Atlas of Colposcopy: Principles and Practice

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Normal / Atrophy
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  • Age: 56
  • HPV status: Negative

  • Speculum examination

    After normal saline

    After normal saline with green filter

    After acetic acid

    Examination with endocervical speculum

    Visualization of the SCJ

    Colposcopy report (2011 IFCPC nomenclature):
    / Post-treatment consequence / Endometriosis

    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 2 transformation zone; normal cervix with atrophic change.
    Management: No further screening is required.
    Histopathology: Not done.
    Comment: The shallow fornix, pale colour of the epithelium, and squamocolumnar junction inside the canal indicate atrophic change. Petechial spots due to sub epithelial haemorrhage are more commonly seen in an atrophic cervix. Petechial spots should not be confused with coarse punctations. Petechial spots are flat, are of variable size, and can occur anywhere on the cervical and vaginal epithelium. Coarse punctations are always seen in the background of dense acetowhite epithelium and may be raised from the surface.

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