The colposcopist may observe granular red lesions, white epithelium with or without abnormal vessels, ulceration, tumor formation and intraepithelial or sub epithelial hemorrhage in invasive lesions. Metastatic tumors to the vagina most commonly occur among women with concurrent or previously treated cervical cancer. Ovarian and rectal cancers, as well as choriocarcinoma, may metastasize to the vagina. Because in these instances cancer is generally suspected after gross visual inspection and palpation, colposcopy is not likely to be clinically useful. Many benign conditions may masquerade as neoplastic lesions and only through colposcopy and biopsy will the precise nature be ascertained.
Atrophic changes are great mimics for colposcopists and pathologists.
It is often difficult for a cytologist to distinguish basal cells associated with severe atrophy from glandular cells or severely dysplastic squamous cells. Prior radiation therapy to the vaginal vault may lead to bizarre, atypical vessels and distinguishing cytological benign radiation changes from more serious lesions is usually only settled after colposcopy and biopsy. 5-fluorouracil are found anywhere in the vaginal canal. Such changes are associated with abnormal colposcopic findings and require biopsy for definitive diagnosis. Three to five percent acetic acid is applied and a complete vault examination is performed.