Observations on the psychological impact of diethylstilbestrol exposure and suggestions on management

The emotional impact of diethylstilbestrol (DES) exposure is described in a series of 50 mothers and daughters interviewed by psychiatrists. Patterns of response to this trauma and methods of resolution are discussed, and opportunities for preventive intervention by gynecologists are suggested. Specific, open dialogue about DES with the patient as a colleage can minimize the emotional sequelae of the experience.

Post-transfusion purpura as a gynecologic complication

Post-transfusion purpura (PTP) is a recently separated category of thrombocytopenic purpura occurring mainly in women. It is an acute, severe thrombocytopenic state with clinical manifestations of hemorrhage that may be fatal. It usually occurs 5 to 8 days after transfusion, usually after administration of whole blood. The typical patient is a middle-aged, multiparous white woman who has received a transfusion and has undergone an operation, often a gynecologic procedure. Diagnosis may be suspected by normal clotting studies, bone marrow biopsy showing increased megakaryocytes, and demonstration of a potent antibody reactive against platelets by clot-retraction inhibition, complement fixation, or 51Cr-release studies. The treatment of choice is exchange transfusion or plasmapheresis, unless these procedures are medically contraindicated. Because of the lack of reports in the gynecology literature on PTP, a case report and discussion are presented.

Carbon dioxide laser therapy of cervical intraepithelial neoplasia: factors determining success rate

Sixty patients with biopsy proven CIN were treated with CO2 laser. Severity of the lesion was equally divided among all three grades of CIN. All patients were biopsied immediately after laser therapy and at six and twelve weeks past treatment. Persistence or absence of disease was evaluated with respect to severity of disease, size of lesion, method of applying laser, whether the endocervical canal was involved, whether only the lesion or the entire transformation zone was lasered, and depth of laser effect. The persistence of disease was 36.7 percent after therapy. Success was not related to severity of disease, size of lesion, or whether the endocervical canal was involved. It was related to depth of coagulation necrosis, method of applying the laser bean, and if the entire transformation zone was treated.

Glandular dysplasia in diethylstilbestrol-associated vaginal adenosis. A case report and review of the literature

A case of diethylstilbestrol-associated vaginal adenosis in which dysplastic glands were identified and examined by light and electron microscopy is reported. Transitions between normal and dysplastic glands were documented in subserial sections. These alterations may characterize an intermediate phase in the development of clear-cell adenocarcinoma of the vagina.

Vaginal and cervical squamous cell dysplasia in women exposed to diethylstilbestrol in utero

Two hundred and fifty patients were examined because of a history of in utero exposure to diethylstilbestrol (DES) or because of the presence of physical findings suggesting such exposure. One thousand biopsies were examined for the presence of neoplasia and then compared to the colposcopic findings. There were no cases of glandular or squamous cell carcinoma. Fifteen (6 per cent) of the patients had squamous cell dysplasia. The degree of dysplasia was mild in 11 and moderate in only 4 (1.6 per cent) of the women. The majority of the cases of dysplasia involved the cervix, whereas the vagina was involved in only four cases, with simultaneous cervical dysplasia in three of these. Patients with cervical mosaic and white epithelium had dysplasia on biopsy much more frequently as compared with patients with similar colposcopic appearances in the vagina. Our results suggest a low incidence of significant squamous precancerous change in the DES-exposed population and provide evidence that colposcopic data concerning dysplasia pertinent to the cervix cannot be applied without modification to the evaluation of dysplasia in vaginal adenosis.

Vaginal adenosis. Factors influencing detection in a colposcopic evaluation

In a colposcopic evaluation of DES-related genital abnormalities, biopsy-proven adenosis was detected in the vaginal walls or hood in 84.5% of 220 women. Patient selection (DES history only vs prior examination) did not significantly influence the detection rate for adenosis. However, the detection rate of adenosis in the vaginal walls showed highly significant correlations with the presence of cervical ectopy and/or hood and with the colposcopic appearance of the area biopsied. Using colposcopy, the columnar pattern had a diagnostic accuracy of 94.4%; mosaic pattern, 85.5%; and white appearance, 68.0%. Differences in the histologic features of mucosal surface glandular tissue, squamous metaplasia, and nonglycogenated squamous mucosa were related to specific colposcopic patterns and helped to account for the variation in the accuracy of the three appearances in detecting adenosis. Biopsy specimens of the hood were not necessary to achieve a high yield of adenosis although we obtained evidence that the hood contains microscopic features typical of vaginal adenosis. Epithelial atypicality in the vagina (moderate squamous cell dysplasia) was demonstrated in only 1 patient.

Vaginal adenosis. Analysis of 325 biopsy specimens from 100 patients

Biopsy-proven vaginal adenosis was found in 88% of a group of 100 asymptomatic young women with known or suspected to have histories of intrautering diethylstilbestrol (DES) exposure. Histologic features were roughly quantitated and were found to vary markedly from patient to patient, but the following proved to be the most consistent features: (1) variation in glandular configuration (simple, complex, cystic); (2) the presence of epithelium recapitulating all parts of the müllerian duct system (endocervical, endometrial and tubal); (3) limited involvement of the vaginal mucosa (no surface involvemtn in 23.8% of the patients); (4) extensive squamous metaplasia; (5) submucosal inflammation. There was no glandular dysplasia or coexistent adenocarcinoma. The squamous epithelium in many specimens contained little or no glycogen, and in some manifested cellular activity consistent with a regenerative response to inflammation. Sufficient atypicality to implicate vaginal adenosis as a premalignant lesion was not found in any biopsy specimen.