Women's Health and Education Center (WHEC)

Gynecologic Pathology and Cytopathology

List of Articles

  • Update on Colposcopic Terminology
    The purpose of this document is review new colposcopy terminology and its implementation for diagnosis, treatment, and research. This document has been expanded to include terminology of both cervix and vagina. The current nomenclature committee is the first that presents and International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology dedicated to colposcopy of the vagina. Various human papillomas virus (HPV) lesions and intraepithelial neoplasia may occur in the vagina as a primary lesion or in continuum with cervical intraepithelial neoplasia. The popular terms “satisfactory colposcopy” and “unsatisfactory colposcopy” have been replaced. The colposcopic examination should be assessed for three variables: 1) adequate or inadequate, with the reason given; 2) squamo-columnar junction visibility; 3) transformation zone type. Other additions were the localization of the lesion to either inside or outside the transformation zone and determinants of size as well as location of cervical lesions. Two new signs are included in the terminology – the “inner border sign” and “ridge sign”.

  • Pathogenesis of Cervical Adenocarcinoma
    The purpose of this document is to review cytological screening, DNA testing procedures and pathological features of glandular cells abnormalities. Consensus guidelines are available for the management of women with cervical cytological abnormalities and cervical cancer precursors. These evidence-based guidelines were developed in 2001 by an expert consensus conference sponsored by the American Society for Colposcopy and Cervical Pathology. Vaccines are currently being developed to reduce susceptibility to HPV infection and persistent infection. Widespread acceptance of these vaccines should significantly reduce the incidence of HPV-associated disease, thereby alleviating a significant fraction of morbidity associated with HPV infections.

  • The Pap Smear
    Before the Pap smear was introduced into clinical practice, carcinoma of the cervix was the leading cause of cancer-related deaths among American women. No other test has been as successful as the Pap smear in eradicating cervical cancer. Cervical cancer is still a leading cause of cancer deaths in women where Pap smear screening is not widely available. Screening for cervical cancer and its precursors with Pap tests represents the most successful cancer detection strategy ever developed. This document reflects emerging clinical and scientific advances. This information should not be constructed as dictating an exclusive course of treatment or procedure to be followed. Variation in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the type of practice or institution.

  • Value of Cervical Cytology: Cervical Dysplasia & HPV
    Dysplasia or cervical intraepithelial neoplasia (CIN) means disordered growth and development of the epithelial lining of the cervix. Although cervical cancer was the leading cause of cancer death in USA in 1930s, both the incidence and mortality from cervical cancer have decreased by almost one half since the early 1970s, largely as a result of widespread screening with the Pap-test. New technology for performing cervical cytology is evolving rapidly, as are recommendations for classifying and interpreting the results. In USA cervical cancer is the third most common gynecologic malignancy and in countries where cytologic screening is not widely available, cervical cancer remains common. Cervical cytology screening programs have markedly reduced the cervical cancer incidence in the communities. The purpose of this document is to provide a review of the best available evidence on screening of cervical cancer.

  • The Bethesda System - An Overview
    By the 1980s, DNA determination by flow cytometry and cell image analysis began to enhance the diagnostic accuracy of cytopathology. The first Bethesda Conference met on December 12-13, 1988 in Maryland (USA) at the National Institutes of Health (NIH) to consider methods of reporting gynecologic cytology in meaningful diagnostic terminology. Between 1988 and 1991, The Bethesda System (TBS) nomenclature materialized on cytology reports in the United State, Europe, Asia and Latin America. Today both exfoliative and aspiration biopsy cytology have gained widespread acceptance. The TBS format and their appropriate usage are the main focus of this document. Specimen adequacy and the terminology and its clarification are discussed in detail.

  • Human Papillomavirus (HPV) And Testing
    The early successes in cervical cancer screening were based on the development of morphologic criteria for recognizing cells shed from cervical cancer and its precursors. However, our ability to manage cervical diseases more effectively has been limited by an incomplete understanding of the pathogenesis and biology of cervical neoplasia. Recognition that human papillomavirus (HPV) causes most cervical neoplasia suggests that improved screening and management strategies that reflect the biology and behavior of HPV infections may be possible. The purpose of this document is to review the structure and biology of HPVs and summarize the clinical applications of HPV testing and areas of ongoing research will be discussed.

  • Pathology Of Breast Cancer
    Understanding the histopathologic features of breast cancer has been recognized as a necessary element for appropriate management of breast carcinoma. There have been two general approaches to prognostication via histopathologic analysis. The first categorizes carcinomas based on specific features, recognizing the so-called special-type carcinomas. The second approach evaluates individual characteristics of the carcinoma, such as nuclear pleomorphism or gland formation (grading). The purpose of this document is to review the histopathology of invasive breast carcinoma, emphasizing the proven and potential settings in which it provides prognostic information. In-situ carcinomas of the breast were first recognized in the early 20th century and were identified morphologically as cells cytologically similar to those of invasive carcinomas but confined to duct structures. Short- and long-term risks associated with specific histologic variants or types of in-situ carcinomas are also discussed in this chapter.

  • Pathologic Features of Uterine Cancer
    The purpose of this document is to enhance the understanding of endometrial hyperplasia and endometrial neoplasia (cancer). Most commonly, the prolonged unremitting estrogen stimulation results in endometrial hyperplasia. All gradations of this phenomenon occur, ranging from one distinguished only with difficulty from a normal exuberant proliferative endometrium (so-called disordered proliferative endometrium) to an atypical one that approaches the appearance of adenocarcinoma.

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