A clinical image of cervical intraepithelial neoplasia (Grade III) in the third trimester of pregnancy

¹Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, ²Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

^&Corresponding author
Laksh Shubhangi Agrawal, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Image in medicine    

Cervical cancer is one of the leading causes of mortality in India. It is 2^nd commonest malignancy during pregnancy after breast cancer. 71.6 per cent of malignant tumour causes cervical cancer cases during pregnancy. The human papillomavirus is the primary aetiology of cervical cancer. In most individuals, the virus flushes out thoroughly, and in the rest, it persists throughout and precipitates a malignant transformation. This patient presented with complaints of spotting while she was pregnant at 35.5 weeks. When pregnant, the symptoms are often mistaken for those of other diseases. A colposcopy was conducted to diagnose the condition. Cervical intraepithelial neoplasia (CIN) grade -3 was diagnosed in the patient, and the Swede score evaluated was 7. A biopsy was done the confirmation of cervical cancer. The colposcopy image revealed that the lesion is about 7mm in length and 2-3mm approximately in width, and the lesion is elongated and circumferential areas around the external OS. Picture (Figure A) indicates the lesion under application of Normal Saline. Picture (Figure B) shows visual inspection with acetic acid solution (VIA), which indicates the ill-defined patchy acetowhite lesion with irregular margins, coarse irregular surface and punctate vessels. In figure (Figure C), a visual inspection with Lugol's iodine (VILI) was performed. The lesion depicts dense saffron yellow iodine in the negative area and dense mustard yellow iodine at 1'o clock. Figure (Figure D), shows green filtered light with the application of Lugol's iodine with punctuate vessels.

Figure 1: A): lesion at 1'o clock under the application of normal saline; B) visual inspection with acetic acid showing punctate vessels; C) visual inspection with Lugol's Iodine showing dense saffron yellow iodine in the negative area and dense mustard yellow iodine at 1'o clock; D) green filtered light with the application of Lugol's iodine showing punctuate vessels