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Atlas of Colposcopy: Principles and Practice

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High grade / CIN2 / CIN3  Go back to the list



  

  • Age: 60
  • HPV status: Positive


  • Vulva before acetic acid

    Vulva after acetic acid

    After acetic acid with green filter

    After acetic acid with green filter

    After acetic acid with green filter

    Colposcopy report (2011 IFCPC nomenclature):


    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, vagina, and vulva.
      
    Management: LLETZ (type 3 excision) biopsies for vaginal and vulval lesions.
      
    Histopathology: Cervical histopathology was invasive squamous cell cancer, vaginal histopathology was HSIL-VAIN 3, and vulvar histopathology was HSIL-VIN 3.
    Comment: Multifocal neoplasias may be seen in the lower genital tract. The patient had a radical abdominal hysterectomy with bilateral pelvic lymphadenectomy and simple vulvectomy.


      
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