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A.32yo patient with Pap showing carcinoma in situ.Next step?
B.32yo patient with Pap showing severe dysplasia. She is 16 weeks pregnant. What do we do? Next step?
C.32yo patient with Pap showing HPV positive. What is the next step here?
D.32yo patient with Pap showing ASCUS.next step?
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A. Cone biopsy?
B. Close follow up?
C. Colposcopy
D. Colposcopy...and biopsy
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A-colposcopy
B-radical hysterectomy-?
C-colposcopy
D-HPV testing ->colposcopy
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B.....cant do it...she is pregnant 
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32yo patient with Pap showing carcinoma in situ. Next step is colposcopy. Ectocervical biopsy is micro-invasive,
ECC is normal. Micro-invasive means invasive less than 3mm past basement membrane. Next step must be cone biopsy, not punch biopsy, not cryo.
* 32yo patient with Pap showing severe dysplasia. She is 16 weeks pregnant. What do we do? Next step is
colposcopy with acetic acid. Do not do the ECC because you can disrupt the pregnancy. So just do the ectocervical biopsy, and it shows severe dysplasia. Treat this patient after the baby is born. If you do laser, cryo, or wide-excision and the patient miscarries, you better have a good lawyer. It takes 8-10 years for full cancer formation. Treat patient
about 2 months after birth to let the uterus cool off because of all the vascularity that grows during pregnancy.
* 32yo patient with Pap showing HPV positive. So, we are even before pre-cancer. We know this is HPV by seeing koilocytosis (halo around nucleus), so cytologist says HPV. What is the next step here? Repeat Pap in 3-6 months.
* 32yo patient with Pap showing ASCUS (atypical squamous cells of undetermined significance). This falls into the HPV area; most common cause of ASCUS is likely HPV infection without koilocytosis. What is the next step?
Answer is repeat Pap in 3-6 months.
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b leep but its a risk of more bleeding and having incompetent cervix - which can cause late miscarraige or premature birth.
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* If Pap comes back with HPV, we can do HPV DNA typing. They can tell you types 6, 11, or 16, 18, 31, etc. So if
the Pap comes back HPV and we get types 6, 11, we can say there is no problem and come back next year. If we get
types like 16, 18, 31, 33, 35, we should do a colposcopy with biopsy.
* So if the Pap comes back HPV, repeat Pap in 3-6 months. If they give you the type, decide based on cancer risk.
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32---A---DYSPLASIA----CIS--/CIN3/HGSIL---COLPOSCOPY AND ECC AND EXCERVICAL HISTOLOGGY TO COMPARE HISTOLOGY AND cytology from pap
b--severe dysplasia/aCIN3/HGSIL---still do colposcopy for excervical curettage for histology but dont do ECC since can cause cervical incompetence
c-still colpo but /? treat the hpv plus HPV DNA ---not sure
D--ascus-management controversial ,,,but if there is inflammation like candida--treat, then repeat pap in 3-6 onths
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d?? liquid smear for HPV??
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