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 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: 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.