLOPIAN TUBE Ciliated cells Propulsion Non-ciliated cells Secretory Intercalated cells Secretory 2 epithelial tissue morphologies: Simple columnar with cilia Simple columnar with microvilli Lamina propria – DICT. Smooth muscular wall – inner circular, outer longitudinal. M – smooth muscles S – serosa Serosa – LOCT. CCheung BL – broad ligament 42  INFUNDIBULUM SIMPLE COLUMNAR WITH CILIA CCheung 43  AMPULLA: ISTHMUS: SIMPLE COLUMNAR WITH CILIA SIMPLE COLUMNAR WITH (Prominent folds) MICROVILLI CCheung 44 ECTOPIC PREGNANCY https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/ectopic-pregnancy/ CCheung 45  FALLOPIAN TUBE mScope slide: FALLOPIAN TUBE -1 CCheung 46 mScope slide: FALLOPIAN TUBE -1 CCheung 47 UTERUS CCheung 48  ANATOMY OF THE UTERUS Hollow muscular organ. Regions of the uterus: Cervix – narrow part that “communicates” with vagina. Body – major part. Fundus – above the uterine tube entrance. https://link.springer.com/chapter/10.1007/978-3-642-31012-6_22 CCheung 49  UTERUS Receives a fertilized egg. Retains the fertilized egg. Nourishes the fertilized egg. Supported by a series of ligaments that hold the uterus in place. Blood supply: Uterine arteries Iliac arteries Ovarian arteries Vaginal arteries https://fineartamerica.com/featured/1-smooth-muscle-in- uterine-wall-asklepios-medical-atlas.html CCheung 50  UTERINE WALL Endometrium Inner layer. Allows for implantation of a fertilized egg; provides environment for fetal development. Sloughs off if no pregnancy occurs (menses). Myometrium Middle layer of smooth muscle. Provides protection for the fetus; Expulsion of the fetus. Perimetrium (visceral peritoneum) Outermost serous layer of the uterus. Mesothelium; single layer of elastic tissue. CCheung 51  MENSTRUAL CYCLE LH inhibited; corpus luteum involutes No fertilization = uterine wall shedding No fertilization = egg disintegrates, hormones inhibited Endometrial wall break down Follicle stimulating hormone (FSH) Uterine blood vessels and glands form in endometrium Mature egg in fallopian tube (24hrs) Uterine wall thickens CCheung 52  ENDOMETRIUM Epithelium Simple columnar with cilia. Pseudostratified columnar with cilia. Simple cuboidal with microvilli. Three Histological Layers Stratum compactum – innermost layer; always changing. Stratum spongiosum – LOCT and glands. Stratum basale – made of DICT attaching to myometrium. Stratum functionalis - compactum + spongiosum that get sloughed off during menstruation and childbirth. Stroma Cells have spindle-shaped nuclei and scanty cytoplasm; presence of mitotic figures. CCheung 53 PHASES OF THE ENDOMETRIUM PROLIFERATIVE PHASE SECRETORY PHASE CCheung 54 PHASES OF THE ENDOMETRIUM MENSTRUATION PHASE POST-MENOPAUSAL PHASE CCheung 55  EARLY PROLIFERATIVE PHASE Height of Functionalis: thinnest. Glands: straight and inactive. Stroma features: unremarkable. CCheung 56  LATE PROLIFERATIVE PHASE Height of Functionalis (F): Very thick. Glands (G): Many mitotic figures; disorderly nuclei. Stroma features: edematous (B) – Stratum basale. CCheung 57  EARLY SECRETORY PHASE Height of Functionalis: slightly thinner than later proliferative phase. Glands: corkscrew- shaped glands; central nuclei, glycogen at base of cells. Stroma features: edema (swelling) subsides. CCheung 58  MID-SECRETORY PHASE Height of Functionalis: Very thick. Glands: Very wide and tortuous; contains secretion in lumina (cellular debris & glycogen); nuclei are pyknotic. Stroma features: edema inside of stromal cells. (V) – vacuoles. CCheung 59  LATE SECRETORY PHASE Height of Functionalis: Shrinkage. Glands: Full of secretion. Epithelium: low columnar to cuboidal; nuclei are pyknotic. Stroma features: RBCs pool, ↑ WBCs, edema resorbed. CCheung 60  MENSTRUAL PHASE Height of Functionalis: In 2-3 days, non-existent. Glands: Slough off, desquamation. Stroma features: Slough off, desquamation. Other features: Stratum basale undisturbed. CCheung 61  MYOMETRIUM 3 non-distinct layers of smooth muscles - for strength (transverse, longitudinal, oblique). Undergoes hyperplasia (increase in cell size) and hypertrophy (increase in cell numbers). Interlaced with elastic fibers + connective tissue components (DICT). Vascular tissue layer: Stratum vasculare – area where large straight and spiral arteries are located. Helicine arteries - undergo ischemia during menstruation CCheung 62  MYOMETRIUM Longitudinal, Transverse and Oblique. CCheung 63  PERIMETRIUM Parietal peritoneum covers most uterus except cervix. Morphology: LOCT. CCheung 64  UTERUS mScope slide: PROLIFERATIVE mScope slide: SECRETORY CCheung 65 mScope slide: PROLIFERATIVE CCheung 66 mScope slide: PROLIFERATIVE CCheung 67 mScope slide: SECRETORY CCheung 68 CCheung 69 CERVIX CCheung 70  CERVIX Protrudes into the upper vagina. Admits spermatozoa to the genital tract during cervix ovulation. Protects the uterus and upper genital tract from bacterial invasion. Passageway for fetus during parturition. https://basicmedicalkey.com/the-female-genital-tract-2/ CCheung 71  CERVIX Endocervix (EC) Continuous with the uterus. Simple columnar. Ectocervix (V) Exposed to hostile environment. SSNK - 3 zones: Basal zone Mid zone Superficial zone Squamocolumnar junction(J) Between ectocervix and endocervical epithelium. Diagnostic site; pap smear samples are taken from here. CCheung 72  CERVIX Ectocervix – Endocervix - Squamocolumnar SSNK Simple columnar junction Diagnostic site CCheung 73  NABOTHIAN FOLLICLES OR CYSTS Cysts filled with mucus that look like tiny bumps on the surface of the cervix. Occur when new tissue regrows on the cervix after childbirth. This new tissue blocks the openings of the cervix's Nabothian glands, trapping their mucous secretion in tiny pockets under the epithelium. https://www.sciencedirect.com/science/article/abs/pii/B9780323900553000065 CCheung 74  CERVIX mScope slide: CERVIX -1 CCheung 75 mScope slide: CERVIX -1 CCheung 76 VAGINA CCheung 77  ANATOMY OF VAGINA Extends from cervix to exterior of body. Receives the penis during sexual intercourse. Serves as the birth canal. Hymen – partially closes the vagina until it is ruptured. CCheung 78 MICROANATOMY OF VAGINA Mucosa: epithelium (SSNK) and elastic lamina propria. Muscularis: 2 ill-defined layers of smooth muscle; exterior (some skeletal muscle). Adventitia: thin layer of elastin fibers. Bartholin’s glands – provides lubrication to the vagina. Also lubricated by the cervical glands. Superficial cells produce glycogen. E: Epithelium | L: Lamina propria | SM: Muscle layer | A: Adventitia CCheung 79 BREAST TISSUE AND MAMMARY GLANDS CCheung 80  MAMMARY GLANDS Present in both sexes, but only functional in females Modified sweat glands Function is to produce milk. Stimulated by sex hormones (mostly estrogens) to increase in size. CCheung 81  ANATOMY Areola Central pigmented area (melanin). Nipple Protruding central area of areola. Lobes Internal structures that radiate around nipple. Lobules Located within each lobe and contain clusters of tubuloacinar glands (inactive) or tubuloalveolar glands (active). Alveolar glands Produce milk when a woman is lactating (producing milk). Lactiferous ducts Connect acini glands to nipple. Lined by stratified cuboidal or stratified columnar. CCheung 82  TEASE PREPARATION Lobules Ducts Interlobular terminal ducts Intralobular terminal duct Terminal duct lobular unit (TDLU) https://ultrasoundregistryreview.com/BreastTrial4.html http://tvmouse.ucdavis.edu/bcancercd/21/TDLU1.html CCheung 83  THE NIPPLE Band of smooth muscles organized in parallel to lactiferous ducts. Lactiferous sinus Formed by the lactiferous ducts before opening onto the surface. Surface epithelium SSK. Ep: Epihelium | S: Sebaceous gland | L: Lactiferous sinus /duct CCheung 84 MELANIN IN BASAL PILOSEBACEOUS ADIPOSE TISSUE IN EPIDERMIS UNITS THE NIPPLE AND AREOLA CCheung 85  Lactiferous duct Intralobular duct Interlobular duct CCheung 86  PHASES OF BREAST TISSUE INACTIVE/RESTING ACTIVE/LACTATING Lobules are far apart. Glands proliferate greatly with many secretory units. Glandular morphology: Glandular morphology: Compound tubulo- acinar Compound tubulo-alveolar Lined by simple cuboidal Lined by simple (with myoepithelial cells) cuboidal (with myoepithelial cells) Thick walls of interlobular, intralobular ducts → Fewer intralobular and lactiferous ducts. interlobular ducts that Overcrowding (lobular drain into lactiferous hypertrophy) of the glands. ducts. Proliferation of septae. CCheung 87 INACTIVE / RESTING BREAST F: Fibrous CT | A: Adipose CT | E: Epithelial cell | M: Myoepithelial cells CCheung 88  ACTIVE/LACTATING BREAST L A L L: lobules |S: septae|A: Acini CCheung 89  BREAST mScope slide: LACTATING mScope slide: RESTING CCheung 90 mScope slide: LACTATING BREAST CCheung 91 mScope slide: RESTING BREAST CCheung 92 PLACENTA CCheung 93  PLACENTA Fusion of membranes of the fetus (chorion) with maternal uterine mucosal layers (the decidua). Forms in the uterus after fertilization has occurred; linked to fetus via the umbilical cord. Physiological exchange between the fetal and maternal circulations: Exchange of respiratory gases. Provides nutrients for and removes wastes. Secretes hormones. Transports macromolecules (viruses, IgG, alcohol). CCheung 94  CHORION Fetal placenta. Forms within 23 days following ovulation. Composition: Connective tissue with two cell layers: 1. Cytotrophoblast – inner larger cuboidal shaped cells. 2. Syncytiotrophoblast – outer dark layer of cells that secretes hcG hormone (human chorionic gonadotrophin). Lacunae – spaces filled with maternal blood from spiral arteries, later called intervillous spaces. Chorionic villi – protrudes into the intervillous space increasing surface area of the placenta that is exposed to maternal blood. Placental blood barrier Oxygen and nutrient exchange from maternal to fetal. CCheung 95 M: mesenchyme | C: cytotrophoblast | S: syncitiotrophoblast L: Lacunae (filled with maternal blood) CCheung 96  DECIDUA Maternal placenta. Formed from endometrial stroma cells that differentiate into decidual cells ~ day 24 of menstruation. Provide nourishment to developing embryo. Cotyledons on the placenta surface: Lobular structures on the surface of the maternal placenta - up to 35 lobes are present. Transmit fetal blood; exchange of oxygen and nutrients with maternal blood. Malformations of these cotyledons are indicative of fetal abnormalities. CCheung 97 Fetal side Maternal side CCheung 98 PLACENTA placenta Umbilical cord http://www.newspiritarrivals.ca/how-to-properly-handle-store-a-placenta/ https://pmgbiology.com/2014/06/02/role-of-the-placenta-a-understanding-for-gcse/ CCheung 99  PLACENTAL CIRCULATION Maternal Spiral arteries Supply blood into the intervillous spaces. Fetal Umbilical arteries Two in number and travel from the fetus through the umbilical cord to the placenta. Carries blood that is low in oxygen and nutrient content. Umbilical vein Single vein returns oxygen rich, nutrient rich blood to the fetus. CCheung 100  PLACENTAL CIRCULATION https://www.researchgate.net/figure/Schematic-representation-of-blood-flow-through-the-placenta-and-surrounding-tissue-Blue_fig3_321751342 CCheung 101  https://www.flickriver.com/photos/jian-hua_qiao_md/20957285359/ https://www.researchgate.net/figure/Histology-of-the-normal-macaque- https://v16.proteinatlas.org/learn/dictionary/normal/placenta CCheung 102 placenta-A-Full-thickness-section-of-a-mid-gestation_fig5_236083403 6 weeks gestational Full term CCheung 103  UMBILICAL CORD Transfer of oxygen and nutrients from the maternal circulation into fetal circulation. Approximately 50 - 60cm in length. Embedded in Wharton’s jelly (mucous CT). Contains two umbilical arteries and one umbilical vein: Umbilical arteries transport deoxygenated fetal blood to the placenta. Umbilical vein transports oxygenated blood back to the fetus. CCheung 104  UMBILICAL CORD Umbilical artery Umbilical artery Umbilical vein Wharton’s jelly A – umbilical arteries Ve – umbilical vein W – Wharton’s jelly https://stimlabs.com/blog/2020/6/30 https://www.ihearthisto.com/ CCheung 105 https://www.lovewhatmatters.com/ PLACENTA & UMBILICAL CORD mScope slide: PLACENTA -2 mScope slide: UMBILICAL CORD CCheung 106 mScope slide: PLACENTA CCheung 107 mScope slide: UMBILICAL CORD CCheung 108  https://sites.duke.edu CCheung 109 FEMALE REPRODUCTIVE SYSTEM [email protected] CCheung 110 https://www.ihearthisto.com/post/113653577867/thank-you-i-you  REFERENCES Geraldine O'Dowd, Sarah Bell, Sylvia Wright. (2023) - Wheater’s Functional Histology. A Text and Colour Atlas; 7th ed. Philadelphia, PA: Elsevier. Chapter 19. CCheung 111