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The Pathologist’s Perspective




Good pathology is crucial to the management of vulvovaginal disease, but how is good pathology obtained? There are two clinical situations in which a tissue sample is sent for pathology: rashes and discrete lesions. Rashes are sent for accurate pathological diagnosis, but lesions require in addition to confirmation of clinical diagnosis, the pathological assessment of prognostic factors and margins. This eChapter describes both approaches in detail, including biopsy techniques, and tips on how to read and understand a pathologist’s report.

The eChapter begins by considering three critical components that ultimately influence the pathologist’s contribution to the diagnosis of vulvovaginal disease: the clinical history and diagnosis, the site of the biopsy, and the type of biopsy. Biopsy techniques are described for maculpapular rashes, erosive or ulcerative rashes and discrete lesions, and illustrations are provided. The next section outlines the contents of a typical pathologist’s report, including an interesting explication of how pathologists work by pattern recognition. The limitations of pathological diagnosis are then discussed, using the context of specific diseases such as psoriasis, fungal infections and non-infectious inflammatory disoreders to illustrate the key concepts of the section. The author then begins an extended discussion on the importance of communication between the clinician and the pathologist, and provides guidance on the avoidance of confusion with pathological terms, with specific examples such as squamous cell hyperplasia given to illustrate the problem. The chapter concludes with an explanation of the dermatological classification system.

This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vaginal Manual is an invaluable resource especially suitable for:

  • Gynecologists
  • Dermatologists
  • General Practitioners
  • Obstetricians
  • Midwives
  • General nurses
  • Practice nurses
  • Nurse Practitioners

There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.


Contents include

  • The importance of clinical history and diagnosis
  • Biopsy sites and types of biopsy
  • Biopsy techniques for Maculopapular, erosive and ulcerative rashes and discrete lesions
  • How to read a pathologist’s report
  • Communication between the pathologist and the clinician: avoiding confusion
  • How pathological findings are classified.
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Author / Editor Biographies

MBBS and FACD.
John Brenan is a dermatologist practicing in Melbourne. He is a past President of the Australian College of Dermatology, consultant dermatologist to the Mercy Hospital for Women and the original dermatologist for the Dermogynaecology Clinic.
MBChB, MMed, PhD, FCOG (SA), FRANZCOG and CGO.
David Allen is a certified gynaecological oncologist practicing at the Mercy Hospital for Women and the Peter MacCallum Cancer Centre, East Melbourne. He is an Associate Professor in the Department of Surgery at the University of Melbourne.
MBBS and FRCPA.
James Scurry is one of Australia's leading gynaecological pathologists. He is a pathologist in Newcastle, New South Wales.
RFD, MBBS, FRCOG (UK) and FRANZCOG
Dr Dennerstein is an Obstetrician and Gynaecologist with medical expertise in the health of the vulva and vagina. He is the former Head of the Dermo-gynaecology Clinic at The Mercy Hospital for Women and co-author of the book entitled: The Vulva and Vagina Manual. He has lectured extensively on this topic, both internationally and nationally. Graeme has extensive experience in family planning and reproductive health. In 1971 he established the Family Planning and Infertility Clinic at the Western General Hospital in Melbourne, serving as its director until 1986. From 1980 to 1989 he was the ...
MAPS
Grazia Marin is a psychologist in private practice in Melbourne and past committee member and Education Officer of the Victorian Psychosexual Society. She is also a member of the International Society for the Study of Vulvovaginal Diseases and is serving on its Patient Education and Sexual Difficulties committees.

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