The contents of this book are based on :

Notes from the histology lectures of Dr. Safraz Ali, at the Department of
Anatomy & Cell Biology, University of Malta. Three different sets of notes
were used, taken during the academic years 2003-2004, 2004-2005 and 2005-
2006.

Lutz Slomiankas Blue Histology website [ available at :

http://www.lab.anhb.uwa.edu.au/mb140/ ], which has also provided most of
the diagrams and light microscope images.

The following textbook was used for verification of the information, whenever it was
judged to be necessary : Young B. and Heath J.W. 2000. Wheater's Functional
Histology 4th Edition. Churchill Livingstone.

Disclaimer : Please note that the present book has been compiled by an
undergraduate medical student with a limited knowledge of histology.
Every attempt has been made for this text to be accurate, but the author
cannot guarantee that mistakes are not present.

This book has been made available for download at :

[ http://respectablequack.blogspot.com ]

The text is released in the public domain. The images used have been obtained either
from Blue Histology or through Google image search, and are the intellectual
property of their creators.
[Basics]
Biopsy Tissue Preparation Staining Microscopy

[Epithelia]

Sheet-form, lies on basement membrane which lies on connective tissue.

Avascular (relies on diffusion from connective tissue).
Protective barrier + absorptive and secretory functions.

Endothelium (blood vessels), mesothelium (serous lining of cavities),

epithelium (external surfaces).
Classification :
o Cuboidal, squamous and columnar.

o Simple epithelium, stratified epithelia.

o Ciliated (only in simple).
o Keratinising.

o Pseudostratified epithelia : All cells lie on basement membrane but not

all reach the luminal surface. Nuclei are scattered in many levels. Have
cilia, which are never present in true stratified epithelium.
o Transitional epithelium : In urinary tract (ureter, bladder). Appearance
varies between cuboidal to squamous, depending on stretch.

Simple squamous :
o Surfaces involved in diffusion of gases or fluids.
o Lungs, capillaries, serous cavities.
o Very flat cells, with irregular shape. Can only be identified by bulging
nucleus.

Simple cuboidal :
o Line small ducts and tubules. Have extretory/ absorptive/ secretory
function.
o Collecting tubules of kidney, thyroid gland.
o Polygonal cells, round nuclei.

Simple columnar :
 o Highly absorptive or secretive surfaces.
o Small intestine, stomach, endocervix.
o Often feature cilia and microvilli. Can be pseudostratified.
o Elongated nuclei, exhibit polarity.

Stratified squamous :
o Basal layer is cuboidal, surface layer is flattened.
o Adapted to withstand abrasion.
o When keratinising, also withstands dryness.
o Epidermis, oesophagus, anal canal, ectocervix.

Stratified cuboidal :
o Robust lining for large excretory ducts of exocrine glands.
o Salivary gland, lactiferous sinus.
o Only 2-3 layers usually.

Basement membrane :
o Basal lamina : glycoproteins, produced by epithelial cells.
o Reticular lamina : reticular fibres, produced by connecting tissue.

Cell junctions :
o Anchoring junctions :
Actin + Cadherins & integrins.
Anchorage point for cytoskeleton.
Desmosome = cell to cell.
Hemidesmosone = cell to extracellular matrix.
o Occluding (tight) junctions
Occludins & claudines.
No diffusion of molecules.
No lateral migration of cell membrane proteins.
o Communicating (gap) junctions
Cylinder-like ectamers, which traverse intercellular gap.
Selective diffusion of (+) molecules between two cells.

Luminal surface specialisations :

o Microvilli.
Form brush border on apical cell surface.
Not visible under light microscope.
Increase surface area.
o Stereocilia.
Long microvilli.
Dont move.
 o Cilia.
Visible under light microscope.
Formed of microtubules.
Move in consistent direction.
o Basolateral folds.
Present in ion-exchanging cells (renal tubules).
o Membrane plaques.
Prevent passage of fluids and electrolytes (urinary tract).
o Glycocalyx.
Proteins, enzymes, sugars.
Present in stomach, protects from autodigestion.

Special cells :
o Goblet cell :
Unicellular exocrine mucous gland.
Found interspersed among columnar epithelia of small
interstine and upper respiratory system.
o Steroid secreting cell :
Adrenal cortex, ovaries, testes.
Prominent SER, lipid droplets in cytoplasm.
Secretory adaptations :
o Protein secreting cells (ER, large nucleus, granules in the apical zone)
o Mucin secreting cells (RER, Golgi, secretory vesicles at the apex)
o Steroid producing cells (SER, free lipid vacuoles, prominent
mitochondria)
o Ion pumping cells (large number of mitochondria, tight junctions)
[Glands]

Exocrine glands
o Discharge their secretion into a duct, which takes it to the surface
epithelium.
Shape of secretory units : tubular, acinar, alveolar.

Duct arrangement : unbranched (simple glands), branched (compound glands).

o Simple tubular : large intestine.

o Coiled tubular : sweat gland.
o Branched tubular : stomach.
o Branched acinar : sebaceous glands.

o Compound tubuloacinar : salivary gland.

o Compound tubular : Brunners glands (duodenum).
o Compound acinar : pancreas.

Secretory mechanisms :
o Merocrine : most common, is simple exocytosis. Usually proteins.
o Apocrine : secretion as membrane-bound vesicle. Usually lipids.
Occurs mainly in breast and sweat glands.
 o Holocrine : the whole gland cell is discharged into the channel. Occurs
mainly in sebaceous glands.
Types of secretion:
o Serous (watery secretions, mostly enzymes)
o Mucous (thick, viscous secretions, glycoproteins)
o Mixed (both serous and mucous secretions, e.g. salivary glands
Duct : epithelium and myoepithelial cells, basement membrane.

Endocrine glands.
o Ductless, secrete directly into blood stream.
o Produce hormones.

Anatomical arrangements:
o Independent endocrine gland (features follicles).
Adrenal glands.
Thyroid gland.
o Endocrine cell collections within exocrine gland.
Endocrine pancreas (islets of Langerhans).
Endocrine testes.
Endocrine ovaries.
o Endocrine cells diffusely distributed along other systems (part of
neuro-endocrine system).
GIT glands.
Respiratory system glands.
[Contractile Cells]

Four types of contractile cells:

o Myoepithelial cells (found in ducts, facilitate movement of secretions)
o Myofibroblast cells (contractile properties, secrete collagen, function
to repair tissues by scar tissue)
o Pericytes (around the blood vessels, same function as myofibroblasts)
o Muscle tissue (cardiac, smooth and skeletal muscle)

Skeletal muscle :
o Very long tubular cells (muscle fibres).
o Multinuclear, nuclei peripherally placed.
o Also called striated muscle because muscle fibres in skeletal muscle
occur in bundles (fascicles) which make up the muscle.
o Innervated by somatic nervous system (voluntary).

o Epimysium : layer of connective tissue which is continuous with the

muscle fascia and surrounds the whole muscle.
o Perimysium : extensions of the epimysium into the muscle that
surround individual fascicles.
o Endomysium : a delicate network of reticular fibres from the
perimysium that surround each individual muscle fibre.
o The function of the connective tissue layers is to transduce the force
generated by the muscle fibres to the tendons.

o Satellite cells : small cells which are closely apposed to muscle fibres
within the basal lamina which surrounds the muscle fibre. Believed to
be persistent myoblasts, and allow the muscle to regenerate.
o Numerous capillaries between the muscle fibres supply the muscle
with oxygen and nutrients.
o Motor end plate : the area of contact between the end of a motor nerve
and a skeletal muscle cell.

I-band = actin filaments.

A-band = myosin filaments which may overlap with actin filaments.
H-band = zone of myosin filaments only (no overlap with actin filaments)
within the A-band.
Z-line = zone of apposition of actin filaments belonging to two neighbouring
sarcomeres (mediated by a protein called alpha-actinin).
M-line = band of connections between myosin filaments (mediated by
proteins, e.g. myomesin, M-protein).
Sarcomere = part of the myofibril between two z-lines.
 Cardiac muscle :
o Muscle cells with single, centrally placed nucleus.
o Has cross-striations like skeletal muscle, but is innervated by the ANS.
o Cells are connected to each other by specialisations of the cell
membrane in the region of the intercalated discs.
o Intercalated discs invariably occur at the ends of cardiac muscle cells
in a region corresponding to the Z-line of the myofibrils (the last Z-line
of the myofibril within the cell is "replaced" by the intercalated disk of
the cell membrane).
o In the longitudinal part of the cell membrane, between the "steps"
typically formed by the intercalated disk, we find extensive GAP
junctions.
o Cardiac muscle does not contain cells equivalent to the satellite cells of
skeletal muscle. Therefore cardiac muscle cannot regenerate.

Smooth muscle :
o Spindle shaped cells with single, centrally placed nucleus.
o Myofibrils are not aligned with each other and do not run exactly
longitudinally or parallel to each other through the smooth muscle
cells. Striations are therefore not visible in smooth muscle.
o Innervation by ANS, therefore involuntary.
[Connective Tissue]

Parenchymus (functional) and stromous (mechanical support) cells.

Provides mechanical and metabolic support.
Consists of cells and the extracellular matrix ( = glycosaminoglycans +
fibrillar proteins + structural proteins).
Usually contains nerves and blood vessels.

GAGS :
o Chains of unbranched polysaccharide comprised of repeating disaccharide
units.
o Negative charge, are strongly hydrophilic and retain positive ions.
o Allow selective diffusion of adherent molecules.
o Four groups :
i. hyalronic acid
ii. chondroitin sulfate and dermatin sulphate [blood vessels, heart]
iii. heparin sulfate and heparin [basement membrane]
iv. keratin sulphate [liver]

Fibrillar proteins :
o Collagen :
Most abundant.
Provides tensile strength.
Linear triple -chain helix.

Collagen types :

i. skin, tendons, bone, ligaments, fasciae, fibrocartilage

ii. hyaline and elastic cartilage
iii. blood vessels, parenchymal organs, nerves
iv. basement membrane
v. smooth and skeletal muscle
vi. ubiquitous
vii. skin
viii. endothelium
ix. cartilage
x. cartilage
xi. cartilage

o Fibrillin :
Main component of ECM and microfibrils.
Present in alveoli, blood vessels, mesangium, spleen.
Mediates adhesion between various components of ECM.
o Elastin :
Produced by fibroblasts.
Has stretch and recoil properties.
Forms elastic fibres by interaction with fibrillin.
Present in alveoli.
 o Fibronectin:
Multifunctional glycoprotein.
Binding sites for collagen, heparin and adhesion molecules.
Connects the cytoskeleton of the cell via integrin to the
collagen and GAG, thus providing structural continuity.

Structural proteins :
o Mediate interaction between connective tissue cells and ECM.
o Laminin, entactin, tenacin.

Cells of connective tissue :

[ Primitive mesenchyme : precursor of all connective tissue cells.]

o Fibroblasts:
Collagen production.
Support nerves, veins, arteries, lymphocytes.
Compartmentalisation of various functional layers in organs.
Support for immune population.
Capsule formation.
Tissue repair.
o Adipocytes
Unilocular (adult) : receptors for GH, insulin, glucocorticoids,
thyroid hormones, shock absorber, insulator.
Multilocular (brown fat): energy production.
o Myofibroblasts
o Chondroblasts (precursors of cartilage, become chondrocytes)
o Osteoblasts

Basement membrane :
o Lamina lucida, lamina densa, lamina fibroreticularis.
o Acts as interface/molecular sieve and controls cell organisation and
proliferation.
[Cartilage]

Specialised type of connective tissue.

Consists of cells and extracellular components.
Does not contain vessels or nerves.
Surrounded by a layer of dense connective tissue, the perichondrium.

Hyaline :
o Most common type, has collagen type II.
o Tracheal rings, articular surfaces.

Fibrous :
o Histologically transitional between dense connective tissue and hyaline
cartilage, so has both type I and type II collagen.
o More robust than hyaline.
o Intervertebral discs.

Elastic :
o Histologically similar to hyaline (so has type II collagen), but with the
addition of a dense network of elastic fibres.
o Very flexible.
o Epiglottis.

[Bone]

Bone is considered a type of connective tissue.

Its functions include locomotion, protection and metabolic function.
Mature bone is lamellar, immature bone is woven.

Macroscopic architecture of bone :

o Compact bone (outer zone) :
Rigid, dense walls.
Haversian system.
o Trabecular bone (inner zone) :
Sponge-like network of thin trabeculae.
Medullary spaces, within the trabeculae, where bone marrow
formation takes place.

Periosteum : dense connective tissue that surrounds the bone. Has osteogenic
potency (cells can differentiate into osteoblasts).
Endosteum : loose connective tissue that lines the marrow cavity. Also has
osteogenic potency.

Microscopic structure of bone :

o Compact bone :
Extracellular matrix, in the form of parallel thin sheets, called
lamellae.
 Lamellae form concentric rings around longitudinal canals. The
latter run parallel to the surface of the bone and are called
Haversian canals. They contain nerves and blood vessels.
Volkmanns canals run perpendicular to the Haversian canals,
and connect them with the inner and outer surface of the bone.
Lacunae contain entrapped osteocytes and communicate with
each other through small canaliculi.
Some lamellae dont belong to Haversian systems :
Circumferential lamellae course parallel to the external
surface of the bone.
Endosteal lamellae course parallel to the internal
surface of the bone.
Interstitial lamellae are irregular and lie between
Haversian systems.

o Spongy bone :
It also has lamellae, but they are not arranged as Haversian
systems.
They are deposited on pre-existing trabeculae, depending on
the required bone rigidity.

Extracellular matrix of bone :

o GAGS
o Collagen Type I (90% of organic substance)
o Hydroxyapatite : concentrated mineral salts, mainly Ca (75% of dry bone
weight)

Cells of Bone :
o Bone stem cells : in periosteum and endosteum.
o Osteoblasts : produce osteoid tissue, leading to bone formation.
o Osteocytes : osteoblasts trapped in the forming bone.
o Osteoclasts : large cells that reshape the bone, through the use of enzymes
that break down the collagen. Their activity is hormone driven
(parathyroid hormone +, calcitonin -).
 Ossification :

o Endochondral :

Model of bone in hyaline cartilage diaphysis (shaft) + epiphyses (articular

portions) primary ossification centre appears at diaphysis and epiphyseal plates
[chondrocytes degenerate and osteoblasts replace them] lamellar bone is deposited
on the cartilage scaffolding secondary ossification centres appear at epiphyses.

o Intramembranous :

Membrane = mesenchymal tissue it differentiates into osteoblasts, which create

multiple centres of ossification the bone produced is woven type, and forms the
primitive trabecular part later, more osteoid is deposited at the necessary sites to
produce primitive compact bone reorganisation replaces woven bone with lamellar
and mature bone is produced

[Bone Marrow]

Meshwork of vascular sinuses and highly branched fibroblasts.

The interstices are packed with haemopoietic cells.
Functions :
o Haemopoiesis.
o Removal of aged and damaged RBCs from circulation.
o B lymphocyte differentiation site.
o Plasma cell site.

Components :
o Stroma : framework of reticulin.
o Sinusoids : dilated vascular spaces which drain towards central vein.
o Haemopoietic cells : precursor and maturing blood cells. Their exit
from the bone marrow is controlled by hormones.
[Skin]

Functions of skin :
o Protection : UV, mechanical, chemical, thermal, physical barrier to
pathogens.
o Thermoregulation : sweat, regulation of blood flow to the surface of
the skin.
o Sensation : touch, pressure, pain and temperature.
o Metabolic : vit.D synthesis, subcutaneous adipose tissue energy
storage.

Layers :
o Epidermis (superficial) : self-regenerating avascular layer of
keratinizing stratified squamous epithelium lying on basal membrane.
o Dermis (deeper part) : tough supporting layer of vascular fibroelastic
tissue.
o Skin Appendages : lie in dermis.
o Subcutaneous tissue : mainly adipose tissue, acts as shock absorber and
insulator.

Epidermis layers :

o Basement membrane :
Attaches epidermis and dermis.

o Stratum basale (basal layer) :

Columnar epithelium.
Mitotic activity, to produce the rest of the epidermis layers.
Hemidesmosomes and desmosomes.

o Stratum spinosum :
Prickle cells, irregularly polygonal and featuring spinous cell
processes.
Several layers thick, cells attached to each other by
desmosomes.
Very resistant to stress, maintains the integrity of the epidermis.

o Stratum granulosum :
Basophilic elongated cells with dark granules.
These cells produce and release keratohyalin, and therefore
play a role in keratinisation of the skin.

o Stratum lucidum :
Single cell layer, cells connected by desmosomes..
Cells lack nuclei and organelles, are mainly composed of cell
membrane and keratin.
 o Stratum corneum (superficial layer) :
Flattened dead cells (keratinocytes).
The layer is mainly a thick band of keratin, that renders the skin
waterproof.

Epidermis cell types :

o Keratinomyocytes :
Predominant cell type of epidermis.
Produce keratin, which ultimately fills the cell and creates an
extracellular water barrier.
o Melanocytes :
Synthesize melanin and transfer it to keratinocytes.
Melanin pigments the skin and protects keratinocytes from
light-induced DNA damage.
Located in stratum basale.
o Langerhans cells :
Present in all layers of epidermis.
Have immune role.
o Merkel cells :
Touch and pressure receptors.
Lie in basal layer, synapse with nerves in papillary dermis.
 Dermis :
o Thick layer of connective tissue.
o Mechanical support to epidermis and skin appendages.
o Vascular : metabolic support of avascular epidermis and
thermoregulation.
o Nerve fibres.
o Lymphocytes, macrophages and mast cells.
o Difficult to discriminate from subcutaneous tissue.

Dermis layers :

o Papillary layer (superficial):

Thin and loose layer of fine interlacing collagen fibres, fine
elastin fibres and fibroblasts.
Lies between rete ridges of deep surface of epidermis.
Contains blood and lymph vessels.
Nerve twigs (Meissners Corpuscles).

o Reticular layer (deep) :

Densely packed thick collagen fibres, long and thick elastin
fibres and fibroblasts.
Lymphocytes, macrophages and mast cells.
Nerve fibres and glomus bodies (temp regulation).
 Skin appendages :

o Pilosebaceous apparatus :

Hair follicle : epidermis downgrowth.

Erector pili muscle : smooth muscle under sympathetic control.
Sebaceous glands :
Derived from follicular sheath.
Produce sebrum (oily secretion), a waterproofing and
moisturising agent for hair and skin.
Mostly holocrine secretion.
Gland located along the hair follicle, secretions are
expelled through follicle duct.

o Sweat glands:
Simple coiled tubular glands, located in the dermis.
Secretory and excretory parts.
Most are merocrine.
In axilla, perineal region and around the nipple, they are
apocrine.

o Glomus bodies :
Arteriovenous shunt.
Regulates blood flow for thermoregulation purposes.

o Sensory receptors :
Pacinian corpuscles : pressure and vibration.
Meissner's corpuscles : touch.
Merkels corpuscles : mechanoreceptors.
[Breast]

Outgrowths of the epidermis along the milk line. Modified sweat glands.
Parts :
o Skin.
o Nipple and areola.
o Breast parenchyma and stroma.

Skin : similar to normal skin but lacking hair follicles.

Nipple and areola :

o Highly pigmented thin skin.

o Bundles of smooth muscle lie deep to nipple and areola. Their fibres
are arranged longitudinally along the lactiferous ducts (due to their
contractility, they cause erection of the nipple).
o 15-20 lactiferous ducts open at the nipple.
o Small projections called Montgomerys tubercles are present on the
areola. Here lie Montgomerys glands (sebaceous) which open directly
to the skin.

Each breast is composed of 15-20 lobes, separated by septa of fibrous

connective tissue.
Each lobe is composed of two components :
o Branching duct system (lactiferous ducts), which subdivides it into
numerous lobules.
o Stroma, consisting of connective tissue and adipose tissue .

Breast parenchyma (branching duct system) : ducts undergo repeated

divisions leading to the formation of terminal ducts.

I. Lactiferous duct.
Lined by two layers of epithelium : one columnar and
one cuboidal.
Outer layer of myoepithelial cells, which contract under
hormonal stimulation (oxytocin) to propulse secretion.
Features lactiferous sinus.
Just before the ducts open onto the nipple, the columnar
epithelium becomes stratified squamous.
II. Interlobular ducts.
Two layers of cuboidal or low columnar epithelium plus
myoepithelial layer.
III. Intralobular ducts (terminal ducts).
IV. Lobule.
Clusters of blind ending ductules.
Along with the terminal duct, they form the terminal
duct lobular unit, which is the functional unit of the
breast.
 Stroma :
o Intralobular.
Loose connective tissue and little adipose tissue.
Provides the space for the proliferation of the ductules that
takes place in lactation. With progressing age, the adipose
tissue is replaced by fibrous tissue.
o Interlobular.
Dense connective tissue and abundant adipose tissue.
Abundant elastic fibres and nerves.
Fibrous septa that separate the lobes.

Normal Histological Changes :

o Birth : the breast is mainly composed of the nipple and a rudimentary
duct system.
o Early puberty : breast disc formation, under areola.
o Puberty :
Increasing oestrogen and progesterone production, due to
maturing ovaries.
The duct system begins to proliferate, the nipple enlarges, the
areola pigmentation increases and adipose tissue accumulates.
o Pregnancy :
Reduction in the amount of adipose and connecting tissue.
Proliferation and branching of duct system (due to oestrogen).
Development of acini of lobules (due to progesterone).
Accumulation of secretory product in acini.
o Lactation :
Merocrine secretion of protein component of milk.
Apocrine secretion of lipid component of milk.
Colostrum, rich in antibodies is initially secreted, followed by
lipid-rich milk.

Beginning of secretion requires presence of suckling.

In long-term absence of suckling, the glandular tissue returns to
an inactive state (fibrous tissue increases, duct system reduces).
o Menopause :
Atrophy.
Only a very small part of duct system remains.
Reduction of fibroblasts leads to reduction of collagen and
elastic fibres.

Pathological Changes :
o Fibrocystic disease : fine needle aspiration to cure.
o Fibroedinoma : young patients, mobile nodule.
o Cancer : lobular or ductal carcinoma.

The male breast usually remains rudimentary. If oestrogen levels are high (e.g.
hepatic cirrhosis) gynecomastia appears.
[Respiratory System]

Mechanical respiration necessary for cellular respiration.

Respiratory system divisions :

o Conducting part (airway) and respiratory part (respiratory bronchiole,
alveolar ducts, alveolar sacs and alveoli).

Upper respiratory :

o Nasal cavity, paranasal sinuses and nasopharynx.

o Filtering, humidification, temperature adjustment of inspired air.

Nasal cavity :
o Pseudostratified columnar ciliated epithelium (respiratory epithelium)
with goblet cells.
o Lamina propria (loose connective tissue with vessels) underlies
epithelium.
o Submucosa.
o Olfactory cells in roof.

Pharynx :
o Nasopharynx has respiratory epithelium.
o Oropharynx has stratified squamous epithelium.
o Rich in lymphoid tissue (MALT) to protect against inhaled pathogens.

Epiglottis :
o Central core of elastic cartilage covered by epithelium.
o Grooves of glands.

Lower respiratory :

o Larynx, trachea, main bronchi, lobar bronchi, segmental bronchi,

bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs,
alveoli.

Larynx :
o Cartilages.
o False vocal cords : respiratory epithelium.
o True vocal cords : stratified squamous epithelium, to withstand
abrasion.
o Reinkes space : absence of lymphatics below true vocal cords.
 Trachea :
o 16-20 c-shaped rings of hyaline cartilage support tracheal mucosa and
prevent collapse of trachea during inspiration.
o The dorsal ends of the rings are connected by smooth muscle
(trachealis muscle) and connective tissue.
o Longitudinal elastic and collagenous fibres (annular ligaments) link the
rings.

o Respiratory epithelium with goblet cells.

o Brush cells : columnar cells with microvilli, unknown function.
o Clara cells : columnar non ciliated cells. Main function is
detoxification, they can also divide and differentiate to act as reserve
cells, and they secrete one of the components of surfactant.
o Lamina propria.
o Submucosa with muco-serous glands.

Bronchi :
o Accompanied by branches of the pulmonary artery, nerves and lymph
vessels, which usually travel in intersegmental and interlobar sheets of
connective tissue.

o Histological structure similar to trachea, but with differences :

Lower columnar epithelium.
Denser lamina propria.
Smooth muscle between lamina propria and submucosa.
Submucosa features less glands.
Cartilaginous frame is arranged into flattened interconnected
plates, instead of rings.
 Bronchioles :
o Terminal segments of the conductive portion.
o Epithelial tissue becomes initially simple rather than pseudostratified
columnar, then becomes low columnar and finally becomes cuboidal.
o No glands.
o No cartilage.
o Thicker smooth muscle layer.

Respiratory bronchioles :
o Gas exchange starts here.
o Simple cuboidal epithelia,
o No goblet cells, no cartilage, no glands.
o Wall is just smooth muscle.

Alveoli :
o The actual alveolus is empty space surrounded by pneumocytes.
o Alveoli are separated by thin interalveolar septa, consisting of two
layers of epithelial cells (pneumocytes).
o The interalveolar septa also contain fibroblasts and connective tissue
with elastic and reticular fibres.
o Between the connective tissue fibres we find a dense, anastomosing
network of pulmonary capillaries.
o The capillary endothelium is in direct contact with the alveolar
pneumocytes, and their basement membranes often fuse.
o Neighbouring alveoli may be connected to each other by small alveolar
pores.

o Type I pneumocytes (alveolar lining cells) :

Large squamous cells.
Cover most of the alveolar surface.

o Type II pneumocytes (surfactant cells) :

Rounded with large nuclei and cytoplasmic vacuoles.
Numerically more than type I but only cover an insignificant
part of alveolar area.
Secrete most components of surfactant, a mixture of
phospholipids and proteins that reduces the surface tension
within alveoli, preventing their collapse during expiration.
Can divide and differentiate into type I to repair the alveoli.

o Alveolar macrophages :
Derived from blood monocytes.
Travel between alveoli.
Phagocytosis of microorganisms and particulate matter.
Usually lie on the surface of pneumocytes type I.
 Air blood barrier :

[ A, alveolar space; EP1, epithelium; BM, basement membrane; EN, endothelium; P,

plasma; C, capillary; EC, erythrocyte. ]

Anything which increases the thickness of the air-blood barrier will impede the
gaseous exchange (e.g. oedema, fibrosis or inflammation). The greater the distance,
the longer the time for the gas exchange to take place.

If there is inflammation of the wall, repair is by fibrous tissue so the elastic tissue is
lost and the lung loses the ability to expand and recoil. The bronchi have cartilage so
the wall does not collapse. But bronchioles have no cartilage only elastic fibers. If
those elastic fibres are lost, the wall will collapse. This is the main problem in
emphysema.
[Blood]

Tissue comprising a variety of cells suspended in a fluid medium.

Plasma :
o Acqueous solution of inorganic salts.
o Constantly in exchange with ECF of other tissues.
o Plasma proteins :
Albumins : protein transport.
Globulins : antibodies and lipid transport.
Fibrinogen : blood clotting.

Red blood cells :

o Biconcave disc shape.
o No nucleus or organelles, essentially are a plasma membrane
enclosing haemoglobin and enzymes.
o Cytoskeleton, which allows them to deform so they can pass
through capillaries.
o Anaerobic metabolism of glucose is sole energy source.

Platelets :
o Are formed from megakaryocytes.
o Can connect with one another through cell membrane bridges.
o Numerous organelles and granules.
o Plug sites of vascular damage and secrete vascular repair factors.
o Clot formation.

Granulocytes :
o Prominent cytoplasmic granules.
o Granules are different in each type :
Neutrophils :
Most common.
Multilobed nucleus.
Very active in phagocytosis of bacteria and cellular
debris in inflammation.

Eosinophils :
Large bilobed nucleus.
Phagocytose antigen-antibody complexes.

Basophils :
Small bilobed nucleus.
Precursors of mast cells.
Involved in allergy.

Mononuclear lymphocytes :
o Lymphocytes :
Smallest white blood cells, but second most common.
Central role in all immune response mechanisms.
B-cells, T-cells and natural killer cells.
 o Monocytes :
Largest white blood cells.
Precursors of macrophages.
Highly motile, very active in phagocytosis.
Necrotaxis and chemotaxis.

[Haemopoiesis]

Takes place in :
o Bone marrow of skull/ribs/sternum/vertebrae/pelvis/femur (adults).
o All bone marrow (children).
o Spleen and liver (embryo).

Multipotential stem cell

Unipotential stem cell

Proerythroblast + Lymphoblast + Myeloblast + Monoblast + Megakaryoblast

Erythrocyte + Lymphocyte + Granulocytes + Monocyte + Platelet
[Circulatory System]

Closed system, transporting blood and nutrients to different parts of the body.
Heart (propulsive force), arterial system, venous system, capillaries
(interface).

Vessels have three layers :

o Tunica intima :
Endothelial lining and basement membrane.
Subendothelial connective tissue (elastic fibres, collagen,
smooth muscle).

Internal elastic lamina (elastic fibres).

o Tunica media :
Circular smooth muscle.
Connective tissue (collagen, elastic fibres and proteoglycans)

External elastic lamina (elastic fibres).

o Tunica adventitia :
Connective tissue fibres (mostly collagen, some elastic fibres
and very little smooth muscle).
Limits not easily distinguishable.
Site of vasa vasorum (more prominent in large veins).
 Arteries :

o Elastic arteries (e.g. aorta) :

Have a lot of elastic tissue, to withstand the blood pressure and
maintain the ejection of blood.
Stretch in systole and recoil in diastole, to maintain a diastolic
pressure.

Tunica intima thicker than in other arteries, internal elastic

lamina very feint.

Very thick tunica media with loads of elastic tissue, external

elastic lamina is hard to distinguish.

Tunica adventitia thinner than tunica media.

o Muscular arteries (e.g. regional arteries) :

Tunica intima much thinner than elastic arteries. Internal elastic

lamina is very prominent.

Tunica media consists of smooth muscle with minimal elastic

fibres.

Tunica adventitia has decreased elastic fibres, blood vessels

and collagen. External elastic lamina is thick and doesnt form
continuous band.

o Arterioles :
Like muscular arteries but with narrow lumen.

Internal elastic lamina is not visible.

 Tunica media has a large amount of smooth muscle, relative to
its size, because peripheral blood pressure depends on the tone
of these arterioles.

Adventitia cant be distinguished from periarterial connective

tissue.

Endothelial cells have selectins (facilitate the migration of

leucocytes in the inflammatory conditions) and secrete the Von
Willebrand factor.

Capillaries :

o Only the tunica intima is present, which typically only consists of the
endothelium and its basal membrane.
o The capillary is surrounded by an incomplete layer of cells, the
pericytes. Pericytes have contractile properties and can regulate blood
flow in capillaries.
o Capillaries secrete substances that are involved in vasodilation (e.g.
NO) and coagulation (e.g. Von Willebrand factor, TPA).

o Capillaries are essentially of two types :

Continuous: when both endothelial cells and basement
membrane form continuous layers.
Fenestrated: when there are gaps between the endothelial cells,
to facilitate diffusion of molecules.

Veins :
o Thinner walls but larger diameter lumen than arteries.
o The layers of the wall are not very distinct.
o Internal and external laminae are usually absent.

o Venules :
Similar structure but larger than capillaries.
They do have 3 layers but these are not distinct.

o Small and Medium-sized Veins :

Tunica intima folds give rise to pocket-like valves.
Tunica media is thinner than tunica adventitia.
Tunica adventitia is more developed in veins than in arteries
(more smooth muscle to prevent distention).
 o Large Veins :
Thin tunica intima and tunica media.
Tunica media is mostly collagen.
Tunica adventitia is very well developed and contains
longitudinal smooth muscle.
Vasa vasorum.

Just before the great veins open into the heart, the tunica
adventitia contains cardiac muscle fibres.

Heart :

o Endocardium (tunica intima) : endothelial lining + subendocardial

layer (elastic fibres, collagen and Purkinje fibres).

o Myocardum (tunica media) : Cardiac muscle + branches of the

conductive system. The muscle cells are very rich in mitochondria,
because of the continuous pumping action. Atrial myocardium secretes
atrial natriuretic hormone (excretion of Na+ and H2O, lowers blood
pressure)

o Epicardium (tunica adventitia) : outermost layer, continuous with the

pericardium.

o Conduction system : more or less similar to cardiac fibres but with

larger cells and less mitochondria.

o Valves : fibrous core, avascular, covered by smooth endothelium to

prevent disruption of blood flow. Inflammation of valves leads to
turbulent flow and thrombogenesis.
[Oral Tissues]

Layers of oral mucosa :

o Thick stratified squamous epithelium.

o Lamina propria (subendothelial dense connective tissue).
o Submucosa with accessory salivary glands.
o Muscle or bone.

Lips :
o Outer surface : skin with pilosebaceous apparatuses.
o Vermillion border : highly vascular, rich innervation, no pilosebaceous
apparatuses, no sweat glands.
o Inner surface : oral mucosa.

Tongue :
o Muscular organ (transverse + longitudinal muscle layers).
o Two parts, due to distinct embryological origin, separated by sulcus
terminalis.

o Anterior 2/3 :
Epithelium thrown in folds.
Numerous accessory salivary glands.
Papillae.

o Posterior 1/3.
Smooth epithelium.
Lingual tonsils.

Filiform Fungiform Circumvallate

Papillae of tongue :

o Filiform :
Smallest and most numerous.
Dense supporting tissue.
Appear whitish, due to heavy keratinisation.
Rough surface for manipulation of food and cleaning oral
cavity.
 o Fungiform :
Globular and small.
Dispersed among filiform papillae.
Appear red, due to high vascularisation.
Thin, non-keratinising epithelium.

o Circumvallate :
Largest and least numerous.
Form row anterior to sulcus terminalis.
Have numerous taste buds.
Encircled by circumvallate cleft.
Serous glands (Von Ebners).

Salivary glands :

o Saliva = mucous, amylase, lysozyme, antibodies, inorganic ions.

o Salivary glands are branched tubulo-acinar glands of either mucous or
serous or mixed types.
o Parotid (mainly serous), submandibular (mainly mucous), sublingual
(mainly mixed).

o Serous cells stain darkly. In mixed glands, they arrange themselves

into demilunes.
o Mucous cells stain poorly.

o Glands are capsulated and divided into lobules by septa.

o Secretory units are surrounded by myoepithelial cells.
o Intercalated ducts (cuboidal) striated ducts (columnar) large
excretory ducts (stratified cuboidal) major excretory duct (stratified
squamous).

o Major glands (see above) secrete when stimulated by parasympathetic,

minor glands (scattered) secrete continuously.
[Lymphoid Organs]

Lymphocytes are distributed throughout the body, at sites that provide a

possible route of entry of pathogens.
.
Some are found isolated, in loose connective tissue or epithelium (MALT).
Others form large non-capsulated aggregations (tonsils, Peyers patches).
Many are found in encapsulated, highly organised structures (lymph nodes).

Thymus :

o Most active in childhood, involutes after puberty.

o Loose collagenous capsule which also gives interlobular septa,

dividing the organ in lobes
o Lobes are divided into higly cellular cortex and less cellular medulla.
o Blood vessels enter and leave thymus parallel to the septa, carrying
lymphocytes.
o Blood-thymus barrier : epithelial cells surround the blood vessels, not
allowing antigenic material to enter. Also, there are no afferent
lymphatics.

o Reticulocytes form a sponge-like (featuring collagen and reticular

fibres) structure that becomes colonized mainly by immature
lymphocytes (mostly T). Macrophages are also present.

o Cortical reticulocytes (nurse cells) envelope the lymphocytes and

secrete hormones to promote their maturation and proliferation.

o Hassalls corpuscles : degenerating keratinized reticulocytes. They are

a characteristic feature of thymus, increasing in number with age.
 Lymph nodes :

o Small, encapsulated bean-shaped organs, in the course of lymphatic

vessels.
o Few mm diameter when inactive, enlarge when mounting immune
response.
o Cortex (highly cellular) and medulla (less circular).

o Functions :
Non-specific filtering of particles and microorganisms from
lymph.
Activation and proliferation of B and T lymphocytes.

o Cell types :
Lymphoid cells (lymphocytes and plasma cells).
Immunological accessory cells (antigen presenting cells,
macrophages).
Stromal cells (endothelial, fibroblasts).

o Structural components : sinuses, parenchyma and blood vessels.

o Sinuses :
Afferent lymphatics divide before entering the node, pierce the
capsule and drain into the subcapsular sinus.
Then lymph passes into the narrow cortical sinuses and then
into the broad interconnected medullary sinuses.
The latter converge upon the hilum which lies in the concavity
of node, before they pass into the efferent lymphatic vessels.

Macrophages can be distinguished in the sinuses, although

theyre present throughout the node.

o Parenchyma :
Meshwork of reticulin fibres that support an ever-changing
population of lymphocytes.

Medulla :
Medullary cords : consist of mature B-cells (plasma
cells) that lie between medullary sinuses and produce
Igs.

Cortex :
Superficial cortex :
o Lymphoid follicles : densely packed immature
B-lymphocytes in superficial cortex.
o Germinal centers : less dense areas of follicles,
site of proliferating B-cells.
Deep cortex : location of T-lymphocytes.
 o Blood vessels :
Arteries enter at hilum and branch inside medulla.
Lymphocytes enter node through specialised high endothelial
venules (HEN), that feature cuboidal epithelium and specialised
adhesion molecules.
Venules exit again through hilum.

Spleen :
o The spleen is, like the lymph nodes, a discriminatory filter. Unlike the
lymph nodes, the spleen is inserted into the blood stream to clear the
blood of aged blood cells and foreign particles and is the site of
immune reactions to blood-borne antigens.

o The spleen is surrounded by a capsule of dense connective tissue from

which branched trabecula extend into the parenchyma of the spleen.

o Parenchyma :

Red pulp : blood vessels (splenic sinusoids) supported by

reticular connective tissue (splenic cords).
White pulp : rounded/oval areas of lymphoid tissue lying inside
the red pulp.

o Blood vessels :

Splenic artery (enters at hilum).

Trabecular arteries (course inside trabecula).
Central arteries (enter white pulp).
Penicillar arteries (exit white pulp).
Sheathed arteries (surrounded by phagocytes and reticular
fibres, enter red pulp).

Closed circulation : sheathed arteries empty directly into

splenic sinusoids.
 Open circulation : sheathed arteries first empty into splenic
cords and then the blood moves into sinusoids, through the
sinusoid fenestrated endothelium.

Sinusoids continue into veins of pulp.

Trabecular veins.
Splenic vein.

Tonsils :

o Palatine, lingual, pharyngeal : form Waldeyers ring.

o Masses of lymphoid tissue, supported by a fine network of reticular
fibre.
o Surrounded by a thick hemicapsule of connective tissue, which
delimits them from the underlying muscle.
o The epithelium that covers them forms deep crypts into the lymphoid
tissue, to facilitate the contact of antigens with the immune cells.
o Do not have afferent lymph vessels but only efferent ones.
o Lymphocytes enter them through specialised venules.
o They feature lymph follicles.

MALT :

o Diffuse populations or non-encapsulated aggregations of lymphoid

tissue, inside the GIT, respiratory tract or genitourinary tract.
o Consists mainly of T-cells.
o Secretes Igs, mainly IgA.
o Their function is quite similar to lymph nodes, as overlying epithelium
is specialised in sampling luminal antigens
[Gastrointestinal Tract]

Breakdown of food and absorption of nutrients.

Generic structure of GIT :

o Mucosa
Columnar epithelium (absorption) and glands (secretion and
epithelium repenishment).
Lamina propria (mechanical and vascular support for
epithelium and glands, site of MALT)
Muscularis mucosa (circular and longitudinal fibres for small
mucosal movements)

o Submucosa
Connective tissue rich in collagen.
Arteries, veins, lymphatics.
Meissners nerve plexus.

o Muscularis propria
Inner circular layer.
Auerbachs nerve plexus lies intermediately.
Outer longitudinal layer.

Responsible for peristalsis.

Prevents distension (megacolon in Hirschsprung disease).

o Adventitia
Loose connective tissue, vessels, nerves.
Introperitoneally surrounded by serosa, a simple squamous
epithelium.

Oesophagus :

o Mucosa : stratified squamous epithelium, to protect from hard food.

o Lamina propria : well-defined.
o Submucosa : mucous glands.
o Muscle layer :
Upper 1/3 skeletal muscle
 Middle 1/3 mixed
Lower 1/3 smooth muscle
o Adventitia : loose connective tissue.

Stomach :

o Mucosa :
Simple, tall columnar epithelium.
Thrown into longitudinal folds (rugae), to accommodate
distension.
Gastric pits, where gastric glands open.
Lamina propria is very cell-rich.

o Gastric glands (in mucosa) :

Cardiac : branched tubular mucous glands.

Principal glands :
Chief cells : most numerous, produce pepsinogen.
Parietal cells : large cells featuring deep invaginations.
Lie between and deep to chief cells and produce
hydrochloric acid.
Mucous cells.
Stem cells : replenish sloughed off cells (first transform
into intermediate cells and then mature into other types
of cells).
Endocrine cells : mainly produce gastrin and
somatostatin.

Pyloric glands :
More endocrine cells and less parietal cells than
principal area.
No chief cells.
 o Muscularis propria features additional inner oblique muscle layer.

Small Intestine :

o Mucosa :

Lamina propria rich in MALT.

Structural features that increase absorptive surface :

Whole mucosa thrown in permanent folds (plicae

circulares).
Plicae feature villi (epithelial covering, lamina propria
core).
The epithelium of each villus features numerous
microvilli.
Between villi lie crypts (of Lieberkhn) where glands
open.

o Cells :
Enterocytes :
Main cells of mucosa.
Columnar epithelium with microvilli coated by
glycocalyx.
Produce all peptic enzymes apart from lipases (which
are produced by the pancreas).
Mucous cells.
Stem cells.
Paneth cells : secrete protein and defensin
Endocrine cells : gastrin and somatostatin, but also secretin and
cholecystokinin.

o Going down the tract, the number of goblet cells increases and the
number of mucous cells increases as well : as the food becomes harder
you need increased amount of mucus.
 o Brunners glands : lie in the submucosa of the duodenum and produce
alkaline secretions to counter the effect of gastric acid.

o Peyers patches : Tiny flattened areas in the mucosa of the ileum.

Epithelium is dome-shaped, without villi. Contain MALT. They help
us distinguish duodenum from ilium.

Colon :

o Similar four-layer microstructure to small intestine.

o No breakdown of foods, only reabsorption of water and inorganic salts.
o Contents of colon are concentrated and hardened.

o Mucosa :
No pliae or villi, but very deep crypts (of Lieberkhn).
Many goblet cells.

o Submucosa contains a fair amount of fat.

o Muscularis propria : circular layer is normal, longitudinal layer forms

three flattened teniae coli.

o Adventitia : features epiploic appendices, small fat-filled pouches.

Appendix :
o No villi, very few crypts.
o Thin muscularis propria, no teniae coli.
o Nerve fibres are smaller in dimension.
o Large accumulations of MALT, especially in younger patients.
[Pancreas]

Connective tissue divides gland into lobes and lobules.

Has both exocrine and endocrine components.

Endocrine part (islets of Langerhans) :

o Scattered throughout exocrine tissue.

o More vascularised than exocrine part.

o Beta cells (insulin),

o Alpha cells (glucagon) and
o Delta cells (somatostatin).
o Gamma cells (pancreatic polypeptide).

Exocrine cells :
o Tubuloacinar serous glands make up the lobes.
o Acinar cells (triangular shaped, contains zymogen granules).

o Ducts :

Lobular ducts (cuboidal or low columnar)

Interlobular ducts (columnar)
Main pancreatic duct (tall columnar)

Duct system also contains neuroendocrine cells.

o Pancreatic juice is a clear alkaline fluid which contains the precursors

of enzymes of all classes necessary to break down the main
components of the diet.
[Liver]

Largest gland in the body.

Functions : detoxification, metabolism of proteins, fats and carbohydrates,
storage of glucogen and vitamins, bile production. Also produces blood
clotting factors and heparin.

Lobule (classic) :
o Structural unit of the liver.
o It is delimited by interlobular connective tissue (not visible in humans).
o In its corners we find the portal triads.
o In cross sections, the lobule is filled by cords of hepatocytes, which
radiate from a central vein and are separated by vascular sinusoids.

Portal triads :
o Fibrous tunnels containing terminal branches of the hepatic artery,
portal vein and a bile duct.

Acinus :
o Functional unit of liver.
o It is served by terminal branches of a single branch of the portal vein
and a single branch of the hepatic artery.

Blood flow :
o Hepatic artery and portal vein branches (in portal triad).
o Sinusoids.
o Central vein.
o Sublobular veins.
o Hepatic vein.

Sinusoids :
o Lined by fenestrated simple squamous epithelium, which separates the
hepatocytes from the bloodstream.
o Kupfer cells (macrophages) are attached to the epithelium.
o Between the hepatocytes and the epithelial cells is a narrow
perisinusoidal space.
o Due to the fenestrations, diffusion from the blood to the perisinusoidal
space is free.
 Bile flow :

o Opposite direction to bile flow.

o Bile canaliculi (three dimensional network within the sheets of
hepatocytes, its walls are formed by adjoining liver cells)
o Very short canals (of Hering) formed by both hepatocytes and
epithelium connect the bile canaliculi to terminal bile ducts.
o Terminal bile ducts empty into the interlobular bile ducts found in the
portal triads.

Hepatocytes :
o Large polyhedral cells, packed with organelles (large nucleus, large
Golgi, ER, ribosomes, glycogen and lipid vesicles, abundant lysosomes
and peroxisomes, abundant mintochondria).

o Three surfaces :
Sinusoidal (70%): microvilli, transfer of material to and from
sinusoid.
Canalicular (15%): irregular microvilli, actin filaments. Tight
junctions isolate the canaliculi from the rest of the surface.
Intercellular (15%) : communicating junctions.

Anatomical zones :
1. Hepatocytes which are in contact immediately with the portal triad.
2. Layer of cells further away.
3. Layer of cells furthest away.
This is used to assess the damage found in cells.

[Gallbladder]

Tall columnar epithelium featuring microvilli.

Folded and caved mucosa.
Like GIT, but no mucous glands in mucosa and no muscularis mucosae.
[Urinary System]

[Kidney]

Distinct parts :
o Cortex : consists of convoluted tubules and renal corpuscles.
o Medulla : consists of loops of Henle and collecting ducts.
o The cortex and medulla together comprise millions of individual
nephrons, all packed together.

Lobe : medullary pyramid (a roughly pyramidal region that projects into the
pelvis) and its associated cortex.
Lobule : a portion of the kidney containing those nephrons that are served by a
common collecting duct.

Functional unit : the nephron, which consists of one renal corpuscle and its
associated tubule.

Renal Corpuscle :
o Each renal corpuscle consists of an epithelial cup called Bowman's
capsule enclosing a knot of capillaries and other elements called the
glomerulus.

o Bowmans capsule :

Two layers of epithelium in which the glomerulus is

invaginated. The space between the two layers is Bowmans
space.
The parietal layer of Bowman's capsule is simple squamous
epithelium.
The visceral layer is made out of special epithelial cells,
podocytes. Those are extremely complex in shape, featuring
small foot-like cytoplasmic processes
The podocyte processes lie around the fenestrated capillaries of
the glomerulus. The openings between the pedicles are called
 filtration slits. They are spanned by a thin membrane, the
filtration slit membrane.

Glomerular filtration barrier :

1. Fenestrated capillary endothelium.
2. Basal membrane (has two thin layers and a central
electron dense layer which is negatively charged and
repels negatively charged anionic particles).
3. Podocyte process layer (also fenestrated).
Prevents larger molecules (e.g. proteins) from entering
Bowman's space.

o Glomerulus :

A small tuft of capillaries and supporting structures suspended

within Bowman's capsule.
The glomerular capillaries feature fenestrated endothelium.
The glomerulus is the source of the initial filtrate of plasma that
is eventually processed into urine.
 Mesangium :

Lies between capillaries at the vascular pole of the

corpuscle.
Mesangial cells (contain angiotensin receptors and
myosin filaments) and extracellular matrix.
Supports the capillary loop system and controls blood
flow through the glomerular loops.

Proximal tubule :

o Longest part of nephron.

o Cuboidal or low columnar epithelium with microvilli
o Extensive interdigitations
o Abundant mitochondria, to support active transport.

Intermediate tubule (loop of Henle) :

o Simple squamous epithelium.

Distal tubule :
o Cuboidal or columnar epithelium, very few microvilli.
o Interdigitations.
o Macula densa (connection between glomerulus and distal tubule)

Collecting tubule :
o Cuboidal epithelium.
o Variable water permeability
 Juxtaglomerular apparatus :

o Regulares renal function through the renin-angiotensin-aldosterone

mechanism.

o Parts :
Macula densa (the distal tubule is in close contact with the
endothelial cells of the efferent and afferent arterioles of the
glomerulus).
Lacis cells (extraglomerular mesangial cells, produce renin).
Juxtaglomerular cells (surround the afferent arteriole, produce
renin).

o Exact mechanism is unknown, it is believed that juxtaglomerular cells

act as baroreceptors.

Renal vasculature :

o Renal vessels (end at pelvis).

o Interlobar vessels (pelvis to medulla).
o Arcuate vessels (medulla to cortex).
o Interlobular vessels (cortex).
o Afferent arteriole, glomerular capillaries, efferent arteriole, peritubular
capillaries (different parts of nephron).
o Vasa recta (maintain osmotic gradient of medulla).

Renal disease :
o Nephritic (obstruction to blood and filtrate flow : increased blood
pressure, increased nitrogenous products, haematuria)
o Nephrotic (permeability disorder : generalised oedema,
hypoalbuminaemia, albuminuria).
[ Ureter ]

Urothelium :
Transitional epithelium, 4-6 layers in thickness.
The cells can stretch and fold on top of each other when the
ureter is contracted/relaxed.
Basal cells are columnar/cuboidal, the middle layer consists of
cells which are polygonal and the top layer consists of
columnar cells when the epithelium is not stretched, and
cuboidal when it is stretched.

Lamina propria: layer of fibrocollagenous tissue, scanty lymphoid inflitrate.

Smooth muscle, which is internally longitudinal and exteriorly circular.

Lumen: folded, seen almost as starshaped, multiple layers.

[ Urinary bladder ]

Same structure as ureter, but microscopically indistinct :

Folded mucosa,
Submucosa (collagen, lymphoid tissue, blood vessels)
Muscle layer.

Close to the neck of the bladder there are 3 distinct muscle layers: inner
longitudinal, middle circular and outer longitudinal. The outermost layer is
the adventitious layer.

Cancer of bladder: management and prognosis depends upon which layer is

infiltrated.
[ Male Reproductive System ]

[ Prostate ]

Very muscular organ (smooth muscle). Outer capsule is divided into

indistinct lobes.
Glandular and stromal components.

Glandular :

Branched tubuloacinar glands.

Three groups :
Mucosal : open into urethra directly
Submucosal : open into urethra via small ducts
Peripheral : open into urethra via long ducts
Two layers :
Tall columnar secretory cells.
Squamous basal cells.

Stromal :
Smooth muscle.
Collagen fibres.

Prostatic hyperplasia and cancer are extremely common. As age progresses,

the prostate enlarges (most common symptom is the obstruction of urine).
Cancer originates in peripheral glands zone and therefore symptoms are
only seen at a very late stage. (the carcinoma grows inwards, and takes long
to compress the urethra).
Prostatic biopsy : through the urethra, you reach the central zone and
through the rectum, you get to the peripheral zone.
[Testis]

Functions :
o Spermatogenesis.
o Male sex hormone (testosterone) secretion.

Coverings :
o Tunica vaginalis (serous external layer).
o Tunica albuginea (thick capsule).
o Vascular layer (deep to tunica albuginea).

o Mediastinum testis (projection of tunica albuginea into testis).

o Septa :
Projections from mediastinum to tunica albuginea
Incompletely divide testis into 250-300 lobules.
Lobules communicate peripherally.
Each lobule has 1-4 seminiferous tubules.

Tubules :
o Seminiferous tubules (lobules).
o Straight tubules (before mediastinum).
o Rete testis (labyrinth of tubules in mediastinum).
o Efferent ductules.

Cell types :
o Spermatogenic series of cells :
Give rise to spermatozoa.
Lie inside tubules.

o Sertoli cells :
Columnar cells that lie among spermatogenic cells.
Secrete hormones.
Protect and nourish spermatogenic cells.
Connect to each other via tight junctions, forming blood-testis
barrier.
 Divide seminiferous epithelium into two compartments basal
and luminal, inhabited by different spermatogenic cells.

o Leydig cells :
Endocrine cells, located in clusters inside the interstitial tissue.
Secrete testosterone.

[Seminal Ducts]

Epididymis :
o Head, body and tail.
o Ciliated pseudostratified columnar epithelium and smooth muscle.
o Surrounded by fibrous tissue.

Vas deferens :
o Star-shaped lumen.
o Low columnar to cuboidal epithelium.
o Three muscular layers (longitudinal-circular-longitudinal).
o Thick adventitia.

Seminal vesicle :
o Thin mucosa, with columnar epithelium and folds.
o Two muscular layers.
o Glandular function.
[Female Reproductive System]
[Uterus]

Cervix, isthmus, body and fundus.

The uterus has two functional parts: the endometrium and the myometrium.

Endometrium

o The mucosal lining which lines the uterine cavity. It has two main
components: the stromal and the epithelial components.

o Epithelial component : simple columnar ciliated epithelium and glands.

o Stroma has connective tissue and stromal cells.

o Has two regions :

Functional part : undergoes cyclical changes according to the
age and then during reproductive phase according to the phases
of the cycle. Is sloughed off during menstruation.Varies almost
every day.
Basal part: does not change, this is the part responsible for
regeneration of endometrium.

Endometrial changes :

o Before menarchy : lined by cuboidal epithelium with small glands

surrounded by endometrial stroma.
o Puberty : oestrogen acts on the endometrium to induce proliferative
changes : the epithelium becomes pseudostratified columnar and the
glands become lengthy and tortuous.

o Progesterone inhibits the contraction of smooth muscle and the entry of

the cells into the premitotic phase, blocking the cell cycle.
o Leukotrienes and prostaglandins increase capillary permeability,
vasoactive substances and oedema results in the stroma. On the 21st
day of the cycle the oedema is at its peak. They also induce the
endothelial proliferation and that is why the blood vessels that are
normally straight become elongated and tortuous.
o Towards the end of the cycle, vessels and glands become elongated.
Endothelial proliferation. The vessels start to spiral. Eventually the
vessel become tortuous.
o Further proliferation: arterial lumen will block and that will cause the
necrosis to start. That is one of the reasons why the endometrium is
sloughed off. The other is that the hormone levels decrease. By about
the 26th day of the cycle, the endometrium is invaded by endometrial
granulocytes (or K cells). These secrete a hormone called 'relaxin' and
this function is of collagenolysis: so this will also contribute to the
breakdown of the collagen. With the lack of progesterone, the
lysosomes lose their membrane integrity and when that happens causes
release of lysosomal enzymes, causing further breakdown of the
 tissues. This is the basis of changes taking place.

o When you send a uterine biopsy you must mention the day of the
menstrual period !!!

Myometrium :
o Fibromuscular layer.
o Muscle fibres form three ill defined layers :
Circular.
Longitudinal.
Serosal.

o The most common tumours here are (benign) fibroid myomes.

Cervix is the lower part of the uterus, has two components:

o Endocervix (continues with isthmus or internal os) : projects into the

vagina, is lined by columnar epithelium. Its stroma contains mucus
producing glands, smooth muscle fibres and collagen.

o Exocervix : stratified squamous epithelium, commonly investigated

due to possibility of cervical cancer. Precancerous lesions are very
common. Cervical cancer remains asymptomatic for 10+ years.

o Squamocolumnar junction :

Between endocervix and exocervix.

Located at the internal os at birth and moves down to the
external os during childhood.
After menarchy, the vaginal pH becomes acidic, endocervical
epithelium (sensitive to the environment) undergoes squamous
metaplasia, and the junction moves to the internal os again.
The transformation zone is where cervical cancer starts and
biopsies are taken.

o Cervical mucin :
is watery and alkaline in the prefollicular phase, to facilitate the
motion of the sperm.
In the luteal phase its thick and acidic, to protect the uterus
from bacteria. The cervical opening is then blocked by thick
mucin.

o Cervical dilatation :
In delivery, the cervix enlarges in diameter 10x, to allow the
foetus to pass through.
Ground substance fibres are pushed apart and cell junctions are
made weaker.
 Ovary :
o Stroma:
Inner part.
Spidle-shaped cells.
Provides support to gametes.
Produces ovaries. that differentiate to form theca interna and
externa, the layers that produce oestrogens and progesterone.
o Medulla.
o Cortex : outer part, gametes in different stages lie here.
o Capsule : tunica albuginea, germinal epithelium (misnomer, does not
give rise to ova).
[Thyroid Gland]

The thyroid gland consists almost entirely of rounded cysts, follicles,

which are separated by scant interfollicular connective tissue.

Follicle :
o The structural and functional building block of the thyroid
gland.
o Simple cuboidal epithelium, which surrounds a lumen filled
with a viscous substance, colloid.
o The size of the follicles is variable ranging from about 50 m
to about 1 mm.

Colloid :
o The secretory product of the follicular cell (extracellular
storage!).
o Its main component, thyroglobulin, consists of triiodothyronine
and tetraiodothyronine (or thyroxine).

C cells (or parafollicular cells) :

o Part of the follicles, situated situated within the basement
membrane of the epithelium
o Have no direct contact with the follicular lumen.

Arterial supply is rich, with a dense network of capillaries between the

follicles.