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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: 166

  • Age: 28

  • Before application of acetic acid: SCJ fully visible. A white patch (leucoplakia) seen on the anterior lip of cervix.

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

    After application of acetic acid: Leucoplakia has become densely white. The margin is elevated. This acetowhite areas at 8 o’clock and 10 o’clock positions.

  • 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 Lugol’s iodine: Patchy iodine uptake on the leucoplakia. Thin acetowhite areas also show partial iodine uptake.

  • Determined eligibility for ablative treatment:  

  • Histopathology: Not done

  • Remarks: This is a case of condyloma with possibly an associated low grade lesion at 8 o’clock and 10 o’clock positions. The condyloma is visible as a white patch even before applying acetic acid (leucoplakia). The lesion becomes densely white after application of acetic acid with a sharp raised margin and looks very similar to a high grade lesion. The features that are suggestive of condyloma are the fresh white colour and the ‘pitted’ appearance of the surface. Please note that the crisscross surface pattern is not ‘mosaic’ that is caused by the blood vessels. However, such lesions should always be considered as VIA positive, if present on the transformation zone. Note the thin acetowhite areas adjacent to the condyloma. The thin acetowhite area has well defined smooth margin and is most likely due to CIN1.


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