Histology for Pathology Female Genital Tract and Breast Theresa Kristopaitis, MD Associate Professor Director of Mechanisms of Human Disease Kelli A. Hutchens,

Histology for PathologyFemale Genital Tract and Breast

Theresa Kristopaitis, MDAssociate Professor

Director of Mechanisms of Human Disease

Kelli A. Hutchens, MD, FCAPAssistant Professor

Assistant Director of Mechanisms of Human Disease

Loyola Stritch School of Medicine

Objectives• Ovary– On a section of ovarian cortex identify stroma and follicles– Define “Graafian follicle”– Explain where “granulosa cells” are normally found in the

ovary– Define “corpus luteum”– Define corpus albicans and identify in a section of ovary

• Fallopian Tube– List the 2 types of cells that line the fallopian tube and

their function

• Uterus / Cervix– On a low power section identify the endometrium and

myometrium– Define endometrial “basalis” and “functionalis”– Identify endometrial glands and stroma– Describe the major changes of the endometrium through the

menstrual cycle (ie menstrual, proliferative and secretory endometrium findings)

– Describe the epithelial lining of the endocervix and ectocervix• Breast (Mammary Glands)• List the flow of milk through the mammary glands• Identify on histologic sections the major components of

breast tissue (lobules of glands, stroma, and adipose tissue)

• Describe the epithelial lining of the intralobular ducts

Objectives

Image from Harvard University Medical School Website

Medulla

Cortex

Ovarian CortexFollicles

Mesothelium(also called germinal epithelium)

Ovarian follicle• Primordial follicle: prior to

puberty• Primary follicle: (after

puberty)– Primary oocyte surrounded

by single layer of squamous cells (granulosa cells) embedded in ovarian stroma

• Secondary follicle:– increased thickness of

granulosa cells and formation of the theca folliculi (stroma cells around the follicle)

• Graafian (pre-ovulatory) follicle: final stage

OocyteGranulosa cells

Primary Follicle

Ovarian Stromal cells

Mature Graafian Follicle• Graafian (pre-ovulatory)

follicle: final stage– Large antrum filled with

fluid (liquor folliculi)– Ready to release oocyte in

response to LH surge– Granulosa cells directly

around the oocyte = corona radiata

– Just prior to release oocyte resumes meiosis then arrests as a secondary oocyte

Oocyte

Granulosa Cells

Graafian (preovulatory) follicle(up to 2.5 cm)

Site of follicular Rupture / Corpus Luteum

A. Granulosa cellsB. Corpora albicans

Corpus Luteum• After ovulation, the

remaining wall of the graafian follicle transforms into the corpus luteum

• The wall of the corpus luteum is folded and contains granulosa lutein cells derived from granulosa cells which secrete progesterone

Corpus Albicans

• In the absence of fertilization the corpus luteum degenerates, decreases in size and form the corpus albicans which consists of dense connective tissue

Fallopian Tubes / Oviducts

• Two, open ended tubes that receive the ovum• Provide the ideal environment for fertilization– Most often occurs in ampulla

• The wall is composed of:– Mucosa: ciliated cells, secretory (peg) cells, and

underlying lamina propria– Muscularis layer– Serosal layer

Fallopian Tube / Oviducts• Mucosa – high power• Ciliated cells (arrows)

– Help sweep oocyte towards uterus

• Nonciliated Peg cells (arrowheads)– Produce secretions to protect

oocyte and promote fertilization• Lamina propria (a)

Lumen

SerosaMucosa

Muscularis

Uterus

• Relative large organ between the fallopian tubes and the vagina

• 3 anatomic regions: fundus, body, and cervix• Site of implantation and placentation• 3 layers– Endometrium– Myometrium– Serosa

Uterus – low power

Endometrium

Myometrium(smooth muscle)

Endometrium

FunctionalisNear the lumenHormonally responsive

BasalisProduces new cells to replace endometrium that was shed duringmenstruation

Endometrium – high power

Endometrial glands Stroma

The endometrium undergoes morphologic and functional changes during the menstrual cycle

Graafianfollicle

Corpus luteumRegressing corpus luteum

Early post-menstrualSparse glandsPredominant basalis

Early proliferativeEndometrium thicker underestrogen influenceGlands straight and thin

Later ProliferativeDarker more compact basal layer

Proliferative Phase

Early Secretory Phase EndometriumGlands tortuous –progesterone effect, mucoid secretions stored within the glands, pending a possible embryo implantation

Mucoid secretions

Secretory Phase Endometrium

Cervix

• Lower part of uterus• Bulges into vagina• Two parts with different histology and a

transitional zone between them:– Endocervix: Simple columnar glands– Ectocervix: Stratified squamous epithelium

CervixTransition zone: simple columnar epithelium of the endocervix with overlying non-cornified stratified squamous epithelium of the ectocervix

Endocervical glands

Breast (Mammary Glands)

• Breasts are composed of two multilobed mammary glands embedded in connective and adipose tissue– Glands are coumpound tubuloalveolar glands that

open into a lactiferous duct which express their contents via the nipple• Milk produced by the secretory alveoli first drains into

intralobular ducts and then interlobular ducts to lactiferous sinus • Intralobular ducts makes of the majority of the

glandular tissue

Breast Tissue

Breast Ducts

Myoepithelial cells

Cuboidal epithelial cells