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The new edition of this atlas integrates all significant advances made in the past 15 years in molecular pathology,tumor virology,and genetics of cervical cancer. It emphasizes the importance of these advances in facilitating its pathological diagnosis and in op- mizing clinical management and prognosis. A new chapter on immunohistochemistry has been added,which includes refined detection methods,e. g. ,the overexpression of INK4a p16 as a molecular marker in the early differential diagnosis of premalignant - sions. The section on etiology and pathogenesis in human papillomavirus-induced neoplasia has been incorporated to represent new insights into the sequences of cel- lar and nuclear deregulation at the molecular level. All chapters have been revised to - clude the newest advances and relevant experiences in how to interpret and manage cervical disease; they are supported by the addition of 35 new microphotographic ill- trations. The tumor nomenclature is adapted to the latest edition of the WHO classi- cation; the morphology code of the international classification of diseases for oncology (ICD-O) has been added. We have also updated the list of references by adding recent relevant publications. Again,the staff of Springer-Verlag deserve our thanks for their patience and skill in preparing the manuscript and in reproducing the microphotographs. Heidelberg,February 2005 Gisela Dallenbach-Hellweg, Magnus von Knebel Doeberitz, and Marcus J. Trunk Heading2 Preface to the First Edition During the past decade our understanding of the histopathology of the cervix uteri has changed greatly.
Reevaluation of tumor classification, differential diagnosis and differential therapy based on modern knowledge. Revision of all chapters to incorporate new facts based on recent discoveries.
Die Ovarialtumoren gehoren heute mit zu den haufigsten Tumoren des weiblichen Genitale. Ihre morphologische Differentialdiagnostik und die sich darauf aufbauende gezielte Therapie ist aufgrund der Vielfalt dieser Tumoren ungleich viel komplizierter als in anderen Organen. Dement- sprechend liegt der Schwerpunkt dieses Buches auf dem Gebiet der Histo- pathologie. Spezialkenntnisse insbesondere tiber die selteneren Formen der Ovarialtumoren hangen von groBen Fallzahlen abo Hier ist der inter- nationale Erfahrungsaustausch von vorrangiger Bedeutung. Die derzeit weltweit anerkannte histogenetische Klassifikation der WHO erfahrt an- hand der Erfahrungen an drei deutschen Frauenkliniken kleine Erganzun- gen und Variationen. Einige Lander, Z. B. Israel verfUgen tiber groBe epi- demiologische Untersuchungen, deren Ergebnisse korrelierend aufgenom- men sind. Zur klinischen Diagnostik wurden in den letzten lahren mo- dernste Untersuchungsmt;thoden neu eingefUhrt; ihre Anwendung setzt jedoch individuell anzupassende kritische Indikationsstellungen voraus. AbschlieBend werden die sich sehr differenziert auf der histologischen Diagnostik aufbauenden modernen Moglichkeiten einer gezielten Thera- pie der Ovarialtumoren ausfUhrlich diskutiert. Hier steht die Chemothera- pie im Vordergrund. 1m Hinblick auf die Frage einer Hormonbehandlung kommt neuerdings auch dem Rezeptornachweis im Tumorgewebe Bedeu- tung zu. Diese Zusammenstellung spricht somit gleichermaBen Pathologen, Onkologen und Gynakologen an und will versuchen, gegenseitige Infor- mationslticken der Fachexperten auf dem Gesamtgebiet der Problematik der Ovarialtumoren in zumutbarer Klirze zu schlieJ3en. Daher nehmen ge- rade die selteneren und bisher weniger bekannten Tumoren in Bild und Text einen verhaltnismaBig breiten Raum ein auf Kosten der hinlanglich bekannten haufigeren Formen, bei denen Spezia1fragen der Differenti- diagnostik aufgrund neuester Erkenntnisse im Vordergrund stehen.
The new edition of this atlas integrates all significant advances made in the past 15 years in molecular pathology,tumor virology,and genetics of cervical cancer. It emphasizes the importance of these advances in facilitating its pathological diagnosis and in op- mizing clinical management and prognosis. A new chapter on immunohistochemistry has been added,which includes refined detection methods,e. g. ,the overexpression of INK4a p16 as a molecular marker in the early differential diagnosis of premalignant - sions. The section on etiology and pathogenesis in human papillomavirus-induced neoplasia has been incorporated to represent new insights into the sequences of cel- lar and nuclear deregulation at the molecular level. All chapters have been revised to - clude the newest advances and relevant experiences in how to interpret and manage cervical disease; they are supported by the addition of 35 new microphotographic ill- trations. The tumor nomenclature is adapted to the latest edition of the WHO classi- cation; the morphology code of the international classification of diseases for oncology (ICD-O) has been added. We have also updated the list of references by adding recent relevant publications. Again,the staff of Springer-Verlag deserve our thanks for their patience and skill in preparing the manuscript and in reproducing the microphotographs. Heidelberg,February 2005 Gisela Dallenbach-Hellweg, Magnus von Knebel Doeberitz, and Marcus J. Trunk Heading2 Preface to the First Edition During the past decade our understanding of the histopathology of the cervix uteri has changed greatly.
This new edition differs from the preceding ones in that there has been extensive revision of most chapters. Recent advances in research gained by immunohistochemical, molecular biological, and cytogenetic methods are included, as far as they are applicable for daily diagnostic work. The chapter on neoplasms, in particular, has been greatly expanded in accordance with the new WHO International Histological Classification of genital tract tumors, covering all pertinent differential diagnostic aspects. The chapter on malignant lymphomas and hematopoetic neoplasms involving the endometrium is a new contribution to this edition (F. D. , Ulm). We have revised the chapter on gestational diseases, incorpor- ing recent advances in the differential diagnosis of gestational trophoblastic tumors. New discoveries and experiences in correlating structure and function in infertility and in h- mone replacement therapy of peri- and postmenopausal patients are also included. Many new microphotographs have been added to illustrate the advances in tumor research and in immunohistochemical detection methods. We have updated the list of references including recent relevant publications. To the correspondents and consultants who have contributed valuable observations and suggestions, bringing thereby to our attention omissions in the second edition, we acknowledge our cordial thanks. We thank Dr. Wolfram Klapper, Director of the L- phom Register of the University of Kiel, for case material for making the micropho- graphic illustrations of lymphomas. The staff of Springer-Verlag has earned our gratitude for their skill in preparing this new edition.
Die Cytologie ist weder in der Forschung noch in der praktISchen Anwendung eine junge Methode. Bevor man lernte, Gewebspraparate durch die Schnitt- technik anzufertigen, war man auf die Untersuchung von Zellen aus Zupfprapa- raten oder von abgestrichenen bzw. abgeschilferten Zellen angewiesen. Kurz nachdem JOHANNES MUELLER (1801-1858) als einer der ersten das Mikroskop in die medizinische Diagnostik eingefuhrt und sein Schuler SCHWANN 1839 die tierische Zelle als Elementarbaustein entdeckt hatte, untersuchte der Franzose DONNE das Colostrum (18i5), fand POUCHET (1847) Zellveranderungen im Vagi- nalsekret wahrend des menstruellen Cyclus und beschrieb BRUCH in Deutschland das flussige Blastem und nackte Kerne als Besonderheit der Krebsmilch. Schon in diesen Ansatzen sind die beiden Richtungen der Cytologie klar erkennbar: die Bemuhungen um eine funktionelle Diagnostik und um eine Charakterisierung von Malignomen an Hand der cytologischen Zusammensetzung des Unter- such ungsma terials. Wahrend die Untersuchung des flussigen Gewebes Blut (nach Einfuhrung spezieller Farbemethoden durch EHRLICH und den Ausbau der Methodik durch WIDAL) als Hamatologie zum festen Bestandteil medizinischer Diagnostik wurde und aus dem Zustandigkeitsbereich des Pathologen in den des klinischen Hama- tologen uberging, entwickelte sich die Gewebsschnittuntersuchung und wurde als Histologie zum unentbehrlichen Bestandteil pathologisch-anatomischer Dia- gnostik, die weitgehend ausserhalb der Klinik lag. Die Beurteilung cytomorpho- logischer Eigenschaften erfolgte damit im Gewebsverband und gestattete bei geringerem Zeitaufwand eine erhoehte Sicherheit gegenuber der Untersuchung aus dem Verband herausgeloester Einzelzellen. Die exfoliative Cytologie trat in den Hintergrund.
Der vorliegende Band VII/4 enthiilt die abschlieBenden Kapitel der speziellen pathologischen Anatomie und Histologie der weiblichen Geschlechtsorgane. Er ist in seiner Gliederung noch von Prof. ROESSLE entworfen worden und umfaBt die Entziindungen und Geschwiilste der Vulva, Vagina und weiblichen Urethra. Diese Grundkapitel werden erganzt durch eine Darstellung der Haut-und vene- rischen Erkrankungen der Vulva und Vagina. Der Band bringt ferner als wichtige Beigaben eine Cytologie des weiblichen Genitaltractus und eine Abhandlung iiber das Portiocarcinom in seinen Vor-und Friihstadien. Mit dem Erscheinen des Bandes VII/4 des Handbuches der speziellen patholo- gischen Anatomie und Histologie ist der urspriingliche Plan vollendet und ab- geschlossen. Es ist damit der Zeitpunkt gekommen, nochmals auf die Anfange dieses groBartigen Verlagswerkes zuriickzublicken, als F. HENKE und O. LUBARSCH die Gestaltung des Handbuches plant en und Dr. F. SPRINGER die Verlegung des Werkes iibernahm. Dariiber hinaus sind wir Prof. E. ROESSLE zu Dank verpflichtet, der das noch unvollendete Werk entscheidend gefordert und gepragt hat. Ohne seinen verpflichtenden Willen ware es nie zur Vollendung dieses umfassenden inhaltreichen Handbuches gekommen.
Although the purpose and scope of this monograph remain unchanged, I have been obliged to revise and rewrite many sections to keep pace with the recent growth in knowledge of endometrial pathology and physiology. New knowledge emanates from every quarter, engendered by improved meth ods of study in virtually every subspecialty, by exemplary cooperation between disciplines, and especially by the exchange of ideas internationally. On the other hand, the catalogue of diseases is everchanging. Some, once common, become rare or even disappear. Others suddenly appear, unique and previously unknown. Increased longevity, modern ways of living and new methods of treat ment have modified or augmented the clinical and diagnostic problems confront ing us. Accordingly, therapy with hormones and intrauterine contraception re ceive special attention, commensurate with the importance afforded them today. Under the precept "nil nocere," the almost unlimited uses for these agents warrant that their effects be carefully monitored by precise morphological stud ies, a prerequisite that succeeds only when clinician and pathologist cooperate closely. The sections on procedures for obtaining endometrial tissue, on steroid receptors, on functional disturbances, and on spontaneous abortion have been changed or expanded to incorporate new facts from recent discoveries that now appear significant. Only time, however, will prove their true value. Much of historical interest in the text has been left intact, for "who wants to read into the future, must consult the past" (Andre Malraux).
In gynecological practice, techniques of examination are being supple- mented more and more by cytodiagnosis. Thus it has become necessary to acquaint the gynecologist of the possibilities, use and Iimits of cyto- diagnosis. Such is the purpose of the book "Gynakologische Cytologie" (Stall, Jaeger, Dallenbach, Springer-Verlag 1968). In general, the practicing gynecologist will merely make the vaginal, ecto-and endocervical smears and leave the diagnosis of them to a cyto- logical laboratory. Only in rare cases will a trained and experienced specialist set up his own cytologicallaboratory for outpatients, although such undertaking would be very desirable for propagating the cyto- logical method. The cytological analysis of unstained fresh smears during the gyne- cological examination allows an immediate study to be made of micro- f!ora and cellular atypia. F or such cytological studies microscopes are employed in which a high-cantrast image of the specimen is obtained by optical means (phase-contrast and interference-contrast microscopy), thereby eliminating the need for fixation and staining. In the nineteen-thirties the Dutch physicist Zernike investigated the formation of high-cantrast images of transparent objects by modifying the path of light. In 1941, his ideas were put into practice by the firm of Carl Zeiss, Jena. Zernike received the Nobel Prize for physics in 1953. The method he had developed proved of great value in biology and in medicine, above all for the examination of living objects. It was intro- duced into gynecology by Runge, Voege, Haselmann and Zinser in 1949.
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