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Development of DES-associated clear-cell carcinoma: the importance of regular screening.

Abstract：

:Because the rate of malignancies in young women exposed in utero to diethylstilbesterol (DES) is low, appropriate population screening methods have not been established. A case is presented that is believed to represent the first reported instance of a DES-exposed daughter who developed clear cell adenocarcinoma of the vagina after initially negative examinations. The patient was followed with Papanicolaou smears, pelvic examinations, and colposcopy every 6 months for 2 years prior to the discovery of malignancy. Initially negative, Papanicolaou smears successfully predicted the presence of an early adenocarcinoma. Palpation aided by colposcopy allowed directed biopsy of the small asymptomatic lesion. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Colposcopy is indicated to direct biopsies when an abnormal cytologic smears is reported or when abnormal bleeding or discharge occurs. Biopsy of any palpable lesion is mandatory. :The value of frequent routine screening of in utero diethylstilbestrol-exposed women has not been established because of lack of documented reports of patients with initially negative examinations who later developed malignancy. LB, a 19-year-old nulligravida with a history of drug exposure in utero, was 1st evaluated for vaginal adenosis at age 15. The patient was followed with Papanicolaou (Pap) smears, pelvic examination, and colposcopy every 6 months for 2 years before malignancy was discovered. After initially negative Pap smears, the patient's smears were classified as Class III 2 years later, and she was referred to the hospital where colposcopy revealed a cervical collar and extensive columnar ectopy covering the entire cervix. A transformation zone, extending onto the upper third of the vagina, showed epithelial and vascular changes characteristic of immature squamous metaplasia. A directed biopsy (aided by palpation) of the area uncovered a clear cell carcinoma. Reactive hyperplasia was present in multiple lymph nodes, and surgery (radical hysterectomy, total vaginectomy, and vaginal reconstruction) was performed. At 24 weeks postoperation, the patient was sexually active and orgasmic, and 1 year postoperation was clinically free of disease, asymptommatic, and enrolled in college, where follow-up continues. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Biopsy of any palpable lesion is mandatory.

journal_name

Obstet Gynecol

journal_title

Obstetrics and gynecology

authors

Anderson B,Watring WG,Edinger DD Jr,Small EC,Netland AT,Safaii H

subject

Has Abstract

pub_date

1979-03-01 00:00:00

pages

293-9

issue

eissn

0029-7844

issn

1873-233X

journal_volume

pub_type

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Development of DES-associated clear-cell carcinoma: the importance of regular screening.