Interactive Case Discussion

and Slide Identification

Michelle M. Szymanowski, MSN, WHNP, RNC Victor M. Feldbaum, MD
OB/GYN Nurse Practitioner OB/GYN Department Chair
Southwest Contemporary Women’s Care Bayfront Health and Johns Hopkins
Gilbert, AZ St. Petersburg, FL
Disclosures
• Michelle M. Szymanowski, MSN, WHNP, RNC – Faculty – Received honorarium from Myriad
Genetics for being a speaker.
• Victor M. Feldbaum, MD – Faculty – No disclosures

Images used with permission:

• All images are from Apgar, Brotzman and Spitzer: Colposcopy Text and Atlas, Elsevier Publishers, 2008.
• Images are copyrighted
Objectives
• Describe normal and abnormal cervical characteristics
• Differentiate cervical lesion severity
25-year old with ASC-H

1. Normal

2. Low-grade

3. High-grade

4. Cancer
25-year old with ASC-H

1. Normal

2. Low grade

3. High grade

4. Cancer
25 year old with LSIL, first Pap

1. Normal

2. Low grade

3. High grade

4. Cancer
28-year old G3 P3 with HSIL

1. Normal

2. Low grade

3. High grade

4. Cancer
26-year old with LSIL. No Pap in 3 years.
Requests OCPs

1. Normal

2. Low grade

3. High grade

4. Cancer
See anything interesting?
42-year old G5 P5 with LSIL

1. Normal

2. Low grade

3. High grade

4. Cancer
25-year old with HSIL

1. Normal

2. Low grade

3. High grade

4. Cancer
21-year old, first Pap smear, LSIL

1. Normal

2. Low grade

3. High grade

4. Cancer
21-year old with HSIL. Sexual onset age 14.
First Pap smear.

1. Normal

2. Low grade

3. High grade

4. Cancer
23-year old with HSIL. Sexual onset age 16.
Abnormal Pap 3 years ago, no follow-up.

1. Normal

2. Low grade

3. High grade

4. Cancer
28-year old with LSIL. 3 “bad” Paps in past
5 years, no follow-up.

1. Normal

2. Low grade

3. High grade

4. Cancer
32-year old with HSIL, regular screening.
New partner last year.
1. Normal

2. Low grade

3. High grade

4. Cancer
65-year old with HSIL

1. Normal

2. Low grade

3. High grade

4. Cancer
26-year old smoker with ASC-H. One previous abnormal
Pap at age 22, did not follow up until now. Very worried!

1. Normal

2. Low grade

3. High grade

4. Cancer
45-year old, no Pap in 5 years, 6 partners
in past 5 years.

1. Normal

2. Low grade

3. High grade

4. Cancer
32-year old, sex worker, number of
partners too numerous to count

1. Normal

2. Low grade

3. High grade

4. Cancer
42-year old with HSIL. No Pap in 5 years
and 2 previous abnormal Paps.

1. Normal

2. Low grade

3. High grade

4. Cancer
Summary
• Reviewed normal and abnormal cervical characteristics
• Reviewed characteristics of cervical lesion severity