Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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Colposcopic diagnosis of preclinical invasive carcinoma of the cervix and glandular neoplasia FIGURE 8.8: Invasive cancer: There is a proliferative growth on the cervix which becomes dense, chalky white after the application of acetic acid. Bleeding partly obliterates the acetowhitening with irregular surface may also indicate a glandular lesion (Figure 8.14). In summary, the accurate colposcopic diagnosis of preclinical invasive carcinoma and glandular lesions depends on several factors: continuing alertness on the part of the colposcopist, strict adherence to the stepby-step approach to examination, the use of a grading index, close attention to surface blood vessels, the honest appraisal of when an examination is inadequate, the appropriate use of ECC to rule out lesions in the canal, and the taking of a well directed biopsy of sufficient tissue on which to base a reliable histopathological diagnosis. FIGURE 8.9: A dense acetowhite lesion in the endocervical canal visible after stretching the os with a long dissection forceps (adenocarcinoma in situ). 75
Chapter 8 a ↑ FIGURE 8.10: Adenocarcinoma in situ : The tips of some of the columnar villi turn densely white compared to the surrounding columnar villi after the application of acetic acid (arrow). The nabothian cysts turn white after the application of acetic acid FIGURE 8.12: Adenocarcinoma: Note the greyish-white dense acetowhite lesion with character writing-like atypical blood vessels (a) a b a b a b b FIGURE 8.11: Adenocarcinoma in situ: Note the elevated lesions with an irregular acetowhite surface, enlarged and hypertrophied villi, papillary patterns (a), and atypical vessels (b), overlying the columnar epithelium FIGURE 8.13: Adenocarcinoma: Note the elongated, dense acetowhite lesion with irregular surface in the columnar epithelium with atypical blood vessels (a) 76
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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
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Preface Health care providers have
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Chapter 1 An introduction to the an
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An introduction to the anatomy of t
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Page 19 and 20:
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Page 23 and 24:
Page 25 and 26:
Chapter 2 An introduction to cervic
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An introduction to cervical intraep
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Page 31 and 32:
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
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: Chapter 8 diagnosis of AIS and aden
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
Page 113 and 114: Chapter 13 (2) (1) FIGURE 13.2: Ele
Page 115 and 116: Chapter 13 (1) (2) (3) (4) (5) (8)
Page 117 and 118: Chapter 13 Once the specimen has be
Page 119 and 120: Chapter 13 in the endocervical cana
Page 121 and 122: Chapter 14 Decontamination, cleanin
Page 123 and 124: Decontamination, cleaning, high-lev
Page 125 and 126: References Herrero, R. (1997) Preva
Page 127 and 128: Further reading Suggestions on furt
Page 129 and 130: Appendix Leukoplakia Condylom
Page 131 and 132: Appendix regardless of your pregnan
Page 133 and 134: Appendix Monsel’s paste Ingredien
Page 135 and 136: Appendix 5 The modified Reid colpos
Page 137 and 138:
Index Acetowhitening . . . . . . .
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Colposcopy and Treatment of Cervical Intraepithelial Neoplasia - RHO

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