Atlas of Colposcopy: Principles and Practice / Activity 6

Case

Early and advanced cancers / Squamous cell cancer
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Age: 54
HPV status: Positive

After normal saline

After acetic acid

Visualization of the SCJ

After acetic acid with green filter

After Lugol’s iodine

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: 10

Case Summary
Provisional diagnosis: Type 3 transformation zone; suspicion of early invasive squamous cell carcinoma.
Management: Multiple punch biopsies.
Histopathology: Squamous cell carcinoma.
Comment: Such extensive lesions with vascular abnormalities should be considered invasive disease. The central part of the transformation zone may be excised with a loop to ensure adequate biopsy material for histopathology. Alternatively, a diagnostic excision can be done by LLETZ or cold-knife conization.

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 3 transformation zone; suspicion of early invasive squamous cell carcinoma.
Management:	Multiple punch biopsies.
Histopathology:	Squamous cell carcinoma.
Comment:	Such extensive lesions with vascular abnormalities should be considered invasive disease. The central part of the transformation zone may be excised with a loop to ensure adequate biopsy material for histopathology. Alternatively, a diagnostic excision can be done by LLETZ or cold-knife conization.