Vaginal Adenosis Research Articles

The incidence and histogenesis of vaginal adenosis: An autopsy study

A detailed histologic study of 100 specimens of vagina obtained from female fetuses and girls up to the age of 25 years revealed adenosis in eight cases, five among 33 subjects less than one month of age and three among 24 patients 13 to 25 years of age. No examples of adenosis were found in 43 patients between one month and 12 years of age. In two of the five fetuses with adenosis there was prenatal exposure to exogenous progestagens. The findings of this investigation, in addition to other evidence, indicate that vaginal adenosis can arise on a congenital basis. The failure to detect it between infancy and puberty suggests that steroid hormones may play a stimulatory role.

CLINICAL DIAGNOSIS OF VAGINAL ADENOSIS

The increased incidence of vaginal adenosis in young girls whose mot hers were given diethylstilbestrol (DES) during pregnancy has heightened the interest and clinical awareness of this teratogenic process. In these cases, exfoliative cytology is usually negative and Schiller's iodine test is imprecise. Examinations were made of 63 young women (12-23 years old) whose mothers had been given DES during the first trimester of pregnancy. 55 were asymptomatic, 6 had noticed a mucus vaginal discharge, 2 had complained of dyspareunia, and none had been pregnant. Cytology of 3 was atypical. In 24, the usual gynecological examination was reported as normal. In 7, a lesion suggesting adenosis had been observed. Visual examination of the cervix and vagina revealed 3 with atypical gross findings. A circular fold in the vaginal fornices partially covered the cervix in 9 cases. Cervical irregularity was observed in another 9 cases. Erythroplakia (reddish brown areas on the cervix or vagina) seen in 8 patients represented columnar epithelium inflammation, or neoplasia. Gross inspection did not determine the pathology. In 41 (71 percent) gross examination of the cervix and vagina failed to reveal any changes. By colposcopic examination columnar epithelium on the surface of the vagina was found in 24 cases (38 percent). After the acetic acid test, grapelike structures of columnar epithelium were visible. In 57 patients (91 percent), columnar epithelium was found in the vaginal wall; these were classified as vaginal adenosis. In 6 patients, the columnar epithelium was seen only on the periphery of the cervix. The incidence of vaginal adenosis seems to correlate directly with methods of detection as most cases are asymptomatic. The diagnosis is difficult to establish by conventional clinical methods. Colposcopic examination was an accurate method, particularly in cases which were not apparent by other methods. Biopsies may be needed also.

The effects of local progesterone on stilbestrol-associated vaginal adenosis

Because stilbestrol (DES)-associated vaginal adenosis appears shortly after onset of puberty, this study was undertaken to assess the effectiveness of local treatment with progesterone as an inhibitor of ovarian estrogens, the possible etiological agents of vaginal adenosis. 5 teen-age women were studied; the mother of each had received varying amounts of DES during the patient's time in utero. The biopsy-proven adenosis cases were marked by redness, squamous pegs, and chronic inflammation before treatment with 20-mg progesterone suppositories, inserted vaginally, 2 times/day. (9 figures depict the cytological appearance of the subjects' vaginas before and after therapy.) Regression of the adenosis occurred in all 5 subjects; regression was marked clinically by gradual elimination of redness of the vaginal mucosa as well as reduction of inflammation, as observed microscopically. In 3 of the 5 patients, no evidence of vaginal adenosis was found on biopsy post-therapy. In the other 2 patients, residual adenosis was confined to the cervical area. Serum progesterone concentrations were measured throughout the study by radioimmunoassay and were found to be low in the 1st half of the cycle (.75-2.3 ng/ml), but the levels increased to high luteal-phase values by the 2nd half of the cycle (8.7-24.5 ng/ml). No alterations in menstrual patterns were seen. Local progesterone application may have great value in treatment of vaginal adenosis, particularly that associated with DES exposure in utero. Therapy with progesterone resulted in regression of disease without interfering with ovulatory patterns.

Vaginal adenosis: diagnosis by palpation.

Vaginal adenosis: diagnosis by palpation.

Studies of nuclear DNA in vaginal adenosis and clear-cell adenocarcinoma

Spectrophotometric measurements of nuclear DNA have been made in 3 cases of clear-cell adenocarcinomas of the vagina and 3 with adenosis. There was a history of maternal ingestion of diethylstilbestrol (DES) in all but one of the patients; one patient with an adenocarcinoma was conceived prior to the use of DES in pregnancy. DNA studies showed each of the adenocardinomas to be aneuploid whereas each of the adenosis specimens was in the diploid-tetraploid range. By analogy with results of DNA studies in other gynecologic malignancies, it is suggested that if adenosis is the tissue in which the clear-cell adenocarcinoma arises, it should have a precursor stote with a shift toward aneuploidy which has not been identified in this study.

Clear-cell adenocarcinoma of the genital tract in young females. Registry report.

Abstract Among 91 Registry cases of vaginal and cervical adenocarcinoma predominantly of the clear-cell type, the patients, eight to 25 years of age, were born throughout the United States and in three foreign countries. Pregnancy histories of 66 of the patients' mothers have been obtained; 49 received stilbestrol or related drugs, nine received unidentified drugs administered because of bleeding or prior pregnancy loss, and eight had a negative history. The dosage and duration of therapy varied widely. The frequent coexistence of vaginal adenosis and occasional presence of transverse vaginal or cervical ridges suggested abnormal development of mullerian epithelium in utero. Seventeen of 65 patients have died or had recurrences despite brief follow-up periods in many cases. Although these cancers are rare, the frequency of asymptomatic cases and the unreliability of vaginal cytology for detection support the value of screening postmenarchal females who have been exposed prenatally to stilbestrol or relate...

Stilbestrol and Vaginal Cancer In Young Women

Regarding maternal ingestion of stilbestrol to high-risk pregnant patients during the late 1940's and early 1950's and the appearance of vaginal adenocarcinoma in their female offspring years later, physicians are advised to examine patients whose mothers received stilbestrol during pregnancy. Once these females reach the menarche, periodic vaginal examinations are required. A diagnosis of cancer should be considered when abnormal vaginal bleeding occurs. It is hypothesized that these cancers originate from adenomatous vaginal lesions that become malignant. The high incidence of benign vaginal adenosis suggests that an anomaly of vaginal epithelial development may be a predisposing condition. Since reporting on 8 patients in 1970, there is more evidence of an association between maternal stilbestrol administration and vaginal cancer in the offspring. More than 80 cases of vaginal and cervical adenocarcinoma in young women have been diagnosed. In most cases the maternal medical history revealed intrauterine exposure to stilbestrol, dienestrol or hexestrol. The Food and Drug Administration has warned all physicians that stilbestrol is contraindicated in pregnant women. Physicians who are contacted by worried mothers or anxious young women can be assured that, as yet, the risk appears to be low, but the public should be made aware that adolescent females and young women who had fetal exposure to stilbestrol need regular vaginal examination.

VAGINAL ADENOSIS

Summary Six cases of vaginal adenosis have been described. In two of them adenocarcinoma of the vagina was present; in one of these clear transition from benign adenosis to carcinoma was evident whilst in the other the association of benign mucous glands with the carcinoma strongly suggests that the latter arose from the former. The first of these patients survived for nine years free from disease and the second died of metastases after 7 years. In a third patient it was thought that early malignant change might be present. Despite the absence of treatment, however, no obvious change has occurred in the lesion over three years and smears have remained negative. The most prominent presenting symptom in the remaining cases was a mucoid vaginal discharge; other important symptoms include dyspareunia and postcoital bleeding. Treatment is discussed.

Vaginal adenosis: clinical and pathological features with special reference to malignant change.

SummarySix cases of vaginal adenosis have been described. In two of them adenocarcinoma of the vagina was present; in one of these clear transition from benign adenosis to carcinoma was evident whilst in the other the association of benign mucous glands with the carcinoma strongly suggests that the latter arose from the former. The first of these patients survived for nine years free from disease and the second died of metastases after 7 years. In a third patient it was thought that early malignant change might be present. Despite the absence of treatment, however, no obvious change has occurred in the lesion over three years and smears have remained negative. The most prominent presenting symptom in the remaining cases was a mucoid vaginal discharge; other important symptoms include dyspareunia and postcoital bleeding. Treatment is discussed.

Vaginal adenocarcinoma arising in vaginal adenosis

Although vaginal adenosis is a rare clinical entity, serial microscopic studies of vaginas obtained at autopsy reveal it to occur rather frequently as an occult finding. It most likely arises after the period of vaginal genesis and is thought to represent gland cell prosoplasia of the normal vaginal squamous epithelium as a tissue reaction to multiple possible factors. It has been considered to pursue a protracted, benign clinical course; however, it is mentioned as possibly a precursor of primary adenocarcinoma of the vagina. Reported is a case wherein adenocarcinoma of the vagina developed from vaginal adenosis, probably of twenty years' duration, and was related to a hematopyocolpos secondary to an imperforate hymen.

Adenocarcinoma of the vagina in adolescence. A report of 7 cases including 6 clear-cell carcinomas (so-called mesonephromas).

Seven cases of adenocarcinoma of the vagina occurring in young women 15 to 22 years of age are reported. Six sought medical advice because of abnormal bleeding, which was assumed to be due to anovulation. Hormonal therapy delayed the correct diagnosis, which was not made until vaginal examination was performed. Vaginal smears contained rare suspicious or malignant cells in 3 cases but were negative in 3 others, indicating that cytologic examination is unreliable as a diagnostic aid. Six of the tumors were clear-cell carcinomas, or so-called mesonephromas, and one was an endometrioid carcinoma. The frequent presence of vaginal adenosis and other evidence suggested that the clear-cell carcinomas were of mullerian and not mesonephric origin. Although the follow-up has not been long, radical surgery with vaginal replacement and ovarian conservation appears to have been a safe and effective method of therapy.

The incidence and distribution of occult vaginal adenosis

A histologic, step-sectional study of vaginas obtained at autopsy from 35 human females has demonstrated the presence of occult submucosal glands in 9 (41 per cent) of the 22 vaginas from postpubertal patients. A listing and pictorial representation of the number and location of these glands which were histologically and histochemically identical to those of the endocervix are presented. No similar evidence of occult vaginal adenosis was seen in the vaginas of prepubertal patients. The findings suggest that the incidence of occult vaginal adenosis and the potential for the development of gross lesions of adenosis are far greater than previously appreciated. They additionally suggest that occult adenosis develops de novo following puberty rather than during vaginal embryogenesis. The cell of origin remains undetermined.