Atlas of Colposcopy: Principles and Practice / Activity 6

Case



High grade / CIN2 / CIN3
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  • Age: 60
  • HPV status: Positive


  • Speculum examination

    After normal saline

    After acetic acid

    After acetic acid with green filter

    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: Not possible (Iodine uptake missing)



    Case Summary
    Provisional diagnosis: Type 3 transformation zone; high-grade squamous intraepithelial lesion (HSIL) of the cervix extending to the vagina.
    Management: LLETZ (type 3 excision) with laser ablation of the residual vaginal lesion.
    Histopathology: HSIL-CIN3.
    Comment: CIN3 lesions may extend to the vagina, especially in elderly women. In such cases, LLETZ is crucial to exclude invasive focus, especially inside the endocervical canal. Hysterectomy with removal of adequate vaginal cuff may be performed after excluding invasive cancer by LLETZ.