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Adenocarcinomas of the Cervix and their Precursors and Neuroendocrine Tumors

Preinvasive Glandular Lesions and Early Invasive Adenocarcinomas Adenocarcinoma in situ Clinical features ■ Adenocarcinoma in situ (AIS), like its invasive counterpart, has increased in incidence over the past 30 years. The median and mean patient ages are in the fourth decade, 10–15 years lower than those with invasive adenocarcinoma. Women with intestinal-type AIS are a decade older than those with typical (endocervical-type) AIS (mean ages 45…

Invasive Squamous Cell Carcinoma of the Cervix and its Precursors

Precursors Classification ▪ The classifications used for precursors of cervical invasive squamous cell carcinoma (ISqCC), in order of their historical development, are: (1) dysplasia/carcinoma in situ (CIS); (2) cervical intraepithelial neoplasia (CIN); and (3) squamous intraepithelial lesions (SILs) (Bethesda; CAP-ASCCP LAST systems) ( Table 5.1 ). Table 5.1 Comparison of classification systems for precursors of squamous cell carcinoma of the uterine cervix Dysplasia, carcinoma in situ…

Tumor-Like Lesions and Benign Tumors of the Uterine Cervix

Tumor-Like Lesions Metaplasias and Ectopias Squamous Metaplasia ( Figs. 4.1 – 4.2 ) ■ This normal process within the transitional zone of postpubertal women results in the replacement of endocervical surface and glandular epithelium by squamous epithelium, resulting in a cephalad migration of the squamocolumnar junction. The replacement may sometimes be incomplete with persistence of endocervical glands on the ectocervix. Extensive glandular epithelium on the ectocervix…

The Vagina

Tumor-Like and Inflammatory Lesions Condyloma Acuminatum ▪ These resemble their vulvar counterparts ( Chapter 1 ) except for a more frequent occurrence of flat condylomas and those with a ‘spiked’ surface due to asperities or minute surface projections that contain capillaries and scanty stroma. Diffuse vaginal involvement may occur. Adenosis ( Figs. 3.1–3.9 ) ▪ Prior to the use of diethylstilbestrol (DES) in pregnant women, vaginal…

Malignant Tumors of the Vulva

Squamous Cell Carcinoma and Its Precursors Vulvar Intraepithelial Neoplasia (VIN) Terminology ■ The main types of VIN – usual VIN (uVIN) and differentiated VIN (dVIN) – each have distinctive clinical and pathologic features. This terminology has been incorporated into the LAST standardization project for HPV-associated lesions ( Chapter 5 ). ■ Although traditionally VIN has been graded I, II, or III, VIN I has an unproven…

Non-Neoplastic Lesions and Benign and Locally Aggressive Tumors of the Vulva

Viral Infections Human Papillomavirus (Hpv) (Including Condyloma Acuminatum) Clinical and gross features ( Fig. 1.1 ) ▪ Sexually transmitted HPV (usually low-risk types, especially HPV 6 and 11) is the cause of condyloma acuminatum (venereal wart), the incidence of which in the USA increased 4- to 5-fold between 1966 and 1981. ▪ Condylomas, which are considered LSIL/VIN1, most commonly involve the vestibule and the medial aspects…

Diet and nutrition

Introduction In 2003, the Director General of the World Health Organization (WHO) unequivocally stated that ‘proper nutrition and health are fundamental human rights’. Good nutrition underpins human health in the sense that it influences growth, physical and intellectual development and the ability to combat disease processes. ‘Bad nutrition’ or malnutrition, whether overnutrition (obesity) or undernutrition, is a major determinant of morbidity and mortality. Knowledge of the…

The alimentary system

Introduction The chemical composition of food is complex and little of it is water soluble; therefore, it cannot enter the body fluids unaltered. A series of digestive processes enables food to be broken down and absorbed. These processes take place in the alimentary canal, which consists of the mouth, oesophagus and gastrointestinal tract, and associated exocrine glands producing secretions that act on food. Basic functions and…

The renal system

Introduction The kidney is an essential organ for life and plays a central role in homeostasis. Homeostasis, originally defined by the great French physiologist Claude Bernard, refers to the stability and maintenance of the internal environment of the body – the so-called ‘milieu intérieur’ (see Ch. 1 ). Key renal functions may be deduced from what happens when the kidneys cease to function or fail. Functions…

The respiratory system

Introduction The primary function of the respiratory system is to move air into the lungs to supply oxygen for the metabolic processes of the body whilst removing sufficient carbon dioxide to maintain the acid–base balance of the blood. Breathing involves actively drawing air in (inspiration) through the nose, mouth and trachea into the lungs, and expulsion of air (expiration). In the lungs, oxygen and carbon dioxide…

Haematology

The Haemopoietic System Blood and its constituents Blood is one of the body's largest tissues, comprising a mixture of cells within a fluid (plasma). Blood permeates all organs and tissues, distributing essential organic and inorganic substances. It maintains homeostasis and body temperature, carries oxygen, acts as a buffering system and has many other functions. Definitions and explanations of many of the terms that are used throughout…

The cardiovascular system

Introduction The cardiovascular system is a network for blood distribution which functions to supply the cells of the body with oxygen and nutrients such as glucose and amino acids; to provide homeostatic control of acid–base balance, fluid balance and thermoregulation; and to transport hormones and immune cells to target tissues. It also transports carbon dioxide (CO 2 ) and other waste products of metabolism away from…

Endocrinology and the reproductive system

Introduction The human body is an astonishingly well-coordinated organism. Made up of several billion cells, the body depends on communication systems that are precisely regulated and that reach every one of those cells. There are two main communication systems in the human body: the nervous system and the endocrine system . In Chapter 8 , we saw how the nervous system is constructed and how it…

Bone, muscle, skin and connective tissue

Introduction The musculoskeletal system is composed of the skeleton, the muscles and accessory tissues, which together allow movement of the body. The bones of the skeleton are living tissue, and they can be found in a variety of shapes and sizes depending on their function. The skeleton is composed of approximately 206 individual bones that articulate with each other via a network of joints. Joints vary…

The nervous system

Introduction The nervous system detects details about the external and internal environments, processes them, determines behaviour and controls body activities. Sensory information is carried to the brain from specialised receptors in the skin, muscles and joints; from special sense organs (for vision, hearing, smell and taste); and from visceral receptors in internal organs (e.g. gut and bladder). The incoming data are integrated with, or modified by,…

Epidemiology: science for the art of medicine

Introduction The term epidemiology has its roots in Greek words meaning, very roughly, ‘a discourse about something visited on the people’. Whilst it is clearly a close cousin of ‘epidemic’, it is important to understand how the two relate to each other. Epidemic , though commonly understood to mean an outbreak of infectious disease, is more strictly defined as the prevalence of a disease among populations…

Infection, immunology and pathology

Introduction Disease results from a failure of homeostasis within the body, which causes impaired function. Failure of homeostasis itself can be due to a multiplicity of causes, extrinsic and intrinsic, many of which are discussed in other areas of this book, and are summarised in Tables 6.1 and 6.2 . Table 6.1 Extrinsic causes of disease Extrinsic factor Agent Example Biological Bacteria Urinary tract infection Viruses…

Human genetics

Introduction Historical background Genetics is a very new science, changing rapidly by the day with advances in technology. Although humans have long been aware of some form of heredity, the mechanisms have only recently become clear. Early philosophers talked about the male ripening the female, or seeds being produced in various organs to be transmitted to the child. In the early 18th century, scientists were divided…

Pharmacology

Introduction Pharmacology is the science that covers the actions, mechanisms of action, uses, adverse effects and fate of drugs in animals and man. The word ‘pharmacology’ comes from the ancient Greek word ‘pharmakon’ and is the science of what drugs do to the body and how the body reacts to xenobiotics, which covers any biologically active substance that is taken with the intent of producing a…

Energy metabolism

Introduction to Metabolism The human organism needs a constant supply of energy to enable a number of processes that are essential to survival. The central issue in metabolism is that the demand for energy is constant but the supply intermittent. Mechanisms are in place which ensure that when metabolic fuel is available in quantities greater than needed immediately, the fuel is stored, and when it is…