Atlas of Colposcopy: Principles and Practice / Activity 6

Case



Early and advanced cancers / Squamous cell cancer
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  • Age: 60
  • HPV status: Positive


  • Speculum examination

    After normal saline

    After acetic acid

    After acetic acid with green filter

    After acetic acid with green filter

    Colposcopy report (2011 IFCPC nomenclature):

    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 transparentThin, milkyDistinct, stearin
    Margins
    Nil or diffuseSharp but irregular, jagged, satellitesSharp and even, difference in level
    Vessels
    Fine, regularAbsentCoarse or atypical vessels
    Lesion size
    < 5 mm5-15 mm or 2 quadrants>15 mm, 3-4 quadrants, or endocervically undefined
    Iodine uptake
    BrownFaintly or patchy yellowDistinctly yellow
    Final Swede score: Not possible (Iodine uptake missing)



    Case Summary
    Provisional diagnosis: Type 3 transformation zone; suspicion of invasive cancer.
    Management: Multiple punch biopsies.
    Histopathology: Squamous cell carcinoma.
    Comment: The lesion is suspicious of invasive cancer because of its large size covering the entire cervix and extensive coarse mosaics and punctations. If invasive disease was not diagnosed on punch biopsies, diagnostic excision by LLETZ or cold-knife conization would have been necessary.