On the Colposcopic Observation and Microscopic Findings of the Non-carcinomatous Diseases in the Field of Obstetrics and Gynecology

Colposcopy, being introduced by H. Hinselmann in 1925, has developed chiefly in the field of early diagnosis of cervical carcinoma, and nowadays it may be said that the use is almost confined to this sole subject. Even in Germany and Australia where colposcopic examination has been accepted as an efficacious diagnostic method and is prevailing in general practice, paper dealing with non-carcinomatous diseases is minimum. Picture seen through colposcope is entirely specific and quite different from that by naked-eye examination, so it is not useless to observe and record the magnified picture of the non-carcinomatous diseases. I tried to evaluate the diagnostic efficacy of colposcopy, especially in non-carcinomatous diseases, observing whether any specific finding may be found or not. Method: 550 cases of out-patients of our clinic, from Dec. 1956 to Aug. 1957, were examined through Hinselmann's colposcope of Möller Optical Works of Germany, Colpophotography in selected cases and biopsy to all cases were carried out too, and the colposcopic findings were identified by the histologic findings in every case for the purpose of interpretation of colposcopic picture. Results and Conclusion: 1) At the second healing stage of erosion, R. Meyer claims “overgrowth” and Fischer-Wasels advanced “squamous metaplasia”. I performed serial section biopsy to 9 blocks of specimen removed from the beginning Nabothian follicles and in 4 blocks, overgrowth, and in 1 block, squamous metaplasia were found. From the results obtained, I conclude that Nabothian follicle may be produced by squamous metaplasia as well as by overgrowth. 2) Among the 402 cases of cervical erosion (bleeding group 108 cases and non-bleeding group 294 cases), nearly one half of the bleeding group and 1/3 of the non-bleeding group were true erosion. Through the entire cases, the incidenee of misdiagnosis was 1.6% (5 cases), but not any specific finding was noted colposcopically. Carcinoma was detected in 10 cases (2.4%) of innocent-looking erosion. If the colposcopic examination is performed as a screening test prior to the beginning of erosio-treatment it may be useful to determine more appropriate therapy to every case. 3) Examining 17 functional bleeding cases colposcopically, 6 cases were acknowledged to be functional, considering the manner of bleeding, history and menstrual cycle etc. In some cases of irregular genital bleeding, the site or, although not always, even the cause of bleeding may be clarified easily by colposcopic examination. 4) Colpitis: no specific finding was found colposcopically, but, examining 61 cases, 18 cases proved to be misdiagnosis and even in 1 case, the entity proved to be carcinomatous. 5) In 22 adnexitis cases, 1 cervical tuberculosis case and 23 primary sterility cases, no pathognomonic finding was found. It must call our attention, however, that in chronic adnexitis and in primary sterility cases, remnant of inflammatory process was quite common. 6) Observing 28 cases of "Erosio gravidarum", it was noted that the remarkable increase of vaginal discharge during pregnancy was due to the marked proliferation of cervical epithelium (colposcopically; ectopy) and also that, in order to avoid histological misdiagnosis, the case history and clinical findings must be refered to. 7) The green color filter, which has been used to observe the fine structure of small vessels, is useful too in discovery of beginning transition zone. 8) Examining 191 cases of patients with the chief complaint of genital discharge, 118 cases proved to be noninflammatory and 2 cases were suffering from postabortive endometritis. Colposcope is useful to follow-up of healing process of the lower genital lesions, such as cauterization therapy, and it may be accepted widely as an useful instrument in the near future.