FEMALE REPRODUCTIVE SYSTEM II

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FEMALE REPRODUCTIVE SYSTEM II
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Reproductive System
Uterus with fundus, lower uterine segment,
cervix, vaginal cuff, right fallopian tube, left
fallopian tube, right ovary, and left ovary.
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Cervix
Here is a normal cervix with a smooth, glistening
mucosal surface. There is a small rim of vaginal
cuff from this hysterectomy specimen. The
cervical os is small and round, typical for a
nulliparous woman. The os will have a fish-mouth
shape after one or more pregnancies.
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Cervix Histology
This is normal cervical non-keratinizing
stratified squamous epithelium. The squamous
cells show maturation from basal layer to surface.
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Cervical Dysplasia
This is cervical squamous dysplasia at high
magnification extending from the center to the
right. The epithelium is normal at the left. Note
how the dysplastic cell nuclei are larger and
darker, and the dysplastic cells have a
disorderly arrangement.
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Pap Smear
This is a Pap smear. The cytologic features of
normal squamous epithelial cells can be seen at
the center top and bottom, with orange to pale
blue plate-like squamous cells. The dysplastic
cells in the center extending to upper right are
smaller with darker, more irregular nuclei.
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The Reason for Pap Smears.
Here is a cervical squamous cell carcinoma.
There is a natural history of progression of
dysplasia to carcinoma, so don't leave dysplasias
alone.
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This uterus has been opened anteriorly through
cervix and into the endometrial cavity. High in
the fundus and projecting into the endometrial
cavity is a small endometrial polyp. Such benign
polyps may cause uterine bleeding.
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This uterus is not enlarged, but there is an
irregular mass in the upper fundus that proved
to be endometrial adenocarcinoma on biopsy. Such
carcinomas are more likely to occur in
postmenopausal women. Thus, any postmenopausal
bleeding should make you suspect that this
lesion may be present.
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This adenocarcinoma of the endometrium is more
obvious. Irregular masses of white tumor are
seen over the surface of this uterus that has
been opened anteriorly. The cervix is at the
bottom of the picture. This enlarged uterus was
no doubt palpable on physical examination. Such a
neoplasm often present with abnormal bleeding.
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In areas of endometriosis the blood is darker and
gives the small foci of endometriosis the gross
appearance of "powder burns". Small foci are
seen here just under the serosa of the posterior
uterus. Such areas of endometriosis can be seen
and obliterated by cauterization via
laparoscopy.
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Menstrual Cycle
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Hormonal Regulation of Cycle

• Proliferative phase
• GnRH stimulates anterior pituitary.
• Anterior pituitary secretes FSH, LH.
• FSH stimulates maturation of follicle.
• Granulosa cells of follicle secrete estrogen.
• Estrogen stimulates growth of endometrium.
• Estrogen inhibits release of LH, sensitizes ant.
  pituitary to GnRH.

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Graafian Follicle

• Granulosa cells
• Corona radiata around ovum
• Cumulus oophorus
• Thecal cells

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Ovulation

• Surge of LH released from ant. pituitary.
• Graafian follicle ruptures.

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Proliferative Phase
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Endometrium Proliferative Phase
Microscopic appearance of normal proliferative
endometrium in the menstrual cycle. In this
phase, tubular glands with columnar cells and
surrounding dense stroma are proliferating to
build up the endometrium following shedding with
previous menstruation.
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Endometrium, Myometrium Proliferative Phase
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Hormonal Regulation of Cycle

• Secretory phase
• LH stimulates remaining follicle to form corpus
  luteum.
• Corpus luteum secretes estrogen, progesterone.
• Progesterone stimulates endometrium to become
  more glandular, vascular.
• Est, Prog. inhibit FSH, LH production.

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Endometrium, Myometrium Secretory Phase
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Hormonal Regulation of Cycle

• Menstrual phase
• Corpus luteum degenerates, forms corpus albicans.
• Estrogen, progesterone levels decline.
• Lining of endometrium deteriorates, sloughs off.
• Low levels of estrogen, progesterone allows
  anterior pituitary to secrete FSH, LH again.

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Menopause

• Cessation of menstrual cycles.
• Caused by aging of ovaries.
• Few follicles remain to respond to FSH.
• Estrogen levels decline.
• Test high levels of FSH
• Adrenals produce some estrogen.

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