Atlas of Colposcopy: Principles and Practice / Activity 6

Case

High grade / CIN2 / CIN3
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Age: 53
HPV status: Positive

After normal saline with green filter

After acetic acid

Examination of endocervix

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: 9

Case Summary
Provisional diagnosis: Type 2 transformation zone; high-grade squamous intraepithelial lesion (HSIL).
Management: LLETZ (type 2 excision).
Histopathology: HSIL-CIN3.
Comment: LLETZ is necessary to exclude invasive cancer. A ring pessary was inserted immediately after LLETZ to avoid exposure of the raw area to mechanical trauma and bleeding. The Ward–Mayo operation (vaginal hysterectomy with repair of pelvic floor) was performed after the histopathology report was received.

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; high-grade squamous intraepithelial lesion (HSIL).
Management:	LLETZ (type 2 excision).
Histopathology:	HSIL-CIN3.
Comment:	LLETZ is necessary to exclude invasive cancer. A ring pessary was inserted immediately after LLETZ to avoid exposure of the raw area to mechanical trauma and bleeding. The Ward–Mayo operation (vaginal hysterectomy with repair of pelvic floor) was performed after the histopathology report was received.