Use of statins and risks of ovarian, uterine, and cervical diseases: a cohort study in the UK Biobank

PURPOSE

To examine the associations between use of statins and risks of various ovarian, uterine, and cervical diseases, including ovarian cancer, endometrial cancer, cervical cancer, ovarian cyst, polycystic ovarian syndrome, endometriosis, endometrial hyperplasia, endometrial polyp, and cervical polyp.

METHODS

We conducted a cohort study among female participants in the UK Biobank. Information on the use of statins was collected through verbal interview. Outcome information was obtained by linking to national cancer registry data and hospital inpatient data. We used Cox proportional hazards regression to examine the associations.

RESULTS

A total of 180,855 female participants (18,403 statin users and 162,452 non-users) were included. Use of statins was significantly associated with increased risks of cervical cancer (adjusted hazard ratio (HR), 1.55; 95% confidence interval (95% CI), 1.05-2.30) and polycystic ovarian syndrome (adjusted HR, 4.39; 95% CI, 1.68-11.49). However, we observed no significant association between use of statins and risk of ovarian cancer, endometrial cancer, ovarian cyst, endometriosis, endometrial hyperplasia, endometrial polyp, or cervical polyp.

CONCLUSION

Our findings suggest that use of statins is associated with increased risks of cervical cancer and polycystic ovarian syndrome, but is not associated with increased or decreased risk of ovarian cancer, endometrial cancer, ovarian cyst, endometriosis, endometrial polyp, or cervical polyp.

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE

To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus

METHODS

This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay.

RESULTS

A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection.

CONCLUSIONS

The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus.

Vascular endothelial growth factor induces growth of uterine cervix and immune cell recruitment in mice

Knowledge of uterine cervical epithelial biology and factors that influence its events may be critical in understanding the process of cervical remodeling (CR). Here, we examine the impact of exogenous vascular endothelial growth factor (VEGF) on uterine cervical epithelial growth in mice (nonpregnant and pregnant) treated with VEGF agents (recombinant and inhibitor) using a variety of morphological and molecular techniques. Exogenous VEGF altered various uterine cervical epithelial cellular events, including marked induction of growth, edema, increase in inter-epithelial paracellular space, and recruitment of immune cells to the outer surface of epithelial cells (cervical lumen). We conclude that VEGF induces multiple alterations in the uterine cervical epithelial tissues that may play a role in local immune surveillance and uterine cervical growth during CR.

Mitochondrial decay is involved in BaP-induced cervical damage

Benzo[a]pyrene (BaP) is a polycyclic aromatic hydrocarbon and a potent inducer of carcinogenesis. Many studies have reported that the carcinogenic effects of BaP might be due to its intermediate metabolites and to reactive oxygen species (ROS) that cause oxidative damage to the cells. However, the mechanisms of BaP-induced oxidative damage in cervical tissue are still not clear. We studied these mechanisms in female ICR mice treated with BaP either orally or intraperitoneally by measuring (1) several general biomarkers of oxidative stress in serum, (2) mitochondrial function in the cervix, and (3) the morphology of mitochondria in cervical tissue. BaP treatment (1) significantly lowered levels of vitamins A, C, and E and of glutathione; (2) reduced activities of superoxide dismutase, catalase, glutathione peroxidase, and glutathione S-transferases; and (3) significantly increased lipid peroxidation levels. In addition, significant increases in the levels of superoxide anion, hydrogen peroxide, and hydroxyl radical were observed. These results were confirmed by morphological changes in mitochondria and by decreases in membrane potential levels and in succinate dehydrogenase and malate dehydrogenase activities. The changes in these biomarkers and mitochondrial damage were BaP-dose-dependent and eventually induced both cell apoptosis and necrosis in cervical tissue. As mitochondria are the major sites of ROS generation, these findings show that mitochondrial decay greatly contributes to BaP-induced cervical damage.

Sensitive methods to detect epithelial disruption: tests for microhemorrhage in cervicovaginal lavages

The toxic effects of topical microbicides might include epithelial disruption, and if sufficiently severe, may cause visible bleeding. We have developed two sensitive methods to detect hemorrhage far below the visual detection threshold: an enzyme-linked immunosorbent assay for human hemoglobin and a method for staining and enumerating red blood cells by fluorescent microscopy. We have applied these methods to cervicovaginal and introital lavages, and found them to be sensitive and quantitative over a broad range. Comparing the new techniques with a standard heme-detection assay (Hemastix) we found them to be more sensitive, more objective, more fully quantitative, and more likely to be indicative of recent events. In pilot studies we found that the red blood cell and hemoglobin concentrations in samples taken in the luteal phase of the menstrual cycle are low, but still within the detection range of the new assays, providing a quantifiable baseline from which increases in blood from epithelial disruption can be detected and quantified. We propose that these new methods may be used for the safety assessment of microbicides by detecting and quantifying microhemorrhage in cervicovaginal secretions before and after exposure to microbicide.

Rupture of the cervix in a sulprostone induced abortion in the second trimester

The authors report one case of cervical rupture in a normal uterus of a 43 years old second gravida, during an abortion at 16 weeks induced by sulprostone, a prostaglandin analogue. Case history and analysis of permittent condictions are listed. They conclude that uterus rupture remains an actual side effect of this prostaglandin E2 use, also when predisposing risk factors as scarred uterus, primigravid patients, age <20 years have been excluded, and gemeprost vaginal suppositories to ripen the cervix have been used.

Prevalence of visible disruption of cervical epithelium and cervical ectopy in African women using Depo-Provera

Associations between Depo-Provera (injectable, progesterone-only contraceptive) use and visible disruption of cervical epithelium and cervical ectopy were investigated using data collected as part of a cervical cancer screening study in periurban Cape Town, South Africa. Women were interviewed about their contraceptive use, and underwent a gynecologic examination that included two 35-mm photographs of the cervix after application of 5% acetic acid. Photographs of 723 subjects were reviewed (blind to clinical information and using systematic criteria developed before review) for evidence of atrophy and epithelial disruption, including inflammation and ulceration. The percentage of the cervix covered with columnar epithelium (ectopy) was also estimated from the photographs. A random sample of 85 photographs was reviewed again for reliability. A total of 121 current users of Depo-Provera were no more likely to have evidence of epithelial disruption (38%) than 574 nonusers (39%), odds ratio (OR) = 1.37, 95% CI: 0.89-2.11 adjusting for age and parity. The prevalence of significant ectopy (columnar epithelium covering > 10% of the cervix) was also no different among current Depo-Provera users (OR = 1.22, 95% CI: 0.80-1.86 adjusting for age and parity). Reliability of visual scoring of epithelial disruption and ectopy was excellent (kappa = 0.8). Although the underlying prevalence of visible disruption of cervical epithelium was very high, current use of Depo-Provera was not associated with increased prevalence of visible disruption of the cervical epithelium or with ectopy in this sample of African women.

Necrotizing vasculitis of the skin and uterine cervix associated with minocycline therapy for acne vulgaris

In recent years, minocycline has become a commonly used agent for the treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, drug-induced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. Skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. Patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.

Genetic damage in exfoliated cells of the uterine cervix. Association and interaction between cigarette smoking and progression to malignant transformation?

OBJECTIVE

To determine, through the micronucleus (MN) test, the cytogenetic effects of cigarette smoking on exfoliated cells from the uterine cervix in women with normal smears and women with inflammatory atypia, squamous intraepithelial lesion (SIL) (cervical intraepithelial neoplasia [CIN] 1-3) and cervical cancer.

STUDY DESIGN

The study group consisted of 200 women divided into three subgroups: group 1 (n = 116), women periodically undergoing cervical cytology and residents of Salvador-Bahia; group II (n = 57), women residing in São Paulo and previously selected because of a possible cytopathologic test positive for such conditions as human papillomavirus infections or malignant or premalignant cervical lesions (CIN 1-3); group III (n = 27), inmates of the Tatuapé Penal Institution, São Paulo. All the women underwent cytologic and colposcopic examination, and biopsies were performed on 68 of them.

RESULTS

Considering the samples as a whole and using the chi(2) test for rare events, the number of MNs in smokers was significantly greater than in nonsmokers. It was also greater in women with larger exposure to smoking. The occurrence of MN was significantly lower in women with normal smears (smokers and nonsmokers) than in those showing any kind of pathologic alteration. In nonsmokers the occurrence of MN was similar between those with inflammatory atypia (IA) or low grade (L) SIL (CIN 1) and significantly higher in women with more severe lesions or high grade (H) SIL (CIN 2 and 3). Smokers with LSIL (CIN 1) showed a higher number of MNs than nonsmokers with a comparable diagnosis and smokers with IA. No differences were observed when compared with smokers with HSIL (CIN 2 and 3). MN occurrence was not associated with other risk factors for SIL or cancer development, such as age at first coitus, number of sexual partners, multiparity and use of hormonal contraceptives.

CONCLUSION

These results suggest that the mutagenic effect of cigarette smoking occurs in cervical cells and that the progression of SIL is associated with increased frequency of chromosomal damage. Moreover, the data suggest that cigarette smoking introduces an additional risk to the progression of low grade LSIL (CIN 1). MN testing would be helpful in monitoring smokers with this kind of lesion.

The daughters of diethylstilbestrol. Lessons from an error

Diethylstilbestrol (DES) has been used extensively to prevent pregnancy disorders in Europe but at different levels depending upon the countries. Lessons from the DES story can be learned for research, information for physicians, communication, administration and industry. However, this paper will focus on the incidence of this story in our practice. We will propose guidelines for different conditions: clear cell adenocarcinoma, adenosis, cervical dysplasia, infertility and pregnancy.

Lymphoproliferative disorder involving the cervix in a patient being treated with FK-506

FK-506 is an immunosuppressive agent used mainly to prevent allograft rejection in organ transplant patients. Recently, it has been applied as a treatment for patients with autoimmune disorders. An entity called posttransplant lymphoproliferative disorder (PTLD) is a well-recognized result of immunosuppression in transplant patients receiving long-term immunosuppression. This disorder is a complication of treatment with FK-506 in 0.7 to 1.6% of transplant patients and is usually of B-cell origin. A majority of patients have serologic evidence of EBV infection. We report a case of a patient receiving long-term FK-506 therapy for multiple sclerosis who developed lymphoproliferative disorder involving the cervix. We will discuss the possible role of FK-506 initiation of this tumor.

Comparison of spermicides on vulvar, vaginal, and cervical mucosa

The objective of this study was to compare the tolerability of Advantage 24 to two other spermicides containing non-oxynol-9 (N-9). These spermicides were Today Sponge (Sponge) and Conceptrol. In order to examine the incidence of complaints and the clinical observation of vaginal ulceration and irritation of the three spermicides, a randomized, open label, three period cross-over trial was conducted. Thirty-three women, ages 18-45, with a normal vaginal environment based on physical exam, Pap smear, vaginal wet prep, colposcopy, and serum N-9 were randomized into four treatment groups. Each treatment was for seven consecutive days with a 21-day washout. Data obtained were studied by one-way analysis of variance, chi-square, and Kruskal-Wallis test. No vulvar or vaginal abnormality was observed from either spermicide. Subjects had fewer and less severe cervical lesions by colposcopy during treatment with Advantage 24 than with Conceptrol or Sponge (p < 0.01). Comparison of the incidence of abnormal gynecological findings, serum N-9 levels, and the incidence of adverse events before and after treatment with the three study drugs indicate that most subjects had normal examinations pre- and post-treatment. Pap smear and colposcopy changes from normal to abnormal accounted for about 50% of all gynecological findings during the Conceptrol and Sponge treatments, but less than 20% during treatment with Advantage 24. All serum N-9 levels were below the level of detection (< 1.9 microgram/ml). Advantage 24 is better tolerated than Conceptrol or the Sponge. Furthermore, the cervical mucosa appears to be less resilient to spermicides than vulvo-vaginal mucosa.

Frequent use of menfegol spermicidal vaginal foaming tablets associated with a high incidence of genital lesions

Menfegol is a spermicide with in vitro activity against human immunodeficiency virus (HIV). A randomized placebo-controlled safety study covered the use of menfegol foaming tablets for 14 days at increasing frequencies of insertion by 125 prostitutes in Dakar, Senegal. The frequencies of colposcopically diagnosed genital lesions were 5.0%, 11.8%, 27.8%, 49.7%, and 29.4% among menfegol recipients when tablets were used once every other day or 1, 2, 4, or 8 times a day, respectively (P < .05). Among placebo recipients, frequencies were 11.1% and 23.5% when tablets were used < 8 times daily and 8 times daily, respectively. There was no association between subjective genital symptoms and the incidence of colposcopically detected lesions. The high incidence of genital lesions when menfegol foaming tablets were used more than once daily suggests that their frequent use should not be recommended to prevent HIV transmission. In use at low frequency, the tablets' toxicity might be balanced by anti-HIV properties. Safety studies on vaginal microbicides should use objective methods, such as colposcopy, to assess the incidence of lesions.

Assessment of estrogen receptor distribution in human endometrium by direct immunofluorescence

OBJECTIVE

To use a direct immunofluorescence technique employing a fluorescein labeled anti-idiotypic antibody that recognizes the estrogen receptor (ER) order to assess the distribution of ER in the uteri of normal women throughout the normal menstrual cycle and of a woman exposed prenatally to diethylstilbestrol (DES).

SUBJECTS

Included in the study were 25 women aged between 35 and 50 years and an amenorrheic patient diagnosed as "DES Syndrome".

LOCALIZATION

Localization of ER expression in frozen sections of uterine tissue was achieved by direct immunofluorescence using a fluorescein labeled anti-idiotypic antibody that interacts with ER.

RESULTS

Analysis of the immunofluorescence staining indicated that in the normal human endometrium the intensity of ER staining varied according to the phase of the cycle as well as according to the cell type. On the other hand, endometrial ER evaluation of the patient with DES syndrome showed minimal expression of ER and after treatment with conjugated estrogens, endometrial biopsy revealed a significant increase in ER expression.

CONCLUSIONS

These findings indicate that the fluorescein labeled anti-idiotypic antibody can be used to detect ER in normal and pathological human endometrium and to monitor changes in ER expression in the endometrium during hormonal therapy.

[Micro-glandular hyperplasia of the uterine cervix. Histo-cytopathological evaluation, differential diagnosis and review of literature]

Microglandular hyperplasia is a lesion of the uterine endocervical mucosa, often associated with a story of contraceptive drugs or pregnancy. It was frequently confused with adenocarcinoma or premalignant glandular changes until its benign nature was recognized. In order to ascertain clinical presentation, hormonal or gestational status, histologic patterns with their variants and cytologic counter-part, we collected and reviewed 28 cases of this condition over a period of a decade. The age ranged from 23 to 54, with a mean of 37.2 years. 11 patients had been receiving oral contraceptives and 5 were pregnant. All samples came from uterine cervix. Cervical smears were available from 17 women. Four histologic patterns were identified, including glandular, reticular, trabecular and solid. Cytologic features varied from aspecific, inflammatory changes of the columnar endocervical cells to more particular findings, including clear cells, strips, sheets, papillae, rosettes and corolla-like aggregates. Moreover, differential diagnostic criteria from cervical neoplasms and various pseudoneoplastic conditions of the cervical glandular epithelium are discussed. An extensive review of the literature is also presented.

Modulatory influence of oral contraceptive pills Ovral and Noracycline on 3-methylcholanthrene-induced carcinogenesis in the uterine cervix of mouse

The present study reports the modulatory influences of combined oral contraceptive formulations, Ovral (0.05 mg ethinylestradiol plus 0.5 mg norgestrel per pill) and Noracycline (0.05 mg ethinylestradiol plus 0.1 mg lynestrenol per pill), on methylcholanthrene (MCA)-induced carcinogenesis in the uterine cervix of Swiss albino mouse. Placement of cotton thread impregnated with beeswax containing approximately 300 micrograms of MCA yielded cervical tumors in 0.0%, 8.6% and 26% animals, respectively, in 30, 60 and 90 days. Concomitant treatments with doses D1 (1/2000th of a pill), D2 (1/200th of a pill) and D3 (1/20th of a pill) of Ovral yielded cervical tumors in 0.0%, 0.0% and 4.5% mice at 30 days, 0.0%, 6.2% and 10% mice at 60 days and in 3.3% (P less than 0.05), 3.4% (P less than 0.05) and 47% mice at 90 days, respectively. Likewise, concomitant treatments with doses D1 (1/2000th of a pill), D2 (1/200th of a pill) and D3 (1/20th of a pill) of Noracycline yielded cervical tumors in 0.0%, 0.0%, 16.6% mice at 30 days, 4%, 3.7% and 54% (P less than 0.05) mice at 60 days and 3.2% (P less than 0.05), 20% and 63% (P less than 0.05) of mice at 90 days, respectively. Both Ovral and Noracycline displayed biphasic action on MCA-induced cervical carcinogenesis in mice. At lower dose levels (D1 and D2), they were inhibitory while at the higher dose level (D3) they were augmentatory in their actions. Both pills also significantly enhanced the incidence of cervical hyperplasia.

[Contraception and risk factors for the development of diseases of the uterine cervix]

In a group of 350 women operated on account of diseases of the uterine cervix in 1986-1988 risk factors associated with cancerogenesis were evaluated. The author provided evidence of a significant rise of CIN in conjunction with contraception. The rise of number of CIN cannot be differentiated from social factors and sexual behaviour of women which are directly related to the increased risk of cancer of the uterine cervix.

Estrogen participation in induction of cervicovaginal adenosis-like lesions in immature mice exposed prenatally to diethylstilbestrol

A high incidence of vaginal adenosis-like lesions (ADL, 67%) was found in 30-day-old offspring of ICR/JCL mice given 4 daily subcutaneous injections of 2,000 micrograms diethylstilbestrol (DES) on days 15-18 of gestation. The prenatally DES-exposed mice and the controls ovariectomized at 10 days of age were given 5 daily subcutaneous injections of 10(-4), 10(-3), 10(-2), 10(-1), or 1 micrograms 17 beta-estradiol (E2), respectively, starting at 25 days of age. ADL was never observed in the age-matched controls given prepubertal injections of any E2 dose. In contrast, high incidences of ADL (63-100%) were found in the vaginal fornix and upper vagina of 30-day-old DES mice receiving prepubertal injections of 10(-3)-1 micrograms E2/day, whereas in DES mice given prepubertal injections of the vehicle alone and a lower daily dose of 10(-4) micrograms E2, incidences were nil and 25%, respectively. Mitotic figures were found in the columnar epithelium with ADL, although the rate was lower than in the ADL-freed stratified epithelium. It is suggested, therefore, that an ovarian hormone (probably estrogen) participates in the prepubertal induction of ADL in DES mice.

A randomized double-blind controlled trial of the value of stilboestrol therapy in pregnancy: long-term follow-up of mothers and their offspring

In the early 1950s, a randomized, double-blind, controlled trial of the value of prophylactic stilboestrol therapy given antenatally to reduce the incidence of late pregnancy toxaemia and to improve perinatal mortality was conducted at University College Hospital, London. Women expecting their first baby were allocated to one or other of two groups. Those in the stilboestrol group started treatment at the 12th week of pregnancy on average and received a mean dose of about 11.5 g of the drug while those in the control group received placebo tablets. In spite of the fact that the original trial documentation was lost, it was possible to be fairly certain which was the treated group and follow-up data from 650 mothers and 660 offspring were obtained from death certificates, cancer registrations and questionnaires sent to general practitioners. We found no indication of any harmful long-term effect of stilboestrol exposure during pregnancy on the mothers--in particular 10 out of 331 women in the untreated group and 9 out of 319 women in the treated group were found to have developed breast cancer. Amongst the daughters, those in the treated group suffered an excess of minor benign lesions of the cervix uteri and an excess (not statistically significant) of unfavourable pregnancy outcomes. None of the daughters had developed clear cell adenocarcinoma of the vagina or cervix uteri. Amongst the sons, we discovered no evidence of any significant excess of genital tract disorders or of impaired reproductive performance in the treated group but one son developed a (fatal) teratoma of the testis. Unexpectedly, psychiatric disease (especially depression and anxiety) was reported by general practitioners about twice as often in the treated group offspring (sons and daughters) as in the untreated group. This result cannot be due to bias, and is unlikely to be due to confounding or chance, and may thus represent an adverse effect of exposure to stilboestrol in utero.

Visualization by light and scanning electron microscopy of reproductive tract lesions in female mice treated transplacentally with diethylstilbestrol

Pregnant female mice were exposed to diethylstilbestrol or 11 beta-methoxy-17 beta-estradiol on Days 9 to 16 of gestation. The female offspring of these animals were then examined for reproductive tract abnormalities. Scanning electron microscopic and histological evaluation of these specimens demonstrated reproductive tract lesions in all treatment groups when compared to matched control mice. These lesions included apparent displacement of the squamocolumnar junction, uterine squamous metaplasia, atypical uterine cell surface specializations, protrusions of uterine cells, vaginal and cervical papillary growths, enlarged uterine cervix, abnormal vaginal and uterine folding patterns, female hypospadias, and the presence of vaginal concretions. Scanning electron microscopic observations proved particularly useful in studying lesions which involved the disruption of the normal structure and shape of the reproductive tract and the displacement of cell types.

Pregnancy outcome in women exposed to diethylstilbestrol in utero

The presence of anomalies in vagina, cervix, and uterine body of women exposed to diethylstilbestrol in utero has provoked interest and concern regarding the reproductive potential of these women. To expand and to evaluate better better the current knowledge in this matter, the outcomes of the pregnancies of exposed women registered in the Stilbestrol Clinic at the Stanford University Medical Center were examined. The results were combined with the published results of similar examinations of other institutions and a summation of all available data is presented. Although it is evident that the majority (79%) of exposed women who have become pregnant and not regularly sought abortion have obtained at least one living infant, the incidence of spontaneous abortion and preterm delivery has consistently been found to be greater in exposed women than in unexposed control women. One of every 30 pregnancies reported in exposed patients has been ectopically located. Additionally, there is suggestive evidence that exposed women with teratologic changes have a higher incidence of pregnancy loss than those without such changes. However, few of these observations can boast statistical validity and statistical validation of the same observation by separate investigators has not been obtained. Moreover, none of th teratologic changes in exposed patients has been seen to preclude normal pregnancy and term delivery.

Neonatal estrogen treatment and epithelial abnormalities in the cervicovaginal epithelium of adult mice

Female NMRI mice were given injections of different doses of 17 beta-estradiol, 17 alpha-estradiol, diethylstilbestrol (DES), dienestrol, trans-stilbene, progesterone, testosterone, 5 alpha-dihydrotestosterone, or olive oil for the first 5 days after birth. When the females were killed at 8 weeks after birth, all the estrogens, effective at different dose levels (10(-2) to 5 microgram/day), had resulted in the display by several of the cervicovaginal preparations studied of a heterotopic columnar epithelium (HCE) in regions where females given injections of olive oil, testosterone, 5 alpha-dihydrotestosterone, progesterone, or trans-stilbene had only the normal squamous epithelium. The further fate of the HCE was followed at two later age stages, 36 to 52 weeks and 14 to 17 months. The HCE developed into glandular-like structures penetrating into the stroma and justifying the designation of adenosis. DES resulted in a more pronounced adenosis than did 17 beta-estradiol; in both cases, metaplasia was a striking component of the adenosis regions. Development of adenosis from HCE was dependent upon presence of the ovaries. Some preparations from 44-week-old females given DES injections showed signs of a beginning malignant transformation in the adenosis regions, more evident in 17-month-old females. Among the 23 preparations in the latter group, 8 had changes morphologically indicating malignancy with examples of adenocarcinoma, mixed carcinoma, and squamous carcinoma. Because of the seemingly low aggressive nature of this malignancy, the term "pseudocarcinoma" is discussed. Ten- to 12-week-old BALB/c and C57BL/6 females given DES injections neonatally had HCE in the uterine cervix and vaginal fornices after neonatal DES injections. Differences in extension of HCE were observed after DES injections for three different 5-day periods in th neonatal and immature stages of NMRI females. An interaction between different DES-sensitive parameters to result in the pseudocarcinomas is discussed.

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.