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Speculum examination |
After normal saline with green filter |
After acetic acid |
After acetic acid with green filter |
After Lugol’s iodine |
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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 2 transformation zone; high-grade squamous intraepithelial lesion (HSIL). |
Management: | LLETZ (type 2 excision). |
Histopathology: | HSIL-CIN3. |
Comment: | At times it is difficult to differentiate between atypical vessels and prominent vessels, especially on an acetowhite lesion. In this case, although some of the vessels look atypical, the overall picture does not suggest invasive cancer. |
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