Case |
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Speculum examination |
After normal saline |
After normal saline with green filter |
After acetic acid |
After acetic acid |
After acetic acid with higher magnification |
After acetic acid |
After Lugol’s iodine |
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Nil or transparent | Thin, milky | Distinct, stearin | |
Nil or diffuse | Sharp but irregular, jagged, satellites | Sharp and even, difference in level | |
Fine, regular | Absent | Coarse or atypical vessels | |
< 5 mm | 5-15 mm or 2 quadrants | >15 mm, 3-4 quadrants, or endocervically undefined | |
Brown | Faintly or patchy yellow | Distinctly yellow |
Provisional diagnosis: | Type 1 transformation zone; high-grade squamous intraepithelial lesion (HSIL) in pregnancy. |
Management: | Multiple punch biopsies obtained from the posterior lip and also from the extension of the lesion to the vaginal wall. |
Histopathology: | HSIL-CIN3. |
Comment: | The posterior lip had a large high-grade lesion that extended to the vagina. Biopsies were obtained to exclude invasive cancer. The anterior lip had a thin acetowhite area with indistinct margin that suggests metaplastic changes. The patient had LLETZ 2 months after normal delivery. The lesion was less extensive at that time. Sometimes apparently high-grade lesions in pregnancy may resolve completely after delivery. A repeat colposcopy 2–3 months after delivery is essential before making any decision about treatment. |
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