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Adenocarcinoma in Situ
Kenneth D. Hatch, MD

This case report illustrates the colposcopic and histologic findings of human papilloma virus (HPV) and cervical intraepithelial neoplasia (CIN). The patient is a 27-year-old woman whose cytology was reported as atypical squamous cells, cannot rule out high grade neoplasia (ASC-H).

The patient had the following colposcopic findings:

	Figure 1. Taken after acetic acid has been applied. The HPV lesion is seen as a faint white epithelium with irregular borders and a lace-like mosaic pattern. It is located peripherally on the cervix. As the colposcopist looks centrally toward the cervical os the lesion changes and a new border is seen. This lesion is raised with smooth borders, a mosaic pattern that has larger vessels, and thicker white epithelium.
	Figure 2. Taken after Lugol solution has been applied. The peripheral HPV lesion has a partial uptake described as “mottled”. The central lesion rejects the Lugol (Lugol-negative) and the raised smooth borders are easily seen. Biopsies were taken from this area.
	Figure 3. H istologic view of the loop electrosurgical excision procedure (LEEP) specimen. The normal epithelium is seen suddenly transitioning into CIN II and III. When performing colposcopy on a patient who has an obvious HPV lesion on the cervix or vagina, the colposcopist should expect the more severe cervical lesion to be in contact with the squamocolumnar junction; it will be more centrally located than the HPV lesion.

 

After the LEEP, this patient had negative HPV and cytology at 4 months.