Paper - Development of the uterine glands in man (1920)
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Development of the Uterine Glands in Man
E. A. Baibigartner, M. T. Nelson, And Wm. Dock
Halstead, Kansas, and St. Louis, Missouri
In his book, A Laboratory Textbook of Embryology ('10) Minot, in speaking of a model of the human uterine glands* said: The model .... demonstrates that the conception of the character of the uterine glands, which has hitherto prevailed, is very inadequate. " Descriptions of the morphology of the uterine glands in the various histological textbooks vary slightly. Piersol ('10) describes them as tubular or shghtly bifurcated, wa\'y invaginations with tortuous blind ends, distributed at fairly regular intervals. Lewis' description, based on Hedblom's model, states that they are branched tortuous glands which occasionally anastomose, and which have in their deeper portions long horizontal branches at right angles to the main tube.
In the older texts (Strieker, '73) the glands are described as simple, although occasionally they give off branched tubes from the center or just below the center. They are twisted or corkscrew-like, and in the fundus may run horizontally to the surface.
The only models of these glands, in any stage, known to us are those of Heblom's, one of which is figured in Minot's Laboratory Textbook of Embryology. The model figured is much more complex than the descriptions of the text-books would indicate. From sections Hitschman and Adler ('08) have described the character of the glands during the various stages of the menstrual cycle, but they give very little information other than is found in the usual texts and no additional information in regard to the glands during the interval stages. Wax models of the glands in the various stages of the cycle should show some very interesting results, and the plan was to incorporate these results in this paper. However, lack of material prevented this at this time.
There is an even greater lack of description of the characteristics of the glands during development. Lewis states that the glands develop at the bases of folds. In Keibel and Mall's Embryology ('12) very little attention is given to their development and only one investigator (Wyder, '78) is quoted. This investigator states that the glands develop independently of the age of the individual.
It seems, therefore, from this brief review of the literature that very little is known of the development of the uterine glands or of their ultimate form. For that reason, the senior author suggested that this problem should yield results worthy of publication. The models were all constructed by the junior investigators.
Development of the Glands
The material upon which this study is based consists of serial sections of portions of the corpora of uteri of fetuses and of adults. The youngest uterus studied was of a six- to sevenmonth fetus, the oldest a uterus of a twenty-five-year-old virgin. The entire fundus of the six- to seven-month fetus was sectioned and a model made of the lumen of the organ, including the epithelial lining and any outpouchings or glands. This model is shown in figure 1. An interesting particular of this stage is the peculiar S-shaped lumen with irregular sides. There are folds of the uterine mucosa from which small outpouchings protrude.
The irregular folds of the epithelium on the sides of the lumen give the effect of a scalloped edge. Rudiments of glands are present. The most prominent epithelial folds are found on the anterior and posterior surfaces and are directed toward the cervix. Only two are shown in the model. These two run almost transversely across the surface of the lumen and have the appearance of crescent-shaped, hood-like eyaginations toward the muscular coat. These folds are quite deep and are apparently constant, as they have been observed by other investigators and we have found them in older uteri. On the outer rim of these crescentic folds there are small outgrowths, which, we conclude from a study of later stages, are the rudiments of glands. The outgrowths have enlarged ends and short, constricted necks. Occasionally these structures are found also at the edge of the uterine lumen, but are found nowhere except in these two places.
In a one-day-old child, the glands, developing from the folds of the mucosa, sometimes form a row (fig. 2). The stalks of the glands are constricted with closely crowded, enlarged, flattened end pieces.
There is only slight modification of this shape in a sevenmonth-old child uterus (fig. 3). The side of the uterine lumen was chosen for reconstruction. This specimen showed, as did several others, a lumen which in transverse section was bootshaped. Glands grow from the ends of the heel and toe parts, as well as from lesser folds. Some of the glands have developed into a T-shape with the original short constricted neck, but with an enlarged tubular end extending at right angles to the stalk. In some only one arm has developed, forming an inverted L-shape. In both the T and L glands, the end piece sometimes has longitudinal furrows, showing partial separation of the end piece into two parallel tubular branches.
A model of a four-year-old specimen shows several of the features mentioned above. The crescentic folds of epithelium described in a six-month fetus are present here (fig. 4). At their outer rims are folds of well-developed glands. The T-shaped glands prevail and occasionally the tubular end pieces have divided, forming parallel tubular branches. Some glands, however, are very simple, being small evaginations with occasionally constricted necks.
Several changes have taken place in the uterine glands of a fourteen-year-old child before puberty. These are evidenced by the further division of the T- and L-shaped glands. Some glands are still simple, showing short narrow stalks and two tubular end pieces extending obliquely into the mucosa (fig. 5). One gland shows the two tubular branches running parallel to the surface of the lumen, as described above, with one end piece turning toward the muscular layer almost at right angles, and sending out two branches, one from each side, then dividing into two parallel tubular end pieces.
Another gland is very much more complex. After the formation of the T-shap.e, one of the arms of the T turns sharply and divides, forming a Y-shape. One of the arms of the Y divides again, whereas the other arm, which is larger, gives off three pairs of branches and terminates in a cluster of five branches. The branching is decussate. Of the terminal cluster one short central terminus appears to be the continuation of the main stalk. The terminations usually point toward the muscle layer and show enlargements.
Owing to a lack of material, we have been unable to model or describe the stages between a fourteen-year-old before puberty and the twenty-five-year-old nullipara of the interval stage. Of the latter, an area of attachment of about twenty-five glands, about 1 mm. by 1.5 mm., was modeled, which area includes one hundred and fifty sections 10 ^i in thickness. Some of the glands are grouped, four glands coming from one slight furrow in the * mucosa (fig. 7) . The others are all more or less isolated, but in quite definite rows. In studying the portions of the glands which lie next to the musculature, one is impressed with the fact that the glands give the appearance of running parallel to the surface of the lumen, and all in the same direction, and that the great preponderance of glandular tissue is in the outer third or half of the endometrium. The constricted necks of the glands are short, the stalks gradually enlarging as they extend obliquely toward the musculature. Some glands show constricted areas at intervals, others present a slightly spiral appearance, but only few show any branches until they are deep into the mucosa, when they all turn, more or less gradually into a direction at right angles to the one which they have just been following — a course nearly parallel with the surface of the lumen.
The mode of termination varies a great deal. One gland forms the familiar T-shape, the cross-bar being tubular and short. Another sends off a lateral branch which immediately divides dichotomously, each branch again dividing, one of the latter branches extending back two-thirds of the distance toward the epithelial surface, terminating in an enlarged end. A third gland, after turning at right angles to the surface, breaks up into two parallel tubes, one subdividing, the other anastomosing with a parallel end piece of another gland.
Some are even more complex in their branchings and divisions (fig. 7) approaching the complex type described for the fourteenyear-old, except that the branches are found more deeply embedded in the mucosa and in general run parallel to the surface at their terminations. Only one single tubular gland is present and it runs parallel to the surface at its distal end.
The models show that anastomosing between glands and between branches of glands is not uncommon. Two simple glands anastomose then divide into several branches (fig. 6). Again, two rather widely separated glands anastomose, then divide into a complex set of branches which extend for some distance along the muscle layer.
Guyon ('58) and de Sinety ('79) found no glands, properly speaking, in the corpus of the fetal uterus, although they found well-developed ones in the cervix. De Sinety states that glands are not developed until the sixth or seventh year. Wyder ('78), who is quoted in Keibel and Mall's Embryology, found no glands in the uteri of ten-year-old girls, and contends that the stages of development bear no relation to age. Tourneux and Legay ('84) found glands in the cervix of a late fetus, but none in the corpus, even at birth. Moricki ('82) described glands in the cervix of fetal uteri. In a premature of nine months, he found well-developed glands, with branches, in the corpus and in a new-born he found many glands in the fundus. The glands varied in form, but were usually tubular with relative large lumina. In adults the glands forked near their ends. Nagel ('91) found that the glands of the corpus developed much later than those of the cervix, although he figured glands in the corpus of a 17-cm. fetus. Wyder appears to have been about the only one who did not find glands in the corpus at birth and is the only one who has stated that the development of the glands is entirely independent of age.
The peculiarly shaped lumen of the uterus of the fetuses and young adults has been noted by other investigators and is apparently constantly present. No explanation of this peculiarity has been offered. The theory that it may be due to the union of the early Miillerian ducts is worthy of consideration.
In all of the specimens upon which this study is based, glands or rudiments of glands are found, from the six-month fetus onward. In the six-month fetus they are present as small outpouchings from the folds of epithelium. Contrary to the findings of Moricke, our specimen of new-born shows glands,, often closely crowded, without branches and not as yet tubular, but rather having the appearance of simple outgrowths with enlarged flattened end pieces and shghtly constricted stalks. This shape is typical of early stages of uterine glands as well as of the early stages in the development of many other glands. The tubular shape and T-shaped branches appear in the first year, however.
The glands increase in length and in number of branches during the early years of life, although the growth is not extreme, and the stages from one to seven years show no marked differentiation. The T-shaped branches and the growth from the ends of the folds of the mucosa are constant characteristics.
Just before puberty, glandular growth seems markedly hastened, although the mucosa may not be much thicker. Of the glands modeled many have T-shaped branchings. Further branchings and subdivisions, beyond the T-shape, are first observed at this time. Some of the glands are closely crowded as in younger stages. The tubular shape is constant, although enlarged ends and irregular enlargements of the stalk are found. The short, constricted necks are here present.
In adults, glands with many branches near their ends, as described by Moricki, have been noted. The narrow, short necks are prominent. The branching gives the effect of a network of tubular glands running parallel to the surface just inside the muscle layer. Anastomoses between different glands are found. Both isolated and grouped glands are common.
The particular feature of the adult glands which has emphasized itself in our minds is that the majority of the glands run parallel to the surface near the muscle layer, and run also in one direction. We do not believe, but cannot deny, that the latter is due to the contraction of the muscular layer. We have not determined what may be the meaning of this running in one direction, nor, unfortunately, can we tell whether this direction is toward the fundus or toward the os uteri.
It has been suggested that the branches which we describe as returning toward the epithelial surface are individual glands which have lost their connection with the surface following menstruation. Hedblom's model of an eighteen-year-old stage shows these structures. However, ours have enlarged ends and have the appearance of terminations similar to glands of whose terminations, deep in the stroma, there is no question.
The tendency for several glands to open side by side in a common furrow or depression of the uterine epithelium has been mentioned.
It will be seen, from the foregoing, that the adult glands are not simple straight tubular glands as the text-books imply, but are branched tubular glands with frequent anastomoses. Our conception of the adult glands forces us to agree with Minot's statement, above quoted, and in general with that of Hedblom as illustrated in his models.
The senior author recently had the opportunity of seeing the series of models made by C. A. Hedblom^ at the Harvard Medical School. One of these is figured in Minot's text and is described by Lewis in the last edition of his Histology. The series consists of an eight-month child, a ten-year child, an eighteen-year nullipara, and of an eighty-two-year-old nuiltiparous woman. The youngest shows irregular folds with small outpocketings. The folds, we believe are mucosal folds such as we have found in our specimens. The glandular rudiments are very small in comparison with those of our specimen of a day old, and really appear in shape much more like the glands of our six-month fetus. The ten-year-old specimen shows small, irregular, short tubular outgrowths with some anastomoses and irregular folds. Here the type does not correspond at all to any of our specimens. The branchings are few and dissimilar to those found by us. The short slender tubular glands here also appear more like small outgrowths found in our six-month fetus.
^We are under obligations to Drs. J. L. Brewer and C. A. Hedblom for permission to make comparisons between our models and those of the latter, now in the department of Anatomy at the Harvard Medical School.
The eighteen-year-old specimen fits well into our series between the fourteen- and the twenty-five-year-old stages. The short narrow stalk and T-like divisions which we describe are not found, but instead a Y-like branching from a longer stalk. One arm of the Y has one or two Y-like subdivisions, whereas the other arm sends off many irregular single branches which further subdivide. Several branches extend for some distance toward the muscular coat, and one gives off a branch which returns one-third of the distance to the uterine lumen, then turns sharply and returns in its original direction. Many terminal branches have enlarged ends similar to those we have found. Anastomoses with other glands are present.
The eighty-two-year-old specimen is a quite remarkable one. Many cystic tubules are found at the ends of short, narrow tubules. Anastomoses between these cysts by means of small tubules are found. The cystic enlargements are elongated oval structures and are found closely crowded and near the surface epithelium. As is well known, the mucosa is thin and the entire depth of the gland is only about one-third that of our adult specimen and even less than that of the eighteen-year-old model of Hedblom.
The work of Scammon reported at the meeting of the American Association of Anatomists ('19) shows that some interesting phases may have been overlooked. It is extremely important and would be valuable to have models of the various stages from birth to three months of age, instead of only at birth. Then, corresponding to the periods of growth, as indicated by lengths of the uterus, models of the sixth year and again about the eleventh would be desirable. The models of seven months and of four years as indicated are quite similar. A specimen from a seven-year-old child shows rather poorly developed glands — certainly not much beyond the four-year stage — while a model of a twenty-one-month child is very similar to the one of seven months.
It cannot be denied, therefore, that it would be interesting to reconstruct more of the stages of the glands between four and fourteen years as well as during the menstrual period, the menopause, and of a parous woman, and that these stages should be included in this paper. Unfortunately, we have not found the material available.
- Glands are found in the corpus of the uterus in a six- to seven-month fetus and in all material studied beyond this age.
- The earliest glands are small irregular outpouchings from semilunar mucosal folds, later developing constricted necks and enlarged end pieces similar to many other gland rudiments.
- The necks persist even to the adult stage, the enlarged ends becoming tubular and dividing T-like with sometimes a second longitudinal division of the end branches.
- The stalks follow an oblique course in the adult, sometimes almost a spiral one.
- Near the muscle layer the branches run parallel to the surface and all in one direction, sometimes forming a network by anastomoses of different branches.
- The greater part of the glandular tissue lies in the lower onethird or fourth of the endometrium.
- Adult uterine glands are compound, anastomosing, tubular glands.
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Cite this page: Hill, M.A. (2020, April 6) Embryology Paper - Development of the uterine glands in man (1920). Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_Development_of_the_uterine_glands_in_man_(1920)
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