Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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Chapter 1 differentiation and maturation of these cells leads to the intermediate layers of polygonal cells with abundant cytoplasm and small round nuclei. These cells form a basket-weave pattern. With further maturation, the large and markedly flattened cells with small, dense, pyknotic nuclei and transparent cytoplasm of the superficial layers are formed. Overall, from the basal to the superficial layer, these cells undergo an increase in size and a reduction of nuclear size. The intermediate and superficial layer cells contain abundant glycogen in their cytoplasm, which stains mahogany brown or black after application of Lugol’s iodine and magenta with periodic acid-Schiff stain in histological sections. Glycogenation of the intermediate and superficial layers is a sign of normal maturation and development of the squamous epithelium. Abnormal or altered maturation is characterized by a lack of glycogen production. The maturation of the squamous epithelium of the cervix is dependent on estrogen, the female hormone. If estrogen is lacking, full maturation and glycogenation does not take place. Hence, after menopause, the cells do not mature beyond the parabasal layer and do not accumulate as multiple layers of flat cells. Consequently, the epithelium becomes thin and atrophic. On visual examination, it appears pale, with subepithelial petechial haemorrhagic spots, as it is easily prone to trauma. Columnar epithelium The endocervical canal is lined by the columnar epithelium (sometimes referred to as glandular epithelium). It is composed of a single layer of tall cells with dark-staining nuclei close to the basement membrane (Figure 1.3). Because of its single layer of cells, it is much shorter in height than the stratified squamous epithelium of the cervix. On visual Columnar cells Stroma Basement membrane FIGURE 1.3: Columnar epithelium (x 40) Crypt opening Columnar cells Crypt FIGURE 1.4: Crypts of columnar epithelium (x 10) 4
An introduction to the anatomy of the uterine cervix Polyp FIGURE 1.5: Cervical polyp examination, it appears reddish in colour because the thin single cell layer allows the coloration of the underlying vasculature in the stroma to be seen more easily. At its distal or upper limit, it merges with the endometrial epithelium in the lower part of the body of the uterus. At its proximal or lower limit, it meets with the squamous epithelium at the squamocolumnar junction. It covers a variable extent of the ectocervix, depending upon the woman’s age, reproductive, hormonal and menopausal status. The columnar epithelium does not form a flattened surface in the cervical canal, but is thrown into multiple longitudinal folds protruding into the lumen of the canal, giving rise to papillary projections. It forms several invaginations into the substance of the cervical stroma, resulting in the formation of endocervical crypts (sometimes referred to as endocervical glands) (Figure 1.4). The crypts may traverse as far as 5-8 mm from the surface of the cervix. This complex architecture, consisting of mucosal folds and crypts, gives the columnar epithelium a grainy appearance on visual inspection. A localized overgrowth of the endocervical columnar epithelium may occasionally be visible as a reddish mass protruding from the external os on visual examination of the cervix. This is called a cervical polyp (Figure 1.5). It usually begins as a localized enlargement of a single columnar papilla and appears as a mass as it enlarges. It is composed of a core of endocervical stroma lined by the columnar epithelium with underlying crypts. Occasionally, multiple polyps may arise from the columnar epithelium. Glycogenation and mitoses are absent in the columnar epithelium. Because of the lack of intracytoplasmic glycogen, the columnar epithelium does not change colour after the application of Lugol’s iodine or remains slightly discoloured with a thin film of iodine solution. Squamocolumnar junction The squamocolumnar junction (Figures 1.6 and 1.7) appears as a sharp line with a step, due to the difference in the height of the squamous and columnar epithelium. The location of the squamocolumnar junction in relation to the external os is variable over a woman’s lifetime and depends upon factors such as age, hormonal status, birth trauma, oral contraceptive use and certain physiological conditions such as pregnancy (Figures 1.6 and 1.7). The squamocolumnar junction visible during childhood, perimenarche, after puberty and early Squamous epithelium SCJ Columnar epithelium FIGURE 1.6: Squamocolumnar junction (SCJ) (x 10) 5
Page 1 and 2: Colposcopy and Treatment of Cervica
Page 3 and 4: INTERNATIONAL AGENCY FOR RESEARCH O
Page 5 and 6: Published by the International Agen
Page 7 and 8: Contents 11 Management that provide
Page 9 and 10: Acknowledgements The authors gratef
Page 11 and 12: Preface Health care providers have
Page 13 and 14: Chapter 1 An introduction to the an
Page 15: An introduction to the anatomy of t
Page 19 and 20: An introduction to the anatomy of t
Page 25 and 26: Chapter 2 An introduction to cervic
Page 27 and 28: An introduction to cervical intraep
Page 33 and 34: Chapter 3 An introduction to invasi
Page 35 and 36: An introduction to invasive cancer
Page 41 and 42: Chapter 4 Table 4.1: Indications fo
Page 43 and 44: Chapter 4 FIGURE 4.2: Colposcope wi
Page 45 and 46: Chapter 4 FIGURE 4.6: Endocervical
Page 47 and 48: Chapter 4 Table 4.2: Preneoplastic
Page 49 and 50: Chapter 5 between the two ocular le
Page 51 and 52: Chapter 5 Obtain specimens for labo
Page 53 and 54: Chapter 5 FIGURE 5.2: Biopsy techni
Page 55 and 56: Chapter 5 tissue tends to mimic inv
Page 57 and 58: Chapter 6 invasive carcinoma. Even
Page 59 and 60: Chapter 6 ages (Figures 1.7d, 1.7e,
Page 61 and 62: Chapter 6 FIGURE 6.7: The colour ch
Page 63 and 64: Chapter 6 Crypt openings Immature s
Page 65 and 66: Chapter 6 a FIGURE 6.17: An area of
Page 67 and 68:
Chapter 7 The colposcopic diagnosis
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Chapter 7 appears as individual sma
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Chapter 7 acid stain is correlated
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Chapter 7 FIGURE 7.15: Moderately d
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Chapter 7 FIGURE 7.23: A dense acet
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Chapter 7 FIGURE 7.30: Mustard yell
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Chapter 7 We recommend that the stu
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Chapter 8 highlights this responsib
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Chapter 8 Appearance before applica
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Chapter 8 diagnosis of AIS and aden
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Chapter 8 a ↑ FIGURE 8.10: Adenoc
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Chapter 9 Inflammatory lesions of t
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Inflammatory lesions of the uterine
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Inflammatory lesions of the uterine
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Chapter 10 Table 10.1: Common sourc
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Chapter 10 Table 10.2 (cont.): A su
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Chapter 11 FIGURE 11.1: Flow chart
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Chapter 11 treatment policies for p
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Chapter 11 Vaginal delivery can be
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Chapter 12 involvement increases wi
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Chapter 12 Table 12.1: Eligibility
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Chapter 12 a b c d e f FIGURE 12.6:
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Chapter 12 during the follow-up in
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Chapter 13 (2) (1) FIGURE 13.2: Ele
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Chapter 13 (1) (2) (3) (4) (5) (8)
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Chapter 13 Once the specimen has be
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Chapter 13 in the endocervical cana
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Chapter 14 Decontamination, cleanin
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Decontamination, cleaning, high-lev
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References Herrero, R. (1997) Preva
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Further reading Suggestions on furt
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Appendix Leukoplakia Condylom
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Appendix regardless of your pregnan
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Appendix Monsel’s paste Ingredien
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Appendix 5 The modified Reid colpos
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Index Acetowhitening . . . . . . .
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Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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