HPV and Cervical Dysplasia Case Studies

Case 1: 31-year-old with mild dysplasia (CIN1) and a high-risk HPV. This was her first abnormal pap.

CIN 1 The image to the left is taken after the first application of an escharotic solution. The yellow/orange area that is stained corresponds to the abnormal cells (dysplasia).
CIN 1 Treatment 2
This is 5 days later at the time of the second treatment. Notice that a significantly smaller area is now staining after the death of much of the abnormal area.
CIN 1 Treatment 6 This is after the 6th treatment. Almost all traces of abnormal cells are gone from the external cervix. There remains faint staining just within the endocervical canal. This case is typical in that the dysplasia usually regresses from the periphery of the cervix toward the canal--the canal being the last to become normal.
CIN 1 resolved This is the ninth and last treatment. Note that there is no staining visible with the ZnCl2/bloodroot solution. A Thinprep pap 3 weeks later verified no evidence dysplasia or atypical cells. This patient will continue on her "oral" regimen of supplements until her next pap in 3 months. If that pap is normal then follow-up is in 6 months. If the 6 month follow-up pap is normal then the patient will go back to annual paps.

Case 2: 45-year-old woman with a high-risk HPV and ASCUS on pap screening. Because this was first abnormal pap colposcopy and biopsy not performed.

This image is after the first treatment with an escharotic. There is staining of abnormal tissue (yellow area) above the canal opening.
ASCUS Treatment Two
After one application the abnormal area is thinning and is less visible. When the response is this good, it is likely that the depth of the lesion is slight and/or the dysplasia is mild.
ASCUS Treatment 7 This image is taken after the 7th treatment. Note that the abnormal area above the opening is absent. There appears to be slight staining just within the endocervical canal so treatment will continue.
ASCUS Resolved This is the 9th and final treatment. A follow-up pap demonstrated the absence of abnormal cells.

Case 3: 32-year-old with 1st abnormal pap 6 years ago. Now biopsy-confirmed mild dysplasia with HPV-16.

CIN 1/HPV-16

The first application of the escharotic demonstrates dysplasia and HPV-infected cells, mostly at lower portion of cervix.

CIN 1/HPV-16

This image was taken after the fourth treatment. Observe that much of the abnormal area is gone, however, there is a persistent area at the lower cervix with slight erosion of surface cells. This likely represents a "deeper" amount of abnormal tissue.

CIN 1/HPV-16

The image here is after the 10th treatment which is 8 weeks after the onset of treatment. Notice that the lesion at the lower part of the cervix is clearing up.

Normal cervix/High-risk HPV negative

This is the 13th and final treatment. A follow-up pap taken 3 weeks later demonstrated the absence of abnormal cells and was negative for high-risk HPV including HPV-16. This patient will continue with the oral part of treatment for at least another 3 months when another pap will be performed. If the 6-month pap is normal, she will continue with annual screening.

Case 4: 23 year-old with CIN 3 in the endocervical canal and the outer cervix. The patient was positive for HPV-16. A progestin-secreting IUD (Mirena) was removed at the 10th treatment due to concern that it was contributing to the dysplasia.

This image was taken at the time of the initial escharotic application. There is staining visible above and below the canal. Note the sutures from a recent cone biopsy as well as the string attached to in intra-uterine device (Mirena).
CIN3 This image was taken at the 7th treatment. The external dysplasia appears to be eliminated but there is evidence of staining within the canal (ECC confirmed CIN3 in the canal).
CIN3 This is the 14th treatment. Note that there appears to be less tissue in the canal (i.e. the opening appears larger). This is because with each application of the escharotic there is a slight loss of abnormal tissue. This was a challenging case and treatment was discontinued at the 19th treatment to do a colpo. Biopsy confirmed that there was a regression from CIN3 to CIN1. The patient decided to have 5 more treatments.
Normal Pap After Escharotic Treatment This is after the 24th and final treatment. A thinprep pap was normal and the HPV-16 virus was undetectable. This patient will have another pap and colpo in 3 months to verify the absence of dysplasia and virus. Note that the canal, after having had time to heal, is of normal size and shape.

Case 5: 24 year-old with ASCUS and High-Risk HPV. Biopsy confirmed atypia with HPV findings.

ASCUS with HR-HPV This image is after the 2nd application of escharotic. Initial staining is often limited at the first visit when treating very mild dysplasia or HPV-infected cells. Staining is usually more prominent after the second or third treatment in these cases.
ASCUS with HR-HPV treatment 4 This image was taken after the 4th treatment. Note that an eschar has formed on the lower cervix.
ASCUS with HR-HPV treatment 5 This image was taken one week after the above image. This is very good healing in just one week.
ASCUS resolved with no HPV present After only 7 treatments there is no evidence of abnormal staining with the escharotic. A thinprep was performed 3 weeks later that was normal and high-risk HPV was undetectable.