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Colposcopy and Leep results don’t match up

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Colposcopy and Leep results don’t match up

Had leep and it doesn't match my colposcopy. My physician said the leep results were great and to just follow up in a year. After reading pathology report on my leep with top hat, I'm concerned maybe she didn't perform the leep correctly? It seems like it was mainly ectocervix and not endocervix? Any one have any insight? 


Colposcopy biopsy results read "transformation zone with high grade squamous intraepithelial lesion (CIN 3) in a background of low squamous intraepithelial lesion (CIN 1)"


Final diagnosis:

A.cervical leep biopsy and extra left layers tissue. 

-benign ectocervical squamous epithelium

-minute benign collumnar/grandular epithelium 

-no HPV changes, dysplasia or neoplasia is evident 

B. Cervical top hat with extra left latera tissue

-benign fibromuscular tissue 

-no surface or grandular epithelium seen. 

-no HPV changes, dysplasia,or neoplasia is evident


Microscopic description 

A.Sections reveal cervical epithelium (predominantly ectocervical squamous epithelium with focal minute edocervical columnar epithelium with mild chronic inflammation suggesting tissue near the transformation zone between ectocervical and endocervical mucosa. No low grade or high grade epithelial dysplasia, hpv cytopathic effect, or malignant neoplasia seen.


B.sections reveal benign fibromuscular(sub epithelial stromal) tissues. No surface or subsurface grandular epithelium is seen. No dysplasia/HPV changes or malignant neoplasia is seen. 


Pathologist comments: no HPV cytopathic effect, low grade or high grade dysplasia, or neoplasia seen. The specimen is composed of predominantly ectocervical squamous epithelium. Only scant columnar / grandular (transformation zone) epithelium is seen suggesting limited transformation zone edge sampling. Since HPV/dysplasia involves transformation zone more commonly than ectocervix, recommend close follow up pap/HPV test surveillance to ensure normality. 



Hey Kkja, 

It may be worth using Jo's "Ask the Expert" element of the website as majority of us are not medically trained so I feel it would be incorrect for anyone to advise you. Unless they have exactly the same result of course xx

1. HPV Vaccine Age 16/17 approx 10/ 11 Years Ago. 2. Age 25 - First Smear Normal

3. Oct 2020 - Second smear Age 27 - Result = HPV Positive & High-grade severe dyskaryosis. Referred for Colposcopy 

4. 16/11/2020

Colposcopy - DR said area too large for on the day treatment. Referred for LLETZ under GA. 5. 30/11/20 pre-op assessment - surgery booked for 21/12

6. Surgery cancelled due to tier 4 Covid pandemic, surgeon requested to see me 23/12 to try and do LLETZ awake

7. 23/12 LLETZ procedure completed 

8. 28/1/21 Results received - CIN2 with test of cure in 6 months time!

Lemon Lavender

Did you find anything more out lovely?


It sounds very complex. Xx

1/01/21 - routine smear (previous smears clear). 

8 days later - letter HPV Positive + high grade severe dyskaryosis. Colposcopy letter arrived 6 days later. 

 26/01/21 - colposcopy appointment, LLETZ - biopsies, Diathermy Ablation

18/02/21 - 23 days after colposcopy. CIN 3. Margins not clear. To be discussed at MDT on 16/3/21. Await results. 

Detailed account of my experience can be found on this thread: https://www.jostrust.org.uk/forum/cervical-screening-smear-test/what-were-your-waiting-times


Basically I went to my new gyno and she said, "wow I've never seen any results like yours." She wanted to wait an entire year to repeat pap but i convinced her to do it in March. She didn't seem concerned. Hoping it's okay. 


More Information

Abnormal cervical cells and treatment

Read about HPV