APGO Educational Objectives: 

Rationale: As with many malignancies, detection of the preinvasive lesion reduces the mortality associated with carcinoma of the cervix. An understanding of the approach to the patient with the cervical lesion is important for all physicians. The student will demonstrate a knowledge of the:

  1. symptoms and physical findings of cervicitis and neoplasia
  2. approach to the patient with an abnormal pap smear
  3. histologic categories
  4. risk factors
  5. course of cervical neoplastic disease including common complications.

 

 

 

 

 

 

 

 



Recommended Reading Assignment: 

  1. Abnormal Pap, Chapter 44 in Obstetrics and Gynecology, 3rd Edition, Beckmann, et al, pp. 512-529, 1998

 

 

 

 

 

 

 



Questions:

  1. Could you identify the clinical facts from the history that maybe etiologic factors for the diagnosis of cervical neoplasia? What additional historical items could be elicited from this patient that may be contributory to the potential diagnosis of cervical neoplasia?
  2. What physical findings in this patient are suspicious for rendering a diagnosis of cervical neoplasia? What are the limitations of diagnosis using a pap smear for the identification of cervical disease?

A colposcopy is performed. A satisfactory exam is obtained. Aceto white lesions are without atypical vessels and are noted at the squamocolumnar junction in focal areas at the 2 o'clock, 3 o'clock and 8 o'clock. The 2 o'clock and 3 o'clock biopsies come back as chronic cervicitis with evidence of mild dysplasia ie., CIN I. The 8 o'clock biopsy comes back with high grade squamous intraepithelial lesions diagnosed as CIN II.

  1. What is known about clinical course of outcome for each of these lesions given there diagnosis?
  2. What are the options for treatment of this patient and how might they be related to the patients desire for future child birth?

The patient elects for a LEEP procedure (Loop electro surgical excision procedure) of the cervix. This is performed without complication. The pathology reports states that a squamous intraepithelial lesion high grade ie. CIN II was excised with other multifocal areas of mild dysplasia, however; at the margin of the specimen CIN II dysplasia was noted to be present.

  1. How would you choose to follow-up on this patient?