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Atlas of Colposcopy: Principles and Practice

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  • Age: 35
  • HPV status: Negative


  • Speculum examination

    After normal saline

    After acetic acid

    After acetic acid

    After acetic acid

    Examination of the vagina

    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 1 transformation zone; subclinical papillomavirus infection (SPI).
      
    Management: Considering the extensive lesion, multiple biopsies should be taken to rule out CIN. No treatment is required for SPI. The woman should be screened after 5 years.
      
    Histopathology: LSIL-HPV changes.
    Comment: Case of extensive SPI. The presence of the lesion away from the transformation zone, fresh white colour, shiny pilled surface, raised border, and satellite lesions help in diagnosis.


      
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