The Human Female Reproductive Tract: A Scanning Electron Microscopic Atlas

251 Pages·1976·18.9 MB·English

by  Dr. Hans Ludwig, Hildegard Metzger (auth.)

H. Ludwig· H. Metzger
The Human Female
Reproductive Tract
A Scanning Electron Microscopic Atlas
With 546 Micrographs
Springer-Verlag
Berlin Heidelberg New York 1976
Dr. HANS LUDWIG, Professor of Obstetrics and Gynecology,
Chairman of the Department of Obstetrics and Gynecology, University
of Essen, School of Medicine, HufelandstraBe 55; 4300 Essen (Germany)
HILDEGARD METZGER, Technician-in-Chief ofthe Morphologic Laboratories,
Department of Obstetrics and Gynecology, University of Essen,
School of Medicine, HufelandstraBe 55; 4300 Essen (Germany)
The basic scientific work that went into this book was supported by
Deutsche Forschungsgemeinschaft, Bonn-Bad Godesberg
Lu 118/2-6
ISBN-13: 978-3-642-66347-5 e-ISBN-13: 978-3-642-66345-1
001: 10.1007/978-3-642-66345-1
Library of Congress Cataloging in Publication Data. Ludwig, Hans, 1929- . The human female
reproductive tract. Includes bibliographical references and index. I. Generative organs, Female-Atlases.
2. Ultrastructure (Biology)-Atlases. 3. Scanning electron microscope. I. Metzger, Hildegard, 1940-
joint author. II. Title. [DNLM: I. Genitalia, Female-Atlases. 2. Placenta-Atlases. 3. Fetal membranes
Atlases. WP17 L948h] QM421.M53 611 '.0189'65 76-9112
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© by Springer-Verlag Berlin Heidelberg 1976.
Softcover reprint of the hardcover 1s t edition 1976
The use of general descriptive names, trade marks, etc. in this publication, even if the former are not
especially identified, is not be taken as a sign that such names as understood by the Trade Marks and
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Typesetting, printmg, and bookbinding by Universitatsdruckerei H. Sturtz AG, Wurzburg
Dedicated to the memory of
ROBERT MEYER
who was the creator of a functional
micromorphology imbedded into
clinical work in gynecology and obstetrics,
and to all of those who succeed
to the precision of his work
Foreword
Life is always intimately bound up with structure and with the continuous
transformation which structures undergo. Modern science and technology
have now made it possible to display these structures before our eyes, right
up to the frontiers of molecular dimensions.
When several years ago Dr. HANS LUDWIG, while working at the First
Department of Obstetrics and Gynecology of the University at Munich,
demonstrated to us some micrographs showing the human oviduct's surface
pattern, my immediate reaction was: This is the environment that encom
passes the very onset of an individual human life.
In fact, scanning electron microscopy, superimposed upon classical micro
morphology, has enabled us to get insight into the landscape of living
structures, their intricate organization and their delicate beauty as well. At
the same time this technique opens up an entirely new perspective in our
three-dimensional view and comprehension of biological events. This
becomes especially evident in the realm of reproductive processes within the
human female reproductive tract.
In this volume the authors give - for the first time systematically - a
description of the surface patterns of the inside of the human vagina, ecto
and endocervix, and the human uterus and oviduct; they depict ovulatory
alterations of the ovarian surface and surface changes under various endo
crine conditions, as well as in relation to the menstrual cycle, pregnancy,
fetal growth, and the menopausal cessation of ovarian functional activity.
In addition they describe surface structures of the placental intervillum, the
basal plate and the amnion.
Dr. LUDWIG has dedicated the atlas to ROBERT MEYER, the pioneer of
gynecologic histopathology. ROBERT MEYER who had to flee Germany,
wrote some time before his death in the United States in his" Short Abstract
of a Long Life" that "the important Jactor in our life is how we influence
other people to think."
It would be most gratifying and fitting if ROBERT MEYER'S profound
ideas were to be fulfilled for the beholder of the pictures being collected
to this atlas.
Munich, June 1976 JOSEF ZANDER
VII
Preface
Scanning electron microscopy (SEM) has been used by us since 1971. At
the beginning of our investigations we were mainly interested in analyzing
the process of implantation and we tried to contribute morphologic data
about the role of fibrin formation, which is associated with placentation.
Thus, we had to start with basic studies concerning the surface of the two
important components in implantation: endometrium and trophoblast. The
extreme difficulties in obtaining human material of very early uterine
pregnancies (abrupted by hysterectomy) forced us to shift our attention
to the examination of oviductal ectopic pregnancies. Soon after we proceeded
to investigate placental development, the surface of membranes, of endo
metrium, of oviduct, and the results of gestational metamorphosis occur
ring in the female reproductive organs in comparison to the exogenous
hormonal influences on the surfaces of their tissue.
The female reproductive tract represents a canalicular system that is ex
tremely sensitive to endocrine regulation. The tissue reacts in general with
all its components, but nevertheless with preference for its internal surface.
Scanning electron microscopy provides a method that is eminently suitable
for further elucidation of morphologic equivalents of biochemical reactions.
We collected material over five years (1971-1972 in Munich; 1973-1975
in Essen) and worked intensively on methods to improve preparation and
microphotography. The selection of micrographs exhibited in this book
should be understood as an attempt to introduce the viewer and reader to
the beauty and variety of human tissular architecture, exemplified by the
shape of the internal surface structure of the human female reproductive
tract. We have limited our subject matter to the normal microanatomy. The
pathologic patterns of the tissue surface will be demonstrated in a second
volume to be published later.
For the past eight years the authors have collaborated in the field of
reproductive biology. Special circumstances have encouraged surgical as
well as laboratory work: the morphologic laboratories, including the scanning
electron microscope and additional apparatus, are situated close to the
surgical wards of the Department of Obstetrics and Gynecology at the
University of Essen, School of Medicine. All specimens have been obtained
from patients or puerpera treated by the senior author or by his associates.
Miss HILDEGARD METZGER is responsible for the preparation and SEM
microphotography, HANS LUDWIG for selecting and assembling the material,
SEM analysis, and interpretation of the ultramorphologic data. No micro
graphs have been published previously. The work could not have been done
without the support of Deutsche Forschungsgemeinschaft Bonn-Bad Godes
berg (Lu 118/2-6), which is gratefully acknowledged.
IX
Preface
We hope the reader will be impressed by the concurrence of logical
tissue organization and beauty of nature. Many discussions on the wards
and in the operating theatre, at conferences, or during work in the
morphologic laboratories have convinced the authors that obstetricians
and gynecologic surgeons might gainfresh reverence for "the tissue" by
deepening their microanatomical knowledge. Viewing SEM micrographs
should cultivate this knowledge in an extraordinary way.
Essen, Spring 1976 HANS LUDWIG
HILDEGARD METZGER
x
Contents Plate Page
Introduction· Materials· Methodology 1
1. The Vagina 8
Tissue Surface of the Vaginal Epithelium 1.1-1.4 8
2. The Ectocervix and Endocervix 16
Transition Zone between the Ectocervix and the
Endocervix 2.1 16
Ectocervix 2.2 18
Endocervix 2.3-2.7 20
3. The Endometrium 31
Gross Architecture of the Endometrial Gland Openings 3.1-3.2 32
Cellular Shape of the Endometrial Surface
Epithelium around the Gland Openings 3.3 36
Endometrial Surface Epithelium 3.4-3.5 38
Cellular Details of the Endometrial Surface Epithelium 3.6 42
Comparative Micromorphology of Ciliated Cells in the
Endometrium 3.7 44
Comparative Micromorphology of the Microvillous
Relief of the Nonciliated Cells in the Endometrium 3.8-3.9 46
The Re-Epithelization of the Postmenstrual Uterine
Cavity 3.10-3.12 50
Endometrium after the Insertion of IUD 3.13-3.15 56
Endometrium under the Influence of Ethinylestradiol 3.16-3.17 62
Endometrium of a Female Fetus (Week 23 of Preg-
nancy) 3.18-3.19 66
Senile Endometrium 3.20-3.23 70
4. The Fallopian Tube 79
Organization of the Ampullary Mucosa of the
Oviduct 4.1 80
Gross Arrangement of Ciliated and Nonciliated Cells
in the Ampulla 4.2 82
Distribution of Ciliated and Nonciliated Cells in the
Ampulla 4.3 84
Relation between Single Ciliated and Nonciliated Cells
in the Ampulla 4.4 86
Boundaries of the Nonciliated Cells Occurring in the
Ampulla 4.5 88
XI
Contents Plate Page
Microvilli of Nonciliated Cells Occurring ill the
Ampulla 4.6 90
Comparative Topology of the Segments in the Oviduct 4.7--4.12 92
Fimbriae of a Female Fetus (Week 23 of Pregnancy) 4.13 104
5. The Ovary 106
The Surface of an Adult Ovary at the Time of
Ovulation 5.1 106
The Surface of an Adult Ovary during the Luteal
Phase 5.2-5.3 108
The Texture of the Second Layer of the Tunica
Albuginea 5.4 112
6. Gestational Metamorphosis of the Tissue Surface
114
Vagina (Pregnancy) 6.1 114
Ectocervix (Pregnancy) 6.2 116
Endocervix (Pregnancy) 6.3-6.5 118
Lower Uterine Segment (Pregnancy) 6.6-6.10 126
Endometrium (Pregnancy) 6.11-6.13 136
The Oviduct (Ectopic Pregnancy) 6.14-6.19 142
The Oviduct (at Term of Pregnancy) 6.20-6.21 154
7. Metamorphosis of the Tissue Surface
by Progestational Agents 159
Ectocervix (Progestogenic Treatment) 7.1 160
Endocervix (Progestogenic Treatment) 7.2-7.5 162
Endometrium (Progestogenic Treatment) 7.6-7.7 170
The Oviduct (Progestogenic Treatment) 7K-7.9 174
8. The Placenta 179
Organization of the Villous Tree 8.1 180
Branching of the Placental Villous Tree 8.2 182
Microvillous Pattern of the Terminal Villi 8.3 184
Details of the Microvillous Pattern of Terminal Villi 8.4-8.5 186
Microvillous Pattern around a Placental Sprout 8.6 190
The Basal Plate 192
Shreds of Endometrium 8.7-8.9 192
Cellular and Noncellular Constituents 8.10 198
Decidual Cells and Cytotrophoblasts 8.11 200
Cytotrophoblast 8.12 202
Decidual Cells 8.13 204
Fibrin in the Basal Plate 8.14 206
Surface of the Syncytiotrophoblast in Toxemia 8.15 208
Infarction of the Intervillous Space in Toxemia 8.16 210
XII
Contents Plate Page
9. The Membranes 213
Organization of the Fetal Surface of the Amniotic
Epithelium 9.1 214
Arrangement of the Amniotic Epithelial Cells 9.2 216
Surface Pattern and Cellular Shape of Amniotic Epi-
thelial Cells 9.3 218
Surface Details of the Amniotic Epithelium 9.4 220
Microvilli of the Amniotic Epithelium 9.5 222
The Fibroelastic Layer of the Amnion (Amnion Seen
from the Chorionic Side after Removal of Chorion) 9.6 224
Surface of Amniotic Epithelium in Blood Group
Incompatibility 9.7 226
Surface of Amniotic Epithelium in Postmaturity 9.8 228
Conclusions 231
References 235
Subject Index 239
XIII