Two cases of vaginal clear-cell adenocarcinoma occurred as a result of maternal ingestion of diethylstilbestrol during pregnancy. The first case was diagnosed during the patient's first office visit. The second patient was first seen by the authors in 1976 and was followed at six-month intervals during the ensuing six years; the adenocarcinoma developed during this interval. Colposcopy and cytology were important in the diagnosis of both cases.
PIP: 2 cases of vaginal clear-cell adenocarcinoma, occurring as a result of maternal ingestion of diethylstilbestrol during pregnancy, are presented. The 1st case was diagnosed during the patient's 1st office visit, but the other patient's disease was diagnosed only after she had been followed regularly for 6 years. In utero exposure to diethylstilbestrol (DES) was documented during the 1st office visit of case 1. Medical records established that the 22-year old patient's mother had begun consuming Ensalstilbestrol, 25 mg daily, and increased the dosage to 25 mg t.i.d. during the 12th-14th week of gestation. She remained on this dosage throughout the pregnancy. 2 vaginal lesions were observed and examined colposcopically. A 1x1 cm mass on the right lateral vaginal wall was colsposcopically benign. A colposcopically directed biopsy of the posterior vaginal wall mass was performed, and histologic examination revealed a vaginal clear-cell adenocarcinoma. The patient had a clinical stage I cancer. Radical abdominal hysterectomy, periaortic node biopsy, bilateral pelvic lymphadenectomy, and total vaginectomy were performed. The resection margins and all lymph nodes were free of disease. A split thickness skin graft vaginoplasty was performed with 90-95% success. The mother of the 18-year old, nulliparous case 2 patient began injections of progesterone and DES at the time of her last menstrual period on February 18, 1956. The patient's physical examination on colposcopy clinic on May 29, 1975 was normal, but it soon became apparent that she was socially retarded and mentally slow. Pelvic examination on the 1st visit was not possible due to her inability to cooperate. Pelvic and colposcopic examination performed under general anesthesia 4 weeks later revealed gross and microscopic DES related changes. Colposcopically directed biopsies confirmed the diagnosis of vaginal adenosis and nabothian cysts. The cervix was also involved. The patient was examined colposcopically, and a Papanicolaou smear was performed approximately every 6 months. These smears were negative, and the colposcopic examinations were unchanged. The patient was hospitalized and again examined under anesthesia on December 8, 1978. Vaginal biopsies revealed vaginal adenosis and chronic inflammation. A Papanicolaou smear performed in 1980 showed focal endocervical cell atypia. On August 26, 1981 the patient was seen because of a vaginal discharge. A mass on the posterior wall was palpated on digital vaginal examination. Colposcopically directed biopsies confirmed the diagnosis of a clear-cell adenocarcinoma arising from the posterior vaginal wall ring. There was no evidence of cancer elsewhere in the vagina or on the cervix. On September 10, 1981 a radical abdominal hysterectomy, bilateral pelvic lymphadenectomy, periaortic node biopsy, and total vaginectomy were performed. The patient was treated wiht 5000 rads to an 8x10 cm midpelvic field, but vaginal reconstruction was not performed due to the patient's asocial lifestyle. An incidence of 0.14-1.4 tumors/1000 DES exposed females through age 24 is generally accepted.