What Are Abnormal Colposcopy Findings?

  1. Hyperkeratosis or Leukoplakia: They are white lesions observe in cervix without applying acetic acid. Especially observing them young ages refers to HPV infection.

In fact leukoplakia is thickening of surface epithelium emerging depending on trauma of cervix. However, if the patient is young, HPV infection must always be considered. Leukoplakia may hide an underlying malignancy although it is a good sense of formation. Therefore it should be evaluated carefully.

  1. Acetowhite epithelium: It is used for identifying emerging structure in cervix as the problematic region is painted white, when 3-5% acetic acid is applied. Acetowhite epithelium is basically observed s a result of abnormal inner-cell ceratine and increased cellular and core intensity.
  2. 3. Vascular Changes: a. Punctuation (Thin or Rough)( Rough punctuation is frequently observed in CIN II or III lesions)b. Mosaicism (Thin or Rough)
You may see these lesions more prominently in the outstanding image above and near in the image taken during colposcopy.

Both findings identify excessive production of capillary vessels in cervix.

Cells start to reproduce abnormally and especially to force capillary vessels as of CIN I in cervix. In this case, point vessel mouths are started to be observed on the surface. Cells excessively increase and force on the vessels reach advanced stage in CIN III or situ cancer level. Therefore clearer but rough point structures (Rough Punctuation) are observed within acetowhite epithelium or without epithelium in cervix.

Mosaicism has similar etiology just like punctuation. Mosaic appearance identifies, I don’t if this is the place, but the structures emerging as a result of surrounding cervical tissues, which develop from “hairpin” capillary, excessively reproduce, by these vessels. It has typically paving stone view. It demonstrates itself as distributed areas with vessels.

  1. Atypical Vascularization: Tumor cells consume oxygen and energy excessively. They start a process of abnormal vessel increase, which we call angiogenesis, in order to feed, to maintain this fast metabolism. This colposcopic appearance is called “atypical vascularization”.

This case may be the earliest and typical finding of tumoral development. Atypical vascularization depending on tumoral development is mixed up. It is observed as very messy.

  1. 5. Condyloma or papillomas
Below you see image of the wart on the cervix painted in white by acetic acid.

What Do We Pay Attention For During Colposcopy?

Regions getting white by the effect of acetic acid [6] and abnormal vessel images are the regions we are interested the most. The patient frequently wonders about visually “bad” regions more as she watches from the screen while we are performing colposcopy, but basically important thing is the areas we talk about.

She is evaluated in terms of abnormal vascularization characteristics such as point, mosaic or abnormal appearance vessels after white epithelium areas. Green filter examination method is used to strengthen the image of the abnormal vessel structure. Green or blue filters darken the color of the vessels, and increase color difference between the vessel and epithelium around it. Presence of point and mosaic pattern vessels in white area region in transformation zone refers to CIN, low stage or high stage.

Abnormal vessels with increased diameter, demonstrating abnormal and excessive changes, spread to wide area, in the shape of spin, comma, hairpin may refer to micro invasive or invasive tumor. What you should know is that even though colposcopyst notes these images, accurate diagnosis may only be finalized as a result of pathologic investigation of the tissue, of which the biopsy is received.

Although many systems categorizing the findings to establish parallelism between abnormal colposcopy findings and the degree of the disease in the tissue are offered, reliability of them is not proved yet [7]. In other words, colposcopy finding is NOT definite indicator of cancer.

Ulcerated areas or corroded regions may depend on trauma, infection or cancer. Similarly, epithelium folded over and over may represent an active tissue reproducing as cancer or wart.

Upper one third part of the vagina, especially near dead-end regions is investigated. Transformation zone and squamocolumnar junction may expand to upper vagina especially in young patients. Adenosis, polypes, cysts, warts, cancer precursors and cancer indicative changes are abnormal vagina findings.

If no lesion is observed, diluted Lugol or Schiller solution may be applied to vagina or cervix in order to aid determination of lesion. Lugol iodine 100 ml pure water includes 5 g iodine and 10 g potassium [8]. Absorption of the paint given in the same way in every side verifies the opinion of the physician performing colposcopy that there is no lesion.

Normal cells including glicogen shall absorb iodine and shall be dark brown. Normal columnar, in other words gland cylindrical cells, high stage lesions and mostly low stage lesions shall not absorb iodine and they shall keep light yellow color. Because tumoral tissue consumes glycogen very fast. Therefore it has light color. In this way, they may easily be distinguished from normal tissue on the purpose of sampling and treatment. However, it is not a routine application and it is applied in case colposcopy specialist has suspicions.

29 Temmuz 2016 tarihinde Prof. Dr. Süleyman Engin Akhan tarafından yayınlanmış ve 08 Eylül 2023 tarihinde de son güncelleme yapılmıştır.


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