Inflammation of F.G.T. Inflammation: reaction of living tissue against an irritant, which is not so sever to cause cell death. Degeneration: morphological.

Inflammation of

F.G.T

• Inflammation: reaction of living tissue against an

irritant, which is not so sever to cause cell death.

• Degeneration: morphological and metabolic changes

of the cells due to an irritant, which is not sever

enough to cause cell death; it affect the cytoplasm but

not nucleus.

Types of inflammation

• Acute:

– Suppurative

– Non-suppurative

• Sub-acute

• Chronic

– Follow acute

– Start as chronic

– Granulomatous

Defense mechanisms of

FGT against inflammation

1- Normal thickness of vaginal epithelium: make

it more resistance to infection.

• So, atrophy of vaginal epithelium make it more

susceptible to infection.

• Causes of atrophy

–Post-menopuse

–Before puberty

–Lactating women

–Corticosteroid therapy.

2- Endo-cervical ciliated epithelium with their mucous

secretion ----- good barrier against ascending infection.

3- Regular menstrual cycle ---- shedding of covering

infected endometrial cells.

4- Phagocytosis: engulfing of foreign bodies ---- immune

defense.

5- Vaginal acidity (pH 4-5): increase vaginal pH----

increase susceptibility to infection.

• Factors help normal vaginal acidity:

– Lactobacilli

– The presence of intermediate cells: contain more

glycogen that maintain normal vaginal acidity.

– Normal level of vit. A and vit.C, keep the integrity

of vaginal epithelium.

– Deficiency of these vitamins make vaginal

epithelium keratinized, and so loss of vaginal

acidity ----- more susceptible to infection.

lactobacilli

Glycogen Lactic acid keep normal acidity

Glycogen present almost in intermediate cells

Reparative cellular changes

• Inflammation could make some cellular changes of

the epithelium (covering or glandular).

• These changes could make cytoplasmic or nuclear

changes.

A- Cytoplasmic changes

1- Loss of cilia of endocervical cells; as in

- Viral infection

- Mechanical effect (trauma)

- Metaplastic changes.

2- Variation of the shape and size of cells

- Small cells: small atrophic cells

postmenopausal cells

- Enlarged cells: hyperactive cells secretion.

3- Vaculation of the cytoplasm.

4- Perinuclear halo: clear spaces around the nucleus.

5- Biphasic cytoplasm: area of esinophilic cytoplasm

with area of basophilic cytoplasm in some cells.

6- Infiltration of the cytoplasm by bacteria, or presence

of acute inflammatory cells --------diagnostic feature of

acute inflammation in smear.

B- Nuclear changes1- Enlargement of the nucleus

2- Multinucleated cells:

- Viral infection

- TB; Langhans giant cells3- Intranuclear vaculation or halo: in viral infection.4- Disturbance of chromatin distribution:

- Rearrangement of chromatin in a circular shape

(peripheral) under nuclear membrane; as in

viral infection.

5- Post-necrotic nuclear changes

- Pyknosis: small dense nucleus.

- Karyorrhexis: fragmentation of the nucleus

- Karyolysis: lysis and dissolved nucleus

6- Stripped nuclei: rounded or oval blue nuclei

without cytoplasm, due to lysis of cytoplasm by

proteolytic enzymes.

- They have well defined sharp nuclear

membrane

- They have fine granular chromatin

- They are usually occur in endocervical and

intermediate squamous vaginal epithelium.

Protective reaction of cervical

epithelium against inflammation

1- Hyperplasia: increase the thickness of cervical epithelium

due to increase the number of cells.

2- Leukoplakia: Increase the layer of keratinized mature

squamous epithelium (superficial and anucleated cells).

- It is a precancerous lesion.

- It is a white plaque covering the cervix.

- Cytological smear show: sheet or cluster or

increased number of keratinized squamous cells.

3- Parakeratosis: Thin layer of mature superficial

covering the cervical squamous epithelial cells.

- Also, it is a precancerous lesion.

4- Squamous metaplsia of the cervix: Change the

covering endocervical cells at the squamo-columner

junction into squamous epithelial cells.

- Also, it is a precancerous lesion.

5- Atypical squamous metaplasia: metaplastic

squamous epithelium with features of atypia;

- Enlarged cells with irregular nuclear membrane.

- Increase the nuclear \ cell ratio

- Disturbance of chromatin nuclear distribution

- Deep hyperchromatic basophilic cytoplasm

- It is a precancerous lesion.

6- Ulcer: Discontinuity of the covering epithelium

7- Cervical erosion: partial loss of cervical epithelium.

8- Cervical ectopia: Rolling out of the inflamed cells

lining the cervical canal over the ectocervix, due to

previous scrapping by repeated pregnancy.

- Cervical ectopia --------- more susceptibility to cervical

infection.

Squamo-columnar junction

Diagnostic features of inflammatory

smear and Protective cellular reaction

1- Normal presence of few neutrophils in vaginal smear in

the following conditions:-

- Menstruation

- During ovulation

2- Normal presence of few number of lactobacilli in the

background of vaginal smear.

3- Dirty background of the vaginal or cervical smear in

acute inflammation.

4- Large number of acute inflammatory cells in smear.

Neutrophils Bacterial Vaginosis

Lymphofollicular cervicitis with macrophage Lactobacillus

5- Acute inflammatory cells + chronic non-specific

inflammatory cells -------- chronic non-specific

inflammation.

6- Chronic inflammatory cells + specific inflammatory

cells ------ chronic specific inflammation; e.g. Langhan`s

cells in TB.

7- Large number of esinophils in cytological smear ------

- allergic inflammation

- Parasitic infection

8- Fibroblast cells + new blood capillaries --------

granulation tissue (Repair).

9- Increase number or clusters of the mature keratinized

cells ------- Leukoplakia.

10- Repair cells + large number of basal vaginal or

cervical cells -------- cervical erosion or ulcer.

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