colposcopy - gfmer.ch .histology colposcopy cytology it has been estimated that annual pap smear

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  • ColposcopyColposcopyColposcopy

    Attila L Major, MD, PhD

  • Histology Colposcopy

    Cytology

    It has been estimated that annual Pap smear testing reduces a womans chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

  • NomenclatureNomenclature

    CIN I CIN II CIN III

    MildDysplasia

    ModerateDysplasia

    SevereDysplasia

    Carcinoma in situ

  • HinselmannHinselmann, 1925, 1925

  • SquamousSquamous EpitheliumEpithelium

    basal layer

    squamousepithelium

    SCJ

    Columnarepithelium

    Stratification

  • SquamousSquamous EpitheliumEpithelium

    stratified, non-keratinizing epithelium

    original squamous epithelium

  • Cytological featuresCytological features

    The standard method for staining cytological preparations is that of Papanicolaou

    squamous epithelium

  • SquamousSquamous EpitheliumEpithelium

    superficial cells

    parabasal cells

  • Colum

    nar Epithelium

    Colum

    nar Epithelium

    Columnarepithelium

  • Colum

    nar Epithelium

    Colum

    nar Epithelium

    Normal columnar epithelium is easily recognised by its characteristic grape-like or villous appearance.

    Following application of acetic acid, the villi often appear white and are more easily recognizable.

    Columnarepithelium

  • Normal Normal CevixCevix, , ColposcopyColposcopy

    original squamousepithelium

    Columnarepithelium

    SCJ

    SCJ

    original squamousepithelium

    Columnarepithelium

  • Transformation ZoneTransformation Zone

    Original SCJ

  • Imm

    ature Im

    mature m

    etaplasiam

    etaplasia

  • Mature Mature metaplasiametaplasia

    The new epithelium results from transformation of columnar to squamousepithelium, through the process of squamousmetaplasia

    Normal transformation zone

  • CIN 1 & CIN 2CIN 1 & CIN 2

    Histology

  • CIN 3 CIN 3

    In CIN 3 differentiation and stratification may be completely absent

    12% ; 2-10 yearsIn early stromal invasion a group of cellshave breached the epithelial/stromaljunction

  • Acetow

    hiteA

    cetowhite

    changechange

  • Acetow

    hiteA

    cetowhite

    changechange

  • Acetow

    hiteA

    cetowhite

    changechange

  • Vas

    Vas

    culacularrpattpatternern V

    ascularV

    ascular patternpattern

  • InvasiveInvasive

  • VulvalVulval condylomatacondylomata acuminataacuminata

  • CondylomaCondyloma

  • #1#1

  • #2#2

  • #3#3

  • #4#4

  • #5#5

  • NomenclatureNomenclature

    CIN I CIN II CIN III

    MildDysplasia

    ModerateDysplasia

    SevereDysplasia

    Carcinomain situ

    The concept of cervical intraepithelial neoplasia proposes that all degrees of abnormality should be given the same name, as part of a continuous spectrum of disease

  • ASCASC--USUSASCUS

    RepeatCytology

    at 6 months

    pos Colposcopy

    neg

    Repeat cytologyat 12 months

    neg Repeat cytologyat 6 & 12 months

    pos

    pos

    management ofhistological

    abnormalities

    Management Option 2.

  • ASCASC--USUSASCUS

    HPV pos Colposcopy

    neg

    Repeat cytologyat 12 months

    neg Repeat cytologyat 6 & 12 months

    pos

    pos

    management ofhistological

    abnormalities

    Management Option 1.

  • HSILHSIL

    HSIL

    Satisfactorycolposcopy yes

    Colposcopy (with ECC)

    no

    Diagnostic excisionalprocedure

    management ofhistological

    abnormalities

    yes

    Lesionidentified

    no

    No Lesionidentified

    management ofhistological

    abnormalities

    Biopsy-confirmed CIN

    Reviewmaterial change in diagnosis

    no change

    Management HSIL

  • AGCAGC

    Management AGC (Atypical Glandular Cells )

    AGC

    Invasive diseaseRefer to specialist

    yes

    Colposcopy (with ECC)Endometrial sampling (> 35 years)

    Initial Pap

    no

    Diagnostic excisionalprocedure (cold-knife

    conization)

    AGC - favor neoplasiaor AIS

    CIN or AIS

    AGC - NOS

    management ofhistological

    abnormalities

    yes Repeat Cytologyevery 6 months (4x)no

    HSIL or AGC

  • ASCASC--HH ASC-H

    Colposcopy negBiopsy-confirmed CINany grademanagement of

    histologicalabnormalities

    no change Change in diagnosis

    Review of the material

    Repeat cytologyat 6 & 12 months

    management ofhistological

    abnormalities

    Management ASC-H (cannot exclude high-grade SIL)

  • LSILLSIL

    LSIL

    Satisfactorycolposcopy yes

    Colposcopy (with ECC)

    no

    management ofhistological

    abnormalities

    yes

    Lesionidentified no No Lesion

    identified

    management ofhistological

    abnormalities

    Biopsy-confirmed CIN

    Repeat cytologyat 6 & 12 months

    ASC or CIN

    Management LSIL

  • LSILLSIL LSILAdolescents;

    option

    Repeat Cytologyat 6 & 12 months ASC or CINnegative

    RoutineScreening

    ColposcopicTriage

    Management LSIL; Option : Adolescents

  • Histology Colposcopy

    Cytology

    It has been estimated that annual Pap smear testing reduces a womans chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

  • MicroglandularMicroglandular endocervicalendocervical hyperplasiahyperplasia

    polypoidal villi

    non-pathologic condition

  • Project Project summariessummaries

    text

  • ScreeningScreening

    It has been estimated that annual Pap smear testing reduces a womans chance of dying of cervical cancer from 4 in 1000 to about 5 in 10,000 a difference of almost 90%

  • MicroglandularMicroglandular endocervicalendocervicalhyperplasiahyperplasia

    Colposcopy NomenclatureHinselmann, 1925Squamous EpitheliumSquamous EpitheliumCytological featuresSquamous EpitheliumColumnar EpitheliumColumnar EpitheliumNormal Cevix, ColposcopyTransformation ZoneImmature metaplasiaMature metaplasiaCIN 1 & CIN 2CIN 3Acetowhite changeAcetowhite changeAcetowhite changeVascular patternInvasiveVulval condylomata acuminataCondyloma#1#2#3#4#5NomenclatureASC-USHSILAGCASC-HLSILLSILMicroglandular endocervical hyperplasiaProject summariesScreeningMicroglandular endocervical hyperplasia

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