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THE CERVIX: Colposcopy: Colposcopic appearance of malignant lesions
The most important goal of the colposcopist is to rule out the presence invasive disease. More advanced disease is often accompanied by a history of menorrhagia or other types of abnormal bleeding. Early invasive disease is commonly asymptomatic, and colposcopy allows diagnostic at a potentially curable stage.
SQUAMOUS LESIONS
Early squamous cancer of the cervix usually presents as very thick white epithelium (either acetowhite or leukoplakia) with uneven density, giving the appearance of piling of thick keratotic layers upon each other. The surface is, therefore, irregular but the borders tend to be sharply defined. In some cases, subtle ulceration can be the only feature present, and may be missed by the inexperienced examiner. Invasive cancer should be suspected in the presence of multiquadrant, high grade disease with extension into the endocervical canal. Areas of coarse punctuation and mosaicism are usually visible in the periphery of the thick, white, “mountain range”-like epithelium. Atypical vessels, which are highly variable in caliber and form, are the hallmark of invasive neovascularization. Not infrequently, hemorrhagic changes and easy contact bleeding are found. Later stages of cervical cancer defy the need for colposcopy, as large, ulcerated lesions are visible without magnification. A punch biopsy of the periphery of the lesion rather than any ulcerated portion becomes instrumental for pathological diagnosis. |
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1: Early Invasive Squamous Cell Carcinoma
2: Advanced Squamous Cancer
3: Microinvasive Cancer
4: Invasive Cervical Cancer
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GLANDULAR LESIONS
The diagnosis of adenocarcinoma in situ or early invasive adenocarcinoma of the cervix is one of the most challenging aspects of colposcopy. The colposcopic findings are often subtle and nonspecific for entities that are clinically infrequent. The stark acetowhiteness of fused, irregular heaps of glandular villi can be seen in the transformation zone and maybe surrounded by completely normal glandular epithelia. Glandular neoplasia is often accompanied by high grade squamous dysplastic lesions. The vascular patterns are usually less striking than in squamous dysplasia or early cancer. Some describe the vascular changes associated with glandular dyplasias as “tendril-like”.
Adenocarcinoma in situ |
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