Burghardt's Primary Care Colposcopy Textbook and Atlas

162 Pages·2017·53.416 MB·English

by  Olaf Reich, Frank Girardi, Karl Tamussino, Hellmuth Pickel

Burghardt’s Primary Care Colposcopy
Textbook and Atlas
Olaf Reich, MD
Associate Professor of Gynecology
Associate Professor of Patholgy
Department of Obstetrics and Gynecology
Medical University of Graz
Graz, Austria
Frank Girardi, MD
Professor Emeritus
Department of Obstetrics and Gynecology
Medical University of Graz
Graz, Austria
Karl Tamussino, MD, FACS
Professor
Department of Obstetrics and Gynecology
Medical University of Graz
Graz, Austria
Hellmuth Pickel, MD
Professor Emeritus
Department of Obstetrics and Gynecology
Medical University of Graz
Graz, Austria
369 illustrations
Thieme
Stuttgart · New York · Delhi · Rio de Janerio
Library of Congress Cataloging-in-Publication Data is available from Important Note: Medicine is an ever-changing science undergoing
the publisher continual development. Research and clinical experience are continu-
ally expanding our knowledge, in particular our knowledge of proper
treatment and drug therapy. Insofar as this book mentions any dosage
or application, readers may rest assured that the authors, editors, and
This book represents selections from Girardi F., Reich O., Tamussino K., publishers have made every effort to ensure that such references are in
Pickel H. Burghardt's Colposcopy and Cervical Pathology, newly edited, accordance with the state of knowledge at the time of production of
published and copyrighted by Georg Thieme Verlag, Stuttgart, Germany the book.
2015. Nevertheless, this does not involve, imply, or express any guarantee or
responsibility on the part of the publishers with respect of any dosage
instructions and forms of application stated in the book. Every user is
requested to examine carefully the manufacturer’s leaflets accompany-
ing each drug and to check, if necessary in consultation with a physician
or specialist, whether the dosage schedules mentioned therein or the
contraindications stated by the manufacturer differ from the statements
made in the present book. Such examination is particularly important
with drugs that are either rarely used or have been newly released on
the market. Every dosage schedule or every form of application used is
entirely at the user’s risk and responsibility. The authors and publishers
request every user to report to the publishers any discrepancies or inac-
curacies noticed.
Some of the product names, patents, and registered designs referred
to in this book are in fact registered trademarks or proprietary names,
even though specific reference to this fact is not always made in the text.
Therefore, the appearance of a name without a designation as propri-
etary is not to be construed as a representation by the publisher that it is
in the public domain.
© 2017 by Georg Thieme Verlag KG
Thieme Publishers Stuttgart
Rüdigerstrasse 14, 70469 Stuttgart, Germany
+49 [0]711 8931 421, [email protected]
Thieme Publishers New York
333 Seventh Avenue, New York, NY 10001 USA
[phone], [email protected]
Thieme Publishers Delhi
A-12, Second Floor, Sector-2, Noida-201301
Uttar Pradesh, India
[phone], [email protected]
Thieme Publishers Rio, Thieme Publicações Ltda.
Edifício Rodolpho de Paoli, 25o andar
Av. Nilo Peçanha, 50 - Sala 2508
Rio de Janeiro 20020-906 Brasil
[phone] / [phone]
Cover design: Thieme Publishing Group
Typesetting by DiTech Process Solutions, India
Printed in Germany by CPI Books GmbH 5 4 3 2 1 This book, including all parts thereof, is legally protected by copyright.
Any use, exploitation, or commercialization outside the narrow limits set
ISBN 978-3-13-130722-4 by copyright legislation, without the publisher’s consent, is illegal and
liable to prosecution. This applies in particular to photostat or mechani-
Also available as an e-book: cal reproduction, copying, or duplication of any kind, translating, prepa-
eISBN 978-3-13-162712-4 ration of microfilms, and electronic data processing and storage.
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
1 Human Papillomaviruses and Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02
1.1 Etiology of Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . 02 1.3 Morphogenesis of Cervical Cancer . . . . . . . . . . . . . . . . 04
1.2 Natural History of Cervical Cancer . . . . . . . . . . . . . . . . 02 1.4 HPV Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06
2 Role of Colposcopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1 Routine Colposcopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.4 Colposcopy to Evaluate Abnormal
2.2 Colposcopy to Evaluate an Abnormal Pap Smear . . . . . 14 Cytologic Findings during Pregnancy . . . . . . . . . . . . . . 14
2.3 Colposcopy to Evaluate Patients Positive 2.5 Colposcopy to Evaluate Lesions before Treatment . . . . 14
for HPV or Other Biomarkers . . . . . . . . . . . . . . . . . . . . . 14 2.6 Colposcopy in Screen-and-Treat
Approaches in Resource-Poor Settings . . . . . . . . . . . . . 14
3 The Colposcope and the Colposcopic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.1 Colposcopic Instruments . . . . . . . . . . . . . . . . . . . . . . . . 19 3.3 The Colposcopic Examination . . . . . . . . . . . . . . . . . . . . 19
3.2 Biopsy Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.4 Therapeutic Implications of
Abnormal Colposcopic Findings . . . . . . . . . . . . . . . . . . 24
4 Teaching and Training Colposcopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.1 Colposcopy Training in Europe . . . . . . . . . . . . . . . . . . . 32 4.2 European Diploma in Colposcopy . . . . . . . . . . . . . . . . . 33
5 Colposcopic Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
6 Colposcopic Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
6.1 Normal Colposcopic Appearances . . . . . . . . . . . . . . . . . 40 6.4 Assessment of Colposcopic Findings . . . . . . . . . . . . . . 91
6.2 Abnormal Colposcopic Findings . . . . . . . . . . . . . . . . . . 51 6.5 Criteria for Diff erential Diagnosis . . . . . . . . . . . . . . . . . 91
6.3 Miscellaneous Colposcopic Findings . . . . . . . . . . . . . . . 73 6.6 Combinations of Abnormalities . . . . . . . . . . . . . . . . . . 98
7 Colposcopy in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
7.1 E ff ects of Pregnancy on Colposcopic Findings . . . . . . . 103 7.4 The Puerperium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
7.2 Benign Changes in Pregnancy . . . . . . . . . . . . . . . . . . . . 106 7.5 Biopsy during Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 111
7.3 Suspicious Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
8 Colposcopy of the Vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
8.1 Histology of the Vulva . . . . . . . . . . . . . . . . . . . . . . . . . . 114 8.3 Vulvar Carcinogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . 122
8.2 Diagnostic Methods for Evaluating 8.4 Preinvasive (Intraepithelial) Lesions . . . . . . . . . . . . . . . 124
Vulvar Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 8.5 Nonneoplastic Conditions . . . . . . . . . . . . . . . . . . . . . . . 132
9 Colposcopy of the Vagina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
9.1 Histology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 9.5 Histologic Terminology and Classifi cation . . . . . . . . . . 140
9.2 Vaginal Carcinogenesis . . . . . . . . . . . . . . . . . . . . . . . . . 138 9.6 Histomorphology of Vaginal SIL . . . . . . . . . . . . . . . . . . 140
9.3 Squamous Intraepithelial Lesions . . . . . . . . . . . . . . . . . 138 9.7 Management of SIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
9.4 Diagnostic Methods for SIL . . . . . . . . . . . . . . . . . . . . . . 138 9.8 Vaginal Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
v
Contents
10 Colposcopy of the Perianal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
10.1 Anatomy and Histology . . . . . . . . . . . . . . . . . . . . . . . . . 144 10.4 Diagnostic methods for AIN . . . . . . . . . . . . . . . . . . . . . 145
10.2 Anal Carcinogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 10.5 Histologic Terminology and Classifi cation . . . . . . . . . . 147
10.3 Anal Intraepithelial Neoplasia . . . . . . . . . . . . . . . . . . . . 144 10.6 Management of AIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
vi
Preface
Colposcopy is a widely used technique to visually e xamine the lower fundamentals of colposcopic technique and how colposcopy can help
genital tract with exposure, a light source, and magnification. The num- one appreciate the dynamic processes at the cervix and lower genital
ber of textbooks on colposcopy testifies to the rapid development of tract that we have to understand to prevent invasive cervical cancer and
the technique over the last 20 years. The first edition of the full version neoplasias of the vulva, vagina, and anus.
of this book was published in German in 1984. Since then revised edi- We thank Dr. Charles Redman (Stoke on Trent) and Dr. Esther Moss
tions of the full version, now called Burghardt’s Colposcopy and Cervical (Leicester) for their contribution to the chapter Teaching Colposcopy.
Pathology in honor of Erich Burghardt who passed away in 2006, have We would like to thank Thieme Verlag for their longstanding support of
appeared in Spanish, Japanese, French, Italian, and English. The pres- this project. And, of course, we thank our wives—Christine, Ursula, Caro-
ent edition of the compact edition is user-oriented resource for general line, and Ulrike—for their support.
practitioners, nurses, and other n onspecialists. Accordingly, we have left
out detailed histologic pictures and descriptions while keeping the col- Olaf Reich,
poscopic images that are the backbone of the book. So-called “extended Frank Girardi,
colposcopy” (i.e., with the acetic acid and the iodine test) is given ample Karl Tamussino,
coverage. Like its predecessors, this book intends to explain both the Hellmuth Pickel
vii