Natural history of diethylstilbestrol-associated genital tract lesions: Cervical ectopy and cervicovaginal hood

There was a marked regression of structural abnormalities associated with in utero exposure to diethylstilbestrol (DES) among 173 women observed for up to 5 years. Cervical ectopy, present in 121 women at initial examination, decreased in extent in 91 women (75.2%) and disappeared completely in 38 (31.4%). The cervicovaginal hood (CVH), present initially in 123 women, diminished in 65 patients (52.8%) and disappeared completely in 35 (28.4%). The longer the follow-up period, the greater the extent of resolution of these lesions. Patients with both findings at entry into the study showed parallel diminution of ectopy and CVH. The investigation documents that DES-associated ectopy and CVH are labile lesions which tend to decrease in extent with time and may eventually disappear.

Comparison of histologic and colposcopic findings in DES-exposed females

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Benign cervical and vaginal changes associated with exposure to stilbestrol in utero

Examinations of 320 young women allegedly exposed to stilbestrol in utero have revealed at least 12 unique and benign variations from normal anatomy, five in the cervix and seven in the vagina. Over two thirds of the patients revealed one or more of these variations. Some have been previously reported, others have not. None changed significantly or deleteriously during observation. All are described and a representative drawing of each is included. A classificational nomenclature is offered. It is felt that familiarity with these changes will allow presumptive identification by simple pelvic examination of at least two thirds of females exposed to stilbestrol in utero.

Pathogenesis of microglandular hyperplasia of the cervix uteri

Microglandular hyperplasia of the cervix has commonly been associated with pregnancy and oral contraceptive use. In a review of 22 cases seen over the last 10 years, 6 of the cases were not associated with hormonal changes. The idiopathic presentation of this lesion is reviewed. Microglandular hyperplasia of the cervix mimicking clear cell carcinoma of the cervix occurred in a 26-year-old woman with a history of in utero stilbestrol exposure who was taking an oral contraceptive. The differentiation of these two unusual lesions of the cervix is discussed.

Cytologic findings in stilbestrol exposed females with emphasis on detection of vaginal adenosis

This prospective study of 271 females believed to have had prenatal exposure to stilbestrol documents the cytologic findings in separate vaginal and cervical preparations. In 233 patients, direct circumferential scrapings of the upper vaginal wall were taken after potentially contaminating mucous secretions had been removed. These specimens were considered evaluable for the cytologic detection of vaginal adenosis. Cellular evidence of vaginal adenosis was observed in 105 (45%) of these patients as determined by the identification of columnar cells and/or metaplastic squamous cells in the vaginal samples. Columnar cells were observed in 87 (37%) of the 233 patients. Metaplastic squamous cells accompanied the columnar cells in 54 cases. In an additional 18 patients (8%) metaplastic squamous cells were the only cytologic evidence of adenosis. Similar cellular changes were observed in 88 per cent of the vaginal samples from 25 patients with biopsy-proven vaginal adenosis. Malignant cells were not found in any of the cytologic or histologic specimens. Dysplastic squamous cells, however, were present in cytosmears from four patients. Biopsies from two of these patients confirmed the diagnosis of squamous dysplasia. Dysplasia also was identified by biopsy in four others. We believe cytology is a valuable aid in the evaluation of patients with a history of intrauterine exposure to stilbestrol. Vaginal adenosis as well as neoplastic and dysplastic lesions can be reflected in properly obtained cellular specimens.

[Colposcopic findings during hormonal contraception]

The best way to recognize individual differences and alterations of colposcopic findings is by photography. The results of an improved colpophotographic technique is the reproduction of the complete portio. In consequence we can observe the changes of the cervix epithelium which often are extensive and hypertrophic and which in some cases are to be found during the time of hormonal contraception. The different effects of the combination-pill and of the sequential pill are described, the question of individual disposition concerning these alterations is discussed.

Late effects in the vaginal and cervical epithelia after injections of diethylstilbestrol into neonatal mice

Diethylstilbestrol, 5 mug per day for the first 5 days after birth, was injected into neonatal female NMRI mice. The animals were killed 13 months after birth. The upper vaginal part and the uterine cervix were serially sectioned. The histologic study showed extensive adenosis comprising most of the cervical wall. In some regions the glandular epithelium had undergone epidermatization. There were suggestive evidences of cancerous development from both the glandular epithelium and the epithelium in the epidermized regions. In the vaginal part, the squamous epithelium showed hyperplasia, but there were also glandular ducts penetrating far into the subepithelial tissue.