Atlas of Colposcopy: Principles and Practice

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Early and advanced cancers / Squamous cell cancer  Go back to the list


  • Age: 50
  • HPV status: Positive

  • After normal saline

    After normal saline with green filter

    After acetic acid

    Visualization of the SCJ

    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)


    Suspicious for invasion

    Miscellaneous finding

    Swede score:

    Swede score
    Aceto uptake
    Nil or transparentThin, milkyDistinct, stearin
    Nil or diffuseSharp but irregular, jagged, satellitesSharp and even, difference in level
    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; suspicion of invasive cancer likely to be squamous in nature.
    Management: Punch biopsy and endocervical curettage.
    Histopathology: Invasive squamous cell carcinoma.
    Comment: This case highlights the importance of endocervical assessment if the squamocolumnar junction is not fully visualized. The ectocervical lesion appeared as HSIL, and the cancer was confined to the canal.

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