Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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Colposcopic appearance of the normal cervix a ↑ FIGURE 6.10: The glassy, pinkishwhite immature squamous metaplastic epithelium (a) with islands of columnar epithelium (narrow arrow) and crypt opening (bold arrow) (after 5% acetic acid application) ↑ ↑ a c b the metaplastic process progresses. Gradually, the tongue-like metaplastic areas fuse together to form a continuously advancing glassy, shining, pinkish-white or mildly pale membrane-like area (Figure 6.13). Finally, the immature metaplastic epithelium becomes a fully developed mature metaplastic squamous epithelium resembling the original native squamous epithelium, except for the presence of some crypt openings (Figure 6.1) and nabothian retention follicles in the metaplastic epithelium (Figures 1.11, a b a FIGURE 6.11: The prominent white line corresponds to the new squamocolumnar junction and tongues of immature squamous metaplasia (a) with crypt opening at 4-8 o’clock positions (b) (after application of 5% acetic acid) FIGURE 6.12: Appearance after 5% acetic acid application: protruding tongues (a) of immature squamous metaplasia towards the external os in the lower lip and the crypt openings (b) after application of 5% acetic acid. Some crypt openings are already covered by metaplastic epithelium (c) which may become nabothian cysts soon. Note the distal crypt opening indicated by the arrow and the pinkish white hue of the metaplastic epithelium compared to the pink colour of the original squamous epithelium 6.3 and 6.14). The retention follicles, in the beginning, may appear as white, dot-like, areas before they enlarge with progressive accumulation of mucus within the follicle, presenting as pimple- or button-like ivorywhite or mildly yellowish areas (Figures 1.11, 6.3 and 6.14). The typical vessel formations in the metaplastic epithelium include long regular branching vessels with gradually decreasing calibre and a network of regular branching vessels (Figure 6.2). These vascular patterns may be seen more prominently over the nabothian follicles (Figure 6.3). When metaplasia occurs in the epithelium covering the protruding cervical polyp, it is covered by pale white epithelium (Figure 6.15). After application of Lugol’s iodine solution As described in the previous chapter, glycogenated cells take iodine, so that they have a uniform dark mahogany brown colour when stained with Lugol’s iodine solution. Therefore, the normal vaginal and cervical squamous (both native and mature 51
Chapter 6 Crypt openings Immature squamous metaplasia Mature squamous metaplasia Island of columnar epithelium FIGURE 6.13: Pale, translucent acetowhitening due to immature squamous metaplasia with several crypt openings after application of 5% acetic acid Nabothian cyst Dots indicating small nabothian cysts ↑ ↑ FIGURE 6.14: Mature squamous metaplasia after the application of 5% acetic acid: Note the nabothian cyst at 5 o’clock position and the multiple dotlike areas indicating retention cysts. Narrow arrows indicate the distal crypt openings. The new squamocolumnar junction has receded into the cervical canal 52
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Colposcopy and Treatment of Cervica
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INTERNATIONAL AGENCY FOR RESEARCH O
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Published by the International Agen
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Contents 11 Management that provide
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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 and 16: 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: Chapter 6 FIGURE 6.7: The colour ch
Page 65 and 66: Chapter 6 a FIGURE 6.17: An area of
Page 67 and 68: Chapter 7 The colposcopic diagnosis
Page 69 and 70: Chapter 7 appears as individual sma
Page 71 and 72: Chapter 7 acid stain is correlated
Page 73 and 74: Chapter 7 FIGURE 7.15: Moderately d
Page 75 and 76: Chapter 7 FIGURE 7.23: A dense acet
Page 77 and 78: Chapter 7 FIGURE 7.30: Mustard yell
Page 79 and 80: Chapter 7 We recommend that the stu
Page 81 and 82: Chapter 8 highlights this responsib
Page 83 and 84: Chapter 8 Appearance before applica
Page 85 and 86: Chapter 8 diagnosis of AIS and aden
Page 87 and 88: Chapter 8 a ↑ FIGURE 8.10: Adenoc
Page 89 and 90: Chapter 9 Inflammatory lesions of t
Page 91 and 92: Inflammatory lesions of the uterine
Page 93 and 94: Inflammatory lesions of the uterine
Page 95 and 96: Chapter 10 Table 10.1: Common sourc
Page 97 and 98: Chapter 10 Table 10.2 (cont.): A su
Page 99 and 100: Chapter 11 FIGURE 11.1: Flow chart
Page 101 and 102: Chapter 11 treatment policies for p
Page 103 and 104: Chapter 11 Vaginal delivery can be
Page 105 and 106: Chapter 12 involvement increases wi
Page 107 and 108: Chapter 12 Table 12.1: Eligibility
Page 109 and 110: Chapter 12 a b c d e f FIGURE 12.6:
Page 111 and 112: 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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