Diagnosing adenocarcinoma in situ (AIS) and adenocarcinoma
Normal columnar epithelium becomes temporarily white after application of acetic acid. If the acetowhiteness persists and is dense in intensity, glandular lesions should be suspected. The lesion extends into the endocervical canal. There may be abnormal blood vessels on the lesion. The villi of the columnar epithelium become fused to each other.
In adenocarcinoma in situ (AIS) or adenocarcinoma, multiple dense acetowhite areas are typically seen on the columnar epithelium. The columnar epithelium appears as if grated coconut has been sprinkled on it.
Adenocarcinoma is suspected if the dense acetowhite area is on the columnar epithelium, has an irregular surface, and has abnormal blood vessels. The atypical blood vessels of adenocarcinoma are often parallel to each other. However, it is important to note that it is difficult and often unnecessary to perform colposcopy of the endocervix. If the cytology suggests a glandular lesion, especially if it is persistent, then a diagnostic procedure, such as a cone biopsy, will need to be performed.