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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

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  • Case: 92

  • Age: 46

  • Before application of acetic acid: Multiple shiny white raised lesions are seen close to the external os and also on the posterior lip. Note the bright white colour of the lesions. This is typical of cervical condylomata.

  • Cervix before application of acetic acid:  
  •  Infective vaginal discharge:   
    Strawberry appearance of cervix
    Bleeding on contact
    White patch

    After application of acetic acid: The white lesions with raised margins are still visible, and most of them are outside the TZ. They are located away from the SCJ. Some acetowhite patches are also seen on the external os.

  • Cervix after application of acetic acid:
    • Squamocolumnar junction visibility:  
    • Squamocolumnar junction location:  
    • Acetowhite area:  
      • If present, description of acetowhite area:
        • Colour:  
        • Margin:  
        • Surface:  
        • Location:  
        • Size:  

  • VIA category:  

  • After application of Lugolís iodine: The lesions do not stain with Lugolís iodine.

  • Determined eligibility for ablative treatment:  

  • Histopathology: LSIL-HPV changes

  • Remarks: Shiny white lesions with raised margins visible before application of acetic acid are characteristic of cervical condylomata, caused by infection with low-risk HPV types. These are benign lesions and do not have any malignant potential. In this case, the lesions are present before application of acetic acid, they are located away from the SCJ, and no new patches are seen after application of acetic acid. Therefore, the cervix has been categorized as VIA-negative. Condylomata appear intensely greyish-white after the application of acetic acid. When condyloma are touching the SCJ, the report is VIA positive. In this case, there are some lesions at the external os also and there could be a lesion below the benign lesions.


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