• Please Note: Cases of the Month has been temporarily suspended as we work on the new ASCCP Risk-Based Management Consensus Guidelines, which will be published in 2020. Check back in early 2020 for new cases, which will serve as a resource and learning tool for the implementation of the new Guidelines.

     

    Each month, ASCCP releases a new case review that will allow you to test your knowledge in anogenital and HPV-related diseases.

    This resource is available exclusively to ASCCP Members. Not a Member? Join ASCCP Today!

  • Apr 22, 2019
    The patient is a 26 year-old G2P2002 who is having regular periods and has never used contraception. She was sexually abused from ages 6 to 12 years, and has been having consensual sex since age 14. She had cervical cancer screening at age 16 when she was pregnant; cytology was negative. Her second pregnancy was at age 18. She was again screened and cytology was negative...
    Mar 27, 2019
    A 21 year-old G1P0010 presents for a gynecologic exam and her first cervical cancer screening. The patient has no current complaints including abnormal vaginal bleeding. She reports 3 sexual partners in the last 6 months and denies use of contraception. She has a BMI of 19.1. The gynecologic exam is normal except for a scant yellow-white cervical discharge. Cervical cytology and STD testing are obtained. STD testing is positive for chlamydia...
    Feb 04, 2019
    A 35 year-old G2P2002 presents for a routine gynecologic exam. She reports no routine gynecologic care in the last several years. She is uncertain of the date of her last menstrual period and has been sexually active without using contraception. As a part of her care, cervical cancer screening is performed. Cytology returns as high grade squamous intraepithelial lesion (HSIL).
    Jan 24, 2019
    The patient is an 80 year-old multiparous female, a recent immigrant, who is brought in by her family with a history of being treated at home for vulvar itching and an “infection”. She brought a CT report from another institution which reported a vulvar mass 11 x 4.1 cm at the introitus with bilateral inguinal adenopathy. She is unable to tolerate a pelvic examination, so examination under anesthesia (EUA) is conducted. At EUA, a 15 x 8 x 5 cm...
    Dec 11, 2018
    A 41 year-old woman, G2P2002, presents for gynecologic health maintenance exam. She has no prior history of cervical dysplasia, though she admits to being infrequently screened previously. She reports no new sexual partners for the past 12 years. She is asymptomatic and has a normal physical exam. Cervical cytology and HPV testing are obtained. Cervical cytology is normal, and the HPV test is positive for unspecified high risk HPV types.
    Nov 28, 2018
    A 32 year-old G0P0 presents to your office for her routine cervical cancer screening. She has no symptoms or complaints. Her last cervical cytology screening was 3 years ago and resulted as negative for intraepithelial lesions or malignancy (NILM). As a primary care provider, you routinely screen women of reproductive age for pregnancy intent during well woman and chronic disease care visits. Your patient answers positively...
    Oct 15, 2018
    A 56 year-old postmenopausal woman presents to your office with several months of vulvar itching. Her medical history is complicated by obesity, chronic renal insufficiency and diabetes. She has had a renal transplant and is immunosuppressed. The patient has a history of tobacco use and abnormal cervical cancer screening.
    Sep 10, 2018
    29 year-old G3P0020 at 14 weeks 3 days gestation presents to your office for further discussion and management of recent cervical cancer screening results showing Atypical Squamous Cells – Cannot Exclude High Grade Squamous Intraepithelial Lesion (ASC-H). Review of her records indicates adequate screening with no history of abnormal cervical cancer screening. Her pregnancy has otherwise been uncomplicated.
    Aug 08, 2018
    A 36 year-old G1P0010, presents to your office for the first time, requesting an annual gynecologic exam. The patient is not currently using any method of contraception; she and her male partner have been in a monogamous relationship for three years and have been trying to conceive for the last 10 months. In the past, the patient used oral contraceptive pills to avoid pregnancies. She has not had a pelvic exam for many years and does not recall the last time she had cervical cancer screening...
    Jul 23, 2018
    A 29- year-old G0P0000 presents for evaluation of her first cervical cancer screening which revealed high-risk HPV (non-16/18) and atypical squamous cells of undetermined significance (ASC-US). She is using Depo-Provera for contraception. She has recently undergone evaluation for amenorrhea and galactorrhea which revealed a 7-8 mm pituitary microadenoma accompanied by mildly elevated prolactin levels...
    Jun 05, 2018
    A 60-year-old nulliparous woman presents with severe vulvar itching. She has been seeing her PCP for regular cervical cancer screening which have all been negative. She remembers seeing a gynecologist as a child because she kept scratching herself “down there." The gynecologist gave her mother some cream to put on her vulva and the itching resolved. Because the exam was upsetting to her, she did not return for follow-up as recommended.
    Apr 25, 2018
    A 57-year old G3P3003 postmenopausal woman is referred for gynecologic evaluation of cervical cytology screening showing high risk HPV-positive HSIL.She reports post-coital spotting for 3 months. Her prior cervical cancer screening was 8 years ago around the time of menopause, and consisted of normal cytology. HPV testing was not performed. She reports no prior history of abnormal Pap tests. She is generally healthy but smokes cigarettes...
    Mar 28, 2018
    A 64 year-old G0 postmenopausal woman comes to your office for follow-up after moving to your area. She does not have her records. She relates that she had a history of regular and negative cervical cancer screening until she had a first cotest two years ago showing negative cytology, but HR-HPV positive. HPV genotying was not done. The cotest was repeated in 12 months and was the same as the previous year...
    Mar 08, 2018
    A 21 year-old G0P0 presents to your office for her first gynecologic examination. She has no symptoms or complaints and does not report chronic medical conditions. She does not smoke or use illicit drugs. She has had two male sexual partners in her lifetime and has been using combination oral contraceptive pills for the past 14 months. She has completed her HPV immunization series.
    Feb 16, 2018
    A 47 year- old G5P5005 premenopausal woman presents with persistent abnormal uterine bleeding. She is scheduled for a D&C and ECC in the OR. She did not undergo office endometrial sampling prior to the OR procedures. The uterine histology revealed weakly proliferative endometrium and the ECC demonstrated at least endocervical adenocarcinoma in situ (AIS).
    Jan 02, 2018
    A 54 yo G0P0 presents to your office to establish care because of an insurance change. She received care from her former gynecologist for the past 15 years. She received annual cervical cancer screening showing no history of cervical abnormalities or gynecologic procedures. She has never had an HPV test. Today, she expects her “annual exam” including a PAP test. PMH is notable for hypertension and Cushing Disease dependent on ACTH...
    Nov 21, 2017
    A 36 year-old G7P40034 presents for routine cervical cancer screening. Her cervical cancer screening has always been normal. Her last cotesting was 5 years ago. She has smoked cigarettes for 15 years and currently smokes 1/2 pack per day. She is currently being treated for trichomonas. She is HIV-negative. Her cervical cotesting returns as HPV-positive ASC-US.
    Oct 26, 2017
    A 23-year-old GO presents for an infertility evaluation. Cervical cancer screening is performed, as she has not been screened previously. Cytology is performed, and her result returns ASC-US. The reflex HPV test is positive for high risk types. Cotesting in 12 months shows HPV-positive HSIL. She is referred for colposcopy. Her colposcopy is shown after application of 3-5% acetic acid.
    Oct 03, 2017
    A 32-year old G4P4 presents with a cervical cytology result of HSIL. HPV testing was not performed. She has had regular cervical cancer screening and denies history of any abnormalities. Patient was referred for colposcopy. There were no atypical vessels on green filter examination. Colposcopy was performed after application of 3-5% acetic acid.
    Sep 05, 2017
    A 34 year- old G3P3 presents for further evaluation of unsatisfactory cervical cytology she had 4 months ago. She has had regular cervical cancer screening without abnormalities. She is using an IUD for contraception. Cervical cotesting performed this day reveals unsatisfactory cytology and a positive HPV test.
    Jul 24, 2017
    A 32 year old woman has her first co-test which returns as cytology negative / HPV positive. Your practice utilizes HPV genotyping for triage management and it returns as HPV 16 positive. She is called back for colposcopy.

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