Case |
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Speculum examination |
After normal saline |
After acetic acid |
After acetic acid |
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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 3 transformation zone; leukoplakia. |
Management: | Multiple punch biopsies. |
Histopathology: | HSIL-CIN3. |
Comment: | In this case, no evidence of high-grade lesion was seen except leukoplakia. Sometimes punch biopsies may not be satisfactory in the presence of leukoplakia. Biopsy with a loop or LLETZ in advised if there is high suspicion of high-grade lesion. |
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