DES is a drug that was administered frequently to pregnant
women who were at high risk for early pregnancy loss during
the 1940s through the 1960s.
Multiple developmental, neoplastic epithelial changes, as well
as malignancies of the female genital tract have been linked
to in utero exposure to DES.
- Developmental abnormalities
About 20% of DES-exposed women have gross structural abnormalities
of the vagina or cervix. These are in the form of transverse
vaginal ridges, narrowing of the vaginal apex, cervical hypoplasia,
portio vaginalis completely covered by columnar epithelium,
and anterior cervical lip protuberances.
- Vaginal Adenosis
Vaginal adenosis refers to the replacement of the normal squamous
epithelium of the vagina by glandular epithelium. It is asymptomatic
and presents as red, granular patches on the vaginal mucosa.
It is common in DES-exposed women but rarely, can also present
in women who have not been exposed to DES.
The lesion comprises glandular epithelium, usually endocervical
type, which may or may not merge with metaplastic squamous epithelium.
Glands in chronically inflamed lamina propria and merging with
metaplastic squamous epithelium on the surface.
Benign but rarely, may give rise to clear cell adenocarcinoma.
- Clear cell adenocarcinoma
Clear cell adenocarcinoma of the vagina is a rare tumor that is
associated with in utero DES-exposure.
It affects young women, average 17 years old. Two thirds of
patients have history of in utero DES exposure. The risk in
exposed population is 1 in 1000.
The tumor develops most frequently in the upper, anterior vaginal
wall as a polypoid mass or flat lesion.
It is composed of tubules, nests, and papillae lined by "hobnail"
cells with clear cytoplasm (hence the name "clear cell")
due to the presence of glycogen.
Clear cell adenocarcinoma showing papillae and nests lined by
"hobnail" cells with clear cytoplasm.
Prognosis is good with 80% 5-year survival.