1. Introduction to Colposcopy

6. Instrumentation

7. Collin’s bivalve specula of different sizes Vaginal side wall retractor Endocervical speculum Cervical punch biopsy forceps with sharp cutting edges

8. A method of identifying outer & inner borders of the transformation zone

14. SCJ

15. Multiple nabothian cysts in the mature squamous metaplastic epithelium occupying the ectocervix Nabothian cyst with regularly branching tree like vessels

16. Normal vascular pattern

19. Coarse punctation Coarse punctation before & after application of acetic acid

25. Post Menopausal Cervix: Epithelium is pale, brittle, lacks lusture, shows sub-epithelial petichiae, SCJ not visualized The entire new SCJ is visible colposcopic examination is satisfactory. the TZ is fully visualized. The metaplastic squamous epithelium is pinkish-white compared to the pink original squamous epithelium

26. Squamous metaplasia Earliest colposcopic changes in immature squamous metaplasia (after 5% AA) in which tips of columnar villi stain white & adjacent villi start fusing together Prominent white line corresponds to the new SCJ & tongues of immature Squamous metaplasia a) with crypt openings at 4-8 o’clock positions b) after application of AA

27. Immature squamous metaplastic epithelium (narrow arrow) on the polyp with intervening areas of columnar epithelium a) after application of AA The endocervical polyp & the immature squamous metaplasia surrounding the os partially take up iodine.

29. Geographic satellite lesion condyloma low-grade lesion

30. Thin acetowhite lesion with geographic margins in the upper lip. Histology indicated CIN 1 Moderately dense acetowhite lesions with irregular margins in the anterior & posterior lips ( CIN 1)

31. circumorificial acetowhite CIN 1 lesion with irregular margin & fine mosaics

32. Moderately dense acetowhite lesions with well defined margins & coarse punctations in the anterior lip & in 3 o’clock position (CIN 2 lesion Dense well defined acetowhite area with regular margins & coarse mosaic ( CIN 2 lesion )

33. A dense acetowhite lesion with varying colour intensity & coarse mosaics (a) in a CIN 2 lesion Acetowhite lesions with coarse punctation (a) & mosaics (b) in a CIN 2 lesion

34. A circumoral dense opaque acetowhite area with coarse mosaics ( CIN 3 lesion) A dense acetowhite lesion with regular margin & coarse, irregular punctation in a CIN 3 lesion.

35. Modified Reid Score

37. Early invasive cancer: note the raised irregular mosaics with umbilication (a), breaking mosaics (b), surface irregularity & the atypical vessels after the application of 5% AA Preclinical invasive Carcinoma

38. Atypical Vessels pattern ِ Note the irregular surface contour with mountains & valleys appearance with atypical blood vessels in the dense acetowhite area Invasive cervical cancer

39. A dense acetowhite lesion in the endocervical canal visible after stretching the os with a long dissection forceps (adenocarcinoma in situ) Glandular lesions

40. Adenocarcinoma in situ: The tips of some of the columnar villi turn densely white compared to the surrounding columnar villi after the application of acetic acid (arrow). The nabothian cysts turn white after the application of AA

41. the greyish white dense acetowhite lesion with character writning-like atypical blood vessels(a) The elongated, dense acetowhite lesion with irregular surface in the columnar epithelium with atypical blood vessels (a) Adenocarcinoma:

42. Reddish “angry-looking”, inflamed columnar epithelium with loss of the villous structure & with inflammatory exudate (before application of 5% AA) Inflammatory lesions of the Uterine Cervix Chronic cervicitis: This cervix is extensively inflammed with a reddish appearance & bleeding on touch, there are ill-defined, patchy acetowhite areas scattered all over the cervix after the application of AA

43. TV after Acetic acid T.V. After Lugol’s Multiple red spots (a) suggestive of Trichomonas vaginalis colpitis ( strawberry appearance), after application of 5% AA Trichomonas vaginalis colpitis after application of Lugol’s iodine (leopard-skin appearance)