Περιεχόμενα
Preface to the Third Edition, ix
Preface to the First Edition, x
Acknowledgements, xi
1 The Histopathology of Lower Genital Tract Neoplasia, 1
1.1 Introduction, 1
1.2 Terminology, 1
1.3 Histopathologic features of cervical intraepithelial neoplasia or squamous intraepithelial lesion, 3
1.4 Cervical glandular intraepithelial neoplasia and adenocarcinoma in situ, 6
1.5 Early invasive carcinoma, 7
1.6 Vaginal intraepithelial neoplasia, 11
1.7 Vulval precancer, 11
1.8 Related topics, 12
1.9 Further reading, 13
2 Human Papillomaviruses in the Pathogenesis of Lower Genital Tract Neoplasia, 14
2.1 Introduction, 14
2.2 Characteristics of human papillomaviruses, 14
2.3 Manifestations of genital human papillomavirus infections, 15
2.4 Prevalence of genital human papillomavirus infections, 18
2.5 Transmission of genital human papillomavirus infections, 19
2.6 Risk factors for genital human papillomavirus infections, 19
2.7 Natural history of cervical human papillomavirus infections, 19
2.8 Molecular pathways of human papillomavirus oncogenesis, 19
2.9 The effect of human papillomavirus/host cell interaction: a prerequisite for neoplasia, 21
2.10 The role of oncogenic human papillomavirus detection in the prevention of lower genital tract precancer, 22
2.11 Further reading, 23
3 Examination for Cervical Precancer: Use of colposcopy, 24
3.1 Introduction, 24
3.2 Tissue basis for colposcopy, 24
3.3 The colposcopic examination, 25
3.4 Video colposcopy, 31
3.5 Image and electronic data management, 31
3.6 Further reading, 32
4 Colposcopy of the Normal Cervix: A prerequisite to establishing the diagnosis of cervical precancer, 33
4.1 Introduction, 33
4.2 Cervical epithelium: natural history, 33
4.3 Cervical epithelium: topography, 34
4.4 Cervical epithelium: colposcopic appearances, 35
4.5 Squamous metaplastic epithelium, 38
4.6 Colposcopy of the adolescent cervix, 44
4.7 Cervical epithelium during pregnancy and puerperium, 46
4.8 The effect of vaginal delivery on the cervical epithelium, 48
4.9 The cervical epithelium during the menopause, 50
4.10 The oral contraceptives and their effect on the cervix, 52
4.11 The congenital transformation zone, 53
4.12 Further reading, 58
5 Cytology and Screening for Cervical Precancer, 59
5.1 Introduction, 59
5.2 Cytologic classifications, 59
5.3 Cytologic reporting, 60
5.4 Clinical referral, 63
5.5 Cytodiagnosis of cervical glandular intraepithelial neoplasia/adenocarcinoma in situ, 66
5.6 Cytologic features of adenocarcinoma, 68
5.7 Screening for cervical cancer, 68
5.8 Improvements to cervical screening, 70
5.9 Cytologic interpretation, 72
5.10 Role of human papillomavirus testing in the UK NHS Cervical Screening Programme, 72
5.11 Primary screening with human papillomavirus testing, 73
5.12 Human papillomavirus test as follow-up after treatment of cervical intraepithelial neoplasia, 74
5.13 Human papillomavirus testing to triage minor cytologic lesions, 74
5.14 Role of type-specific human papillomavirus tests, 74
5.15 Further reading, 75
6 Diagnosis of Cervical Precancer: Use of colposcopy, 76
6.1 Introduction, 76
6.2 Which cytologic abnormalities need further investigation?, 76
6.3 Colposcopy: the initial clinical examination, 76
6.4 The rationale for the use of colposcopy in the diagnosis of cervical precancer, 77
6.5 Colposcopic appearance of the abnormal (atypical) cervical epithelium, 78
6.6 The classification of colposcopically abnormal (atypical) cervical epithelium, 87
6.7 Colposcopic examination of the precancerous/cancerous cervix, 88
6.8 Benign condyloma of cervix, 104
6.9 Correlation of diagnostic methods in the detection of cervical squamous precancer, 111
6.10 Lack of correlation between diagnostic methods, 116
6.11 The diagnosis of early invasion, 117
6.12 Preclinical invasive carcinoma (colposcopically overt/suspect): colposcopy and pathology, 122
6.13 Precancerous glandular lesions of the cervix, 125
6.14 Colposcopic diagnosis of early adenocarcinoma of the cervix, 128
6.15 Further reading, 135
7 Management of Cervical Precancer, 136
7.1 Introduction, 136
7.2 Rationale behind treatment, 136
7.3 Colposcopic and pathologic characteristics of cervical intraepithelial neoplasia lesions: a prerequisite to treatment, 136
7.4 Colposcopically directed biopsy, 139
7.5 How to manage abnormal cytology?, 140
7.6 Which lesions to treat, 143
7.7 Prerequisites for treatment, 144
7.8 Methods of treatment, 145
7.9 Excision techniques for treating cervical intraepithelial neoplasia, 153
7.10 Management of extension of the abnormal (atypical) transformation zone, 163
7.11 Hysterectomy in the treatment of cervical intraepithelial neoplasia, 166
7.12 Immediate complications of cervical intraepithelial neoplasia treatment, 166
7.13 Long-term complications of cervical intraepithelial neoplasia treatment, 168
7.14 Follow-up after treatment of cervical intraepithelial neoplasia, 171
7.15 Treatment of suspected recurrence, 174
7.16 Precancer in pregnancy, 174
7.17 Precancer in the HIV-positive patient, 178
7.18 Management of early invasive squamous carcinoma of the cervix (FIGO stage I), 180
7.19 Further reading, 184
8 Vaginal Intraepithelial Neoplasia, 185
8.1 Introduction, 185
8.2 Natural history of vaginal intraepithelial neoplasia, 185
8.3 Etiology, 186
8.4 Clinical presentation, 186
8.5 Vaginal intraepithelial neoplasia following hysterectomy, 189
8.6 Biopsy of the vaginal intraepithelial neoplasia lesion, 191
8.7 Pathology of vaginal intraepithelial neoplasia: is it a precancerous lesion?, 193
8.8 Vaginal precancer and cancer: part of the lower genital tract neoplastic syndrome, 194
8.9 Treatment of vaginal intraepithelial neoplasia, 199
8.10 Further reading, 204
9 Vulval Intraepithelial Neoplasia, 205
9.1 Introduction, 205
9.2 Epidemiology and pathogenesis, 205
9.3 Natural history of vulval intraepithelial neoplasia: the rationale for treatment?, 207
9.4 Pathology, 209
9.5 The clinical examination in general, 211
9.6 The clinical examination (specific), 215
9.7 Vulval intraepithelial neoplasia affecting the pilosebaceous unit, 222
9.8 Superficially invasive carcinoma of the vulva, 223
9.9 Lichen sclerosus, 228
9.10 Paget?s disease (non-squamous intraepithelial neoplasia), 230
9.11 Vulval lesions masquerading as cancer or precancer, 231
9.12 Skin and accessory appendages that are important for the management of vulval intraepithelial neoplasia, 237
9.13 Management of vulval intraepithelial neoplasia, 239
9.14 Treatment of superficial invasive vulval carcinoma, 254
9.15 Further reading, 255
10 Perianal and Anal Intraepithelial Neoplasia, 256
10.1 Epidemiology, 256
10.2 Etiology, 256
10.3 Association with other genital intraepithelial neoplastic diseases, 257
10.4 Examination, 257
10.5 Presentation, 258
10.6 Lesions masquerading as intraepithelial neoplasia, 260
10.7 Anal canal involvement, 261
10.8 Management and treatment, 262
10.9 Further reading, 267
11 Genital Tract Adenosis, 268
11.1 Introduction, 268
11.2 Developmental anatomy, 268
11.3 Developmental anomalies caused by diethylstilbestrol, 269
11.4 Present situation, 272
11.5 Further reading, 272
12 Infective and Other Conditions Causing Confusion in Diagnosis of Lower Genital Tract Precancer, 273
12.1 Introduction, 273
12.2 Trichomonas vaginalis, 273
12.3 Bacterial vaginosis, 273
12.4 Candidiasis, 274
12.5 Herpes genitalis infection, 275
12.6 Human papillomavirus infection, 279
12.7 Cervical deciduosis in pregnancy, 280
12.8 Polypoid lesions of the cervix, 282
12.9 Further reading, 285
Index, 287
