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Abnormal colposcopic findings
General principles
All parts of vagina must be examined:
- upper third /lower 2 thirds
- anterior/posterior/lateral (right or left)
All four walls of the vagina starting from vaults, down to the introitus should be examined. Speculum must be completely opened and rotated 360 degrees, especially if vaginal folds are prominent.
Abnormal (neoplastic) epitheium, which is undifferentiated retains high content of proteins and does not contain glycogen. This is why it remains white after the application of both Acetic acid and Iodine solution. Schiller's test is more valuable when examining vagina because neoplastic epithelium remains unstained.
Although colposcopic changes observed in the vagina are basically the same as those that can be seen on the cervix (AW epithelium, mosaic, punctuation, leukoplakia and atypical blood vessels), there are some differences. Colposcopic grade of vaginal lesions is usually slightly higher (changes look more severe) than for cervical intraepithelial neoplasia same degrees.
Grade 1 (Minor)
Thin aceto-white epithelium
Fine punctuation
Fine mosaic
Grade 2 (Major)
Dense aceto-white epithelium
Coarse punctuation
Coarse mosaic
Before the application of acetic acid, fields of Vaginal intraepithelial neoplasia (VAIN) are slightly raised, sometimes granular, pink or white lesions with sharp borders, typically localized at vaginal vaults or along the periphery of the cervix. Due to the loose nature of the vaginal mucosa, shape and limits of lesions are irregular, which sometimes makes diagnosis very difficult.
Aceto-white epithelium is less opaque than on the cervix and the lesion that corresponds to a higher degree of dysplasia can be estimated as finding of much less severity. Vascular forms, however, are more prominent on the vaginal epithelium and can can be seen as a coarse punctuation with atypical features. Rarely, almost never, a mosaic pattern is found. Changes are characteristically Iodine negative. The application Lugol's solution is the most important part of the examination, because the changes that correspond VAIN are usually bright yellow colored and their sharp borders are highlighted.
Suspicious for invasion
Atypical vessels
Additional signs: Fragile vessels, Irregular surface, Exophytic lesion, Necrosis, Ulceration (necrotic), tumor/gross neoplasm
Non-specific
Columnar epithelium (adenosis)
Lesion staining by Lugol's solution (Schiller's test): Stained/non-stained,
Leukoplakia
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