Twenty-first refresher course. Chan Kit Sheung
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1 Twenty-first refresher course Chan Kit Sheung
2 Case 1
3 Case 1, 29y old, G3P2, referred from MCHC Cervical smear on : LGSIL, defaulted appointment Cervical smear in 12/2014: negative
4 Colposcopy impression: HPV changes Cervical biopsy: condyloma
5 Case 2
6 37y old, G3P1, non-smoker Referred from MCHC Cervical smear: LGSIL
7 Colposcopy impression: HPV changes Cervical biopsy: condyloma
8 Case 3
9 51y old, G3P1, menopause for 4 years Referred from MCHC Cervical smear : LGSIL
10 Colposcopy impression: HPV changes (cervix & vagina) Cervical biopsy: condyloma (cervix & vagina)
11 Case 4
12 31 years old, P1(C/S), multiple partner(3), non-smoker Cervical smear normal 2 years ago Referred from MCHC CS: ASCUS, HR HPV +ve
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14 Colposcopy impression: CIN II, HPV Cervical biopsy: 1 o clock CIN I, condyloma LEEP: CIN II, clear margin
15 Case 5
16 46 year s old, P2, non-smoker Referred from MCHC, regular CS in MCHC for 10y Last CS: ASCUS, HR HPV +ve
17 Colposcopy impression: HPV + CIN I Cervical biopsy: Condyloma (2 & 4 o clock)
18 Case 6
19 23 years old, sexually active since 18 years old, P0+1(STOP), non-smoker, multiple partners (5) First CS: Atypical glandular cells
20 Colposcopy impression: CIN II Cervical biopsy: 12 o clock condyloma 6 & 7 o clock CIN I Endocervical curettage: no significant pathology
21 Colposcopy 7 months later
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24 Colposcopy impression: CIN I (anterior lip), HPV Cervical biopsy: 1 o clock - CIN II 4 o clock condyloma Endocervical curettings: no dysplastic cells seen Endocervical cytobrush: negative
25 Case 7
26 34 years old, P2, single partner, non-smoker Referred from MCHC, irregular CS in the past 3 years Cervical smear: negative Indication for colposcopy: post-coital bleeding for 3-4
27
28 Colposcopy impression: HPV Cervical biopsy: 2 o clock - CIN II, condyloma 8 o clock no significant pathology 12 o clock condyloma LEEP: CIN II at 9 & 10 o clock. Clear margins
29 Case 8
30 27 years old, P2, 2 partners, chronic smoker(3y) Referred from private First CS: HGSIL
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33 Colposcopy impression: CIN II-III Cervical biopsy: 8 & 11 o clock - CIN II LEEP: circumferential CIN III with glandular involvement, clear margin
34 Case 9
35 39 years old, P1+4(STOP), single partner, non-smoker LEEP in 2008 for CIN III Follow-up CS : HGSIL
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41 Colposcopy impression: CIN II-III, VAIN I-II Cervical biopsy: 2, 6, 10 o clock condyloma Vaginal biopsy: VAIN I Refused diagnostic LEEP and laser therapy to VAIN
42 Case 10
43 78 years old, P5+3, single partner, non-smoker LEEP in 2004 for persistent CIN I since 2002 Follow-up CS : ASC-H
44 Colposcopy impression: HPV, VAIN I-II Cervical biopsy: 3, 6 o clock condyloma Vaginal biopsy: VAIN II Endocervical cytobrush: LGSIL
45 Case 11
46 29 years old, P2+1, single partner, non-smoker Referred from MCHC First cervical smear: ASCUS and HRHPV +ve
47 Colposcopy impression: HPV + CIN II Cervical biopsy: 6 o clock CIN III LEEP : CIN II from 4 7 o clock
48 Case years old, menopause x 2 years, widowed P3+5(TOP), single partner, non-smoker Cervical smear: negative Referred by GP for right vulval reddish and mild ulceration x 10 years Seen in Gynae. OPD: 2x2x2cm erythematous patch over right vulval region, no ulcer Vulval excisional biopsy: VIN III Follow-up 3w later: no local lesion seen
49 Colposcopy 6 months later excisional biopsy
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57 Referred to QMH for suspicious of vulval carcinoma Wide local excision performed 1 month later Pathological findings: Squamous cell carcinoma arising in a background of VIN, 4mm in thickness, involving deep margin Bilateral radical groin dissection + radical right hemivulvectomy performed 1 month later Pathological findings: Usual VIN, no invasive tumour Metastatic carcinoma detected in 1 out of 17 right groin LN, left groin LN & deep LN were negative Final diagnosis: CA vulva stage 3a (G2-3 SCC), no adjuvant RT is needed.
58 Case 13
59 30 years old, P1, single partner, ex-smoker (8-9y) CS in private in 2011: CIN I CS in 2013: HGSIL
60
61 Colposcopy impression: CIN III + HPV Cervical biopsy: 12o clock CIN II, condyloma LEEP : focal CIN I at 8 o clock, clear margin
62 Case 14
63 48 years old, P2, sexually active since 18 years old, multiple partners (4-5), ex-smoker x 3-4y, stopped 2 years Referred from Social Hygiene Clinic CS: HGSIL
64
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66 Colposcopy impression: CIN II-III Cervical biopsy: 2 o clock - suspicious of squamous cell carcinoma 6 o clock - no malignancy
67 LEEP: CIN III with early stromal invasion at 12 o clock, 5mm(W), 1mm(D) CIN II at 1,2,9,11 o clock TLHBSO : no residual CIN or tumour
68 Case 15
69 31 years old, G8P6+1(TOP), divorced, multiple partner (3), non-smoker Referred from FPA First CS: ASCUS and HR HPV +ve Pregnant for 30 weeks at colposcopy
70
71 Colposcopy impression: HPV Cervical biopsy not taken
72 6 months after normal delivery
73 Colposcopy impression: HPV Cervical biiopsy: 1 & 4 o clock - condyloma
74 Case 16
75 26 years old, P1+1, single partner, non-smoker Referred from MCHC CS: HGSIL, HRHPV +ve
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79 Colposcopy impression: CIN III,?microinvasive Cervical biopsy: 1 o clock - CIN III 4 o clock condyloma LEEP: CIN III with focal glandular involvement at 11 o clock, clear margins
80 Case years old, P0 Sexually active since 21y old Single partner, non-smoker Referred from private for warty growth at cervix CS : LGSIL First CS in private at 6 months ago: ASCUS, low risk HPV +ve
81 Colposcopy impression: cervical warts Cervical biopsy: condyloma
82 Case 18
83 53 years old, P2+1, one Caesarean section done in China 28y ago, single partner, non-smoker Regular CS in MCHC for 24 years Referred from MCHC CS: LGSIL
84
85 Colposcopy impression: HPV, CIN I,VAIN I Cervical biopsy: 9 & 10 o clock condyloma, CIN I Vaginal biopsy: condyloma, VAIN I
86 Case 19
87 53 years old, P2, menopause, single partner, non-smoker Regular CS in MCHC for 10 years Referred from MCHC CS: ASCUS, HR HPV +ve
88
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90 Colposcopy impression: HPV, VAIN I Cervical biopsy: 4 & 12 o clock - condyloma Vaginal biopsy: left side - condyloma right side VAIN I
91 Case 20
92 61 years old, P2+4, menopause x 15 years Single partner, non-smoker First CS normal at 2 years ago Referred from MCHC 2 nd CS: LGSIL, needed to rule out HGSIL
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96 Colposcopy impression: CIN I-II, VAIN II, HPV Cervical biopsy: 2,6,11 condyloma Vaginal biopsy: 8, 11 o clock: VAIN III, condyloma Endocervical cytobrush: LGSIL TAHBSO + vaginal cuff excision: VAIN II at 4 o clock, clear margin,
97 Case 21
98 75 years old, P3, menopause x 25 years, single partner, non-smoker CIN II with LEEP in OLMH 2005 CS: LGSIL (KWH) ASC H (OLMH) HGSIL (OLMH)
99 Colposcopy impression: VAIN II, HPV Cervical biopsy not possible (dimple os) Vaginal biopsy: 3 & 9 o clock - VAIN II-III, condyloma 12 o clock - VAIN I, condyloma Endocervical cytobrush: negative
100 Case 22
101 39 years old, P2+3(TOP), single partner, smoker x 2-3 years No previous cervical smear Laser therapy for cervical cysts in China 7-8 years ago CS taken in China 2w ago: CIN II, HR HPV +ve Attended Gynae. clinic for irregular PV bleeding x 3w and post coital bleeding x 2 years
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105 Colposcopy impression: cervical carcinoma, endocervical type Cervical biopsy: 6,8 o clock squamous cell carcinoma 12 o clock high grade CIN with glandular involvement Endocervical curettings: squamous cell carcinoma Robotic Radical hysterectomy + bilateral salpingectomy + PLN dissection performed in PMH
106 Case 23
107 F/40, P2, sexually not active, non-smoker No previous CS Referred from MCHC Cervical smear: HGSIL
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110 Colposcopy impression: cervical carcinoma Cervical biopsy: 11 o clock - papillary squamous cell carcinoma
111 Case 24
112 38 years old, P1, domestic helper, non-smoker Single partner, healthy in the past No CS before Attended Gynae. OPD for postcoital vaginal bleeding for 6 months Cervical smear: unsatisfactory, mainly polymorphs
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115 Colposcopy impression: Chronic cervisitis with HPV infection?? Cervical cancer (??adenocarcinoma)
116 Cervical biopsy: Extensive granulomatous inflammation, no dysplasia or malignancy Many epithelioid cells granulomas With central suppurative necrosis Contains Langhan type giant cells Acid fast bacilli detected
117 6 weeks after anti-tb treatment
118 12 weeks after treatment
119 12w after anti-tb treatment
120 6 months after anti-tb treatment
121 Case 25
122 31 year-old clerk, married, Para 0, non smoker 2004: CS: atypical glandular cells NOS Colposcopy in Baptist Hospital Cervical biopsy 9 and 11 o clock: no CIN, glandular dysplasia or invasive malignancy EA: proliferative endometrium, no evidence of endometrial hyperplasia or malignancy Endocervical curettage: no tissue 2006: CS taken in FPA Atypical glandular cells, suggestive of adenocarcinoma in situ
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125 Colposcopy impression: CIN III and AIS Endocervical cytobrush : adenocarcinoma in situ Cervical biopsy: 2 &5 o clock - no tumor Endocervical biopsy: 6 oclock - adenocarcinoma in situ Endocervical curetting: no tumor Endometrial aspirate: proliferative endometrium
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