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 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 changes 1- Enlargement of the nucleus 2- Multinucleated cells: - Viral infection - TB; Langhans giant cells 3- 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.

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 Lactobacillus Lymphofollicular cervicitis with macrophage

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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