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Speculum examination |
After normal saline |
After acetic acid |
Examination with endocervical speculum |
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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; high-grade squamous intraepithelial lesion (HSIL). |
Management: | LLETZ (type 3 excision). |
Histopathology: | HSIL-CIN2. |
Comment: | Obtaining a punch biopsy in such a case is quite difficult and unreliable. LLETZ based on colposcopy findings (“see and treat”) is both diagnostic and therapeutic in this case. |
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