Atlas of Colposcopy: Principles and Practice / Activity 6

Case

Normal / Atrophy
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Age: 56
HPV status: Negative

Speculum examination

After normal saline

After normal saline with green filter

After acetic acid

Examination with endocervical speculum

Visualization of the SCJ

Colposcopy report (2011 IFCPC nomenclature):
/ Post-treatment consequence / Endometriosis

General assessment
Adequacy:

Squamocolumnar junction visibility:

Transformation zone:

Normal colposcopic findings
Original squamous epithelium:

Columnar epithelium:

Metaplastic squamous epithelium:

Deciduosis in pregnancy:

Abnormal colposcopic findings
General principles
Position and size

Location of the lesion:

Location of the lesion by clock position:
No. of quadrants:

% of cervix:

Grade 1 (minor)

Grade 2 (major)

Non-specific

Suspicious for invasion

Miscellaneous finding

Swede score:

Swede score 0 1 2
Aceto uptake Nil or transparent Thin, milky Distinct, stearin
Margins Nil or diffuse Sharp but irregular, jagged, satellites Sharp and even, difference in level
Vessels Fine, regular Absent Coarse or atypical vessels
Lesion size < 5 mm 5-15 mm or 2 quadrants >15 mm, 3-4 quadrants, or endocervically undefined
Iodine uptake Brown Faintly or patchy yellow Distinctly yellow
Final Swede score: Not possible (Iodine uptake missing)

Case Summary
Provisional diagnosis: Type 2 transformation zone; normal cervix with atrophic change.
Management: No further screening is required.
Histopathology: Not done.
Comment: The shallow fornix, pale colour of the epithelium, and squamocolumnar junction inside the canal indicate atrophic change. Petechial spots due to sub epithelial haemorrhage are more commonly seen in an atrophic cervix. Petechial spots should not be confused with coarse punctations. Petechial spots are flat, are of variable size, and can occur anywhere on the cervical and vaginal epithelium. Coarse punctations are always seen in the background of dense acetowhite epithelium and may be raised from the surface.

Swede score	0	1	2
Aceto uptake	Nil or transparent	Thin, milky	Distinct, stearin
Margins	Nil or diffuse	Sharp but irregular, jagged, satellites	Sharp and even, difference in level
Vessels	Fine, regular	Absent	Coarse or atypical vessels
Lesion size	< 5 mm	5-15 mm or 2 quadrants	>15 mm, 3-4 quadrants, or endocervically undefined
Iodine uptake	Brown	Faintly or patchy yellow	Distinctly yellow

Provisional diagnosis:	Type 2 transformation zone; normal cervix with atrophic change.
Management:	No further screening is required.
Histopathology:	Not done.
Comment:	The shallow fornix, pale colour of the epithelium, and squamocolumnar junction inside the canal indicate atrophic change. Petechial spots due to sub epithelial haemorrhage are more commonly seen in an atrophic cervix. Petechial spots should not be confused with coarse punctations. Petechial spots are flat, are of variable size, and can occur anywhere on the cervical and vaginal epithelium. Coarse punctations are always seen in the background of dense acetowhite epithelium and may be raised from the surface.