Miscellanous colposcopic findings

1. ABOUBAKR ELNASHAR
BENHA UNIVERSITY, EGYPT
AHOUBAKR ELNASHAR

2. 1. Cevicovaginitis
I.Red punctate vaginitis:
Over a pale pink background, some red dots are
seen which extends diffusely. The red spots are
iodine negative. Tricomonas vaginalis in 50% of
cases
ii.White punctuate vaginitis:
white dots on hyperaemic mucosa. Fungus in
95% of cases.
AHOUBAKR ELNASHAR

3. AHOUBAKR ELNASHAR

4. iii. Focal vaginitis:
Some red spots or stains & in between unchanged
mucosa with increased vascularity.
Tricomonas vaginalis in 98% of cases
iv. Follicular cervicitis:
Creamy white, raised, rounded swellings under
ectopic columnar epithelium & immature metaplastic
squamous epithelium. Acetic acid test or Schiller
iodine test do not change the picture.
It is associated with chlamydia infection
v. Atrophic vaginitis:
Red spots on atrophic mucosa.
AHOUBAKR ELNASHAR

5. 2. Atrophy
The mucosa is pale, smooth, dry, thin
,squamocolumnar junction may disappear in the
cervical canal.
Fine network of capillaries. Iodine test is negative
(devoid of glycogen)
AHOUBAKR ELNASHAR

6. AHOUBAKR ELNASHAR

7. 3. Polyps
i. Mucous polyps:
small, pink & relatively smooth surface, upon which
it is possible to observe the fissures of the normal
endocervical tissue.
After acetic acid, it becomes paler. If there is
metaplasis, with acetic acid whitish zones appear.
AHOUBAKR ELNASHAR

8. ii. Adenomatous polyp:
colposcopic picture is quite similar to that of ectopy
iii.Fibrous polyp:
Larger with firmer consistency, surface is smooth,
purple with frequent petichae, necrotic zones
AHOUBAKR ELNASHAR

9. AHOUBAKR ELNASHAR

10. 4. Papilloma
is exocervical polyps
It is most frequently seen during pregnancy. They
may have the appearance of columnar epithelium
with a much more clearly visible central capillary
network. Each papilla is long.
It is often multifocal.
After actic acid, the vessels in papilloma usually
completely disappear.
AHOUBAKR ELNASHAR

11. 5. True erosion
denuded epithelium.
Loss of epithelium is followed by formation of
granulation tissue & subsequent epithelization with
abundance of newly formed capillaries.
It is bright red with so rich vascularization.
AHOUBAKR ELNASHAR

12. 6. Update of colposcopy of genital HPV
Meisels et al (1982):
Florid,
spiked,
flat,
condylomatous vaginitis.
Flat condyloma & mild dysplasia represent the same
biologic phenomenon, namely, productive HPV
infection (Reid,1993).
The expression of viral activity may be clinical or
subclinical when it is recognizable only on
colposcopy.
AHOUBAKR ELNASHAR

13. Exophytic & flat condylomata are not homologous
diseases.
Exophytic is usually caused by cutaneotropic viruses
(6,11).
Flat are more likely to contain
medium (31,33) or
high risk (16,18) HPV types.
Micropapillary condyloma should not be confused
with micropapillomatous labialis.
AHOUBAKR ELNASHAR