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  • Title: A clinicopathologic study of vagina and cervix in DES-exposed progeny.
    Author: Zerner J, Fu YS, Taxiarchis LN, Reagan JW, Richart RM.
    Journal: Diagn Gynecol Obstet; 1980; 2(4):245-56. PubMed ID: 7215109.
    Abstract:
    In this survey of 210 women with a history and/or gross changes of the cervix and vagina characteristic of DES exposure, changes related to vaginal adenosis were correlated with age. The mean age of women with columnar epithelium alone was 18.5 +/- 3.2 years, columnar epithelium with squamous metaplasia was 20.2 +/- 3.4 years, and squamous metaplasia alone was 23.0 +/- 2.7 years. These findings suggest that involution of vaginal adenosis occurs with increasing age. Involution of glands in the superficial stroma in most cases occurred concurrently with that of surface columnar epithelium. However, those deeply seated and complex glands in the stroma might lag in the metaplastic process and might persist. The pitfalls of misinterpretation of squamous cell changes in histologic samples were discussed. The lack of correlation between the colposcopic findings of mosaicism and/or punctuation and squamous cell neoplasia was confirmed in this study. A clinical study was undertaken to determine whether involution of vaginal adenosis occurs at a comparable age in women with different types of adenosis. 210 women with a history and/or gross changes of the cervix and vagina characteristic of diethylstilbestrol exposure were studied by the following means: 1) palpation of the vagina; 2) direct visualization and colposcopic examination of the vagina and cervix; 3) cellular smears of the vagina and cervix; 4) staining of the vagina and cervix with 1/2-strength Lugols solution; and 5) biopsies to document abnormal findings discovered colposcopically. Microsopic findings are illustrated. Diagnostic correlations are tabulated. The involution of vaginal adenosis through squamous metaplasia was related to the age of the women, indicating that involution occurs with increasing age. The involution process is described from microscopic findings in the study. Misinterpretation of squamous cell changes is possible. In fact, misinterpretation of reserve cell hyperplasia and immature squamous metaplasia as dysplasia and overevaluation of dysplastic epithelium are the major sources of the high frequency of dysplastic findings. There is a lack of correlation between colposcopic findings of mosaicism and/or punctuation and squamous cell neoplasia.
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