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Ovary and Fallopian Tubes
CervixAbout this video
The following sources were used to create these tutorials:
Drake RL, Vogl W, Mitchell AWM, Gray H. Gray’s Anatomy for Students. 2nd ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2010.
Ellis H. Clinical Anatomy: Applied Anatomy for Students and Junior Doctors. 12th ed. Wiley-Blackwell; 2010.
Hansen JT, Netter FH. Netter’s Clinical Anatomy. Philadelphia: Saunders/Elsevier; 2010.
Impey L, Child T. Obstetrics & Gynaecology. 3rd ed. Wiley-Blackwell; 2008.
Click here to view tutorials on basic anatomy of the female reproductive tract.
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Ovaries and Fallopian Tubes
- Ovarian Cyst Accidents
- Polycystic Ovary Syndrome
- Ovarian Cancer
Ovarian Cyst Accidents
Three things can happen with ovarian cysts:
- Haemorrhage into the cyst
- Rupture of the cyst into the peritoneal space
- Ovarian torsion
Polycystic Ovary Syndrome
- Endocrine disorder
- Multiple enlarged follicles scattered underneath the surface of the ovary.
- Polycystic ovaries on ultrasound
- Irregular menstruation
- Raised testosterone leading to hirsutism and acne
There are three main groups of cells within the ovary:
- Epithelial Ovarian Cells: outer layer of cells, also known as the germinal epithelium
- Germ cells: cells which make the eggs in the ovary
- Connective tissue: supportive tissue of the ovaries
- Granulosa cells
- Thecal cells
Ovarian cancer can arise from any of these three main groups of cells, however the most common type comes from the surface epithelium.
This constitutes 80-90% of all ovarian cancers and is more common in older, post-menopausal women.
Serous type is most common type of surface epithelial ovarian cancer.
Germ cell cancers are more common in younger women.
Sex-cord stromal tumours are quite rare.
This fallopian tubes open DIRECTLY into the peritoneal cavity – this is the only direct communication with the intraperitoneal space.
This direct communication is a possible route for the spread of an infection – a sexually transmitted infection such as gonorrhoea, or chlamydia could spread into the peritoneum.
Blastocyst implants in the wrong place, i.e. not in the endometrium.
Locations of ectopic pregnancy:
- Fallopian tubes – this is the most common sites for ectopic pregnancy
- Ampulla is the most common site in the fallopian tube for ectopic pregnancy
- Cornua of the uterus
Structures supporting the uterus:
- Uterosacral ligament extending posteriorly from the cervix to the sacrum
- Transverse cervical/cardinal ligament extending laterally to the pelvic side wall side wall
- Pubocervical ligament extending anteriorly
- Levator ani muscle
If these structures are weakened, then the pelvic organs can prolapse.
It is useful to think of the prolapses in terms of three different compartments:
- Urethrocele – urethra bulges into anterior wall of vagina.
- Cystocele – bladder bulges superiorly into anterior wall of vagina.
- Urethrocele + cystocele = cystourethrocele.
- Uterine prolapse
- Graded from 1 to 3:
- Grade 1: Prolapse contained within the vagina.
- Grade 2: Further descent: cervix reaches level of introitus but the fundus stays inside the pelvis
- Grade 3: the entire uterus is prolapsed outside the vagina – procidentia.
- Causes of uterine prolapse are:
- Previous vaginal delivery
- Iatrogenic causes/previous pelvic surgeries
- Low oestrogen levels in post-menopausal women
- Graded from 1 to 3:
- Enterocele – pouch of Douglas protrudes downwards.
- Vaginal vault prolapse – Occurs after a hysterectomy. The superior end of the vagina prolapses and the vagina inverts on itself.
Benign Uterine Tumours
- Intrauterine Polyps
Common causes for heavy menstrual bleeding (menorrhagia).
Uterine leiomyomata (leiomyoma = singular).
Benign tumours of smooth muscle and connective tissue differentiation, which affect the myometrium.
Three subtypes of fibroid:
- Subserosal: just below the serous layer of the uterus
- Intramural: directly within the wall of the myometrium.
- Submucosal: underneath the mucosa.
Benign tumours which grow into the cavity of the uterus
Usually endometrial in origin
These cause menorrhagia and intermenstrual bleeding.
Characterised by ectopic endometrial tissue (areas of endometrial tissue that is out of place)
This tissue is responsive to oestrogen, just like the endometrium and therefore changes in size during the menstrual cycle as hormone levels change.
Chronic, cyclical pelvic pain is a common symptom of endometriosis.
Within the pelvic cavity, the common sites for endometriosis are
- Chocolate cysts (endometrioma): accumulations of blood which appear a dark brown colour.
- Pouch of Douglas (rectouterine pouch)
- Vesicouterine pouch
- Uterosacral ligaments
- Fallopian tubes
Also affects: rectum, vagina, bladder
Sites outside of the pelvic cavity can also be affected:
- Old wound scars
Long-term, endometriosis can lead to pelvic adhesions, and to immobile pelvic viscera.
Ectopic endometrial tissue within the myometrium
Most common malignancy of the female reproductive tract
Prolonged exposure to unopposed oestrogen (oestrogen without the protective effects of progesterone) is the biggest risk factor
- portion of the vagina which protrudes into the vagina
- squamous epithelium
- lines the endocervical canal
- columnar epithelium
Squamocolumnar junction occurs where the squamous epithelium meets the columnar epithelium
During puberty and pregnancy, the cervix gets pushed out and the columnar cells of the endocervix are exposed to the acidic environment of the vagina.
This causes metaplasia of the columnar cells to squamous cells and this area of change is called the transformation zone.
At the transformation zone, the cervix is more susceptible to neoplastic change.
Benign condition of the cervix where the cervix protrudes out, exposing the columnar cells of the endocervix.
Results in a red area around the external os and is a common cause of post-coital bleeding (bleeding after intercourse).
Normal finding in:
- younger women
- pregnant women
- women using the combined oral contraceptive pill
Cervical intra-epithelial neoplasia (CIN)
Pre-malignant, pre-invasive stage of cervical cancer.
Atypical cells can be detected by a smear test
Smear test is a cytological test, which detects cellular changes, not histological changes.
The degree of cellular change (dyskaryosis) corresponds to the degree of CIN
Three grades of CIN:
- CIN 1: mild dysplasia – affects lower 1/3 of epithelium.
- CIN 2: moderate dysplasia – affects lower 2/3 of epithelium.
- CIN 3: severe dysplasia – full thickness. Carcinoma in situ
Most often occurs near the external os, at the transformation zone.
Most common cause is human papillomavirus (HPV)
Squamous cell carcinoma (SCC) is the most common type
Adenocarcinoma is the second most common type.