Histology for Pathology Female Genital Tract and Breast

1. Histology for PathologyFemale Genital Tract and Breast Theresa Kristopaitis, MD Associate Professor Director of Mechanisms of Human Disease Kelli A. Hutchens, MD, FCAP Assistant Professor Assistant Director of Mechanisms of Human Disease Loyola Stritch School of Medicine

2. 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

3. Objectives • 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

4. Medulla Cortex Image from Harvard University Medical School Website

5. Ovarian Cortex Follicles Mesothelium (also called germinal epithelium)

6. 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 Ovarian Stromal cells Oocyte Granulosa cells Primary Follicle

7. Mature Graafian Follicle Oocyte • 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 Granulosa Cells Graafian (preovulatory) follicle (up to 2.5 cm)

8. Site of follicular Rupture / Corpus Luteum A. Granulosa cells B. Corpora albicans

9. 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

10. 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

11. 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

12. Fallopian Tube / Oviducts Mucosa • 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) Serosa Muscularis Lumen

13. 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

14. Uterus – low power Endometrium Myometrium (smooth muscle)

15. Endometrium Functionalis Near the lumen Hormonally responsive Basalis Produces new cells to replace endometrium that was shed during menstruation

16. Endometrium – high power Endometrial glands Stroma

17. The endometrium undergoes morphologic and functional changes during the menstrual cycle Corpus luteum Graafian follicle Regressing corpus luteum

18. Proliferative Phase Early post-menstrual Sparse glands Predominant basalis Early proliferative Endometrium thicker under estrogen influence Glands straight and thin Later Proliferative Darker more compact basal layer

19. Secretory Phase Endometrium Mucoid secretions Early Secretory Phase Endometrium Glands tortuous –progesterone effect, mucoid secretions stored within the glands, pending a possible embryo implantation

20. 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

21. Cervix Transition zone: simple columnar epithelium of the endocervix with overlying non-cornified stratified squamous epithelium of the ectocervix Endocervical glands

22. Breast (Mammary Glands) • Breasts are composed of two multilobed mammary glands embedded in connective and adipose tissue • Glands are coumpoundtubuloalveolar 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

23. Breast Tissue

24. Breast Ducts Myoepithelial cells Cuboidal epithelial cells