Vaginal adenosis

Vaginal adenosis is a benign abnormality in the vagina, commonly thought to be caused by intrauterine and neonatal exposure of diethylstilbestrol and other progestogens and nonsteroidal estrogens, however it has also been observed in otherwise healthy women and has been considered at times idiopathic or congenital. Postpubertal lesions have also been observed to grow de novo. It has a rather common incidence, of about 10% of adult women.[1][2][3]

Causes

Vaginal adenosis is characterised by the presence of metaplastic cervical or endometrial epithelium within the vaginal wall, considered as derived from Müllerian epithelium islets in later life. In women who were exposed to certain chemicals, vaginal adenosis may arise in up to 90%. Since these contraceptives were discontinued, incidence has dropped dramatically.[4] Risk is however still present in subsequent generations due to recent exposure.[5]

It is thought steroid hormones play a stimulatory growth in adenosis formation.[6] Vaginal adenosis is also often observed in adenocarcinoma patients.[7][8]

Diagnosis

Colposcopically, it presents itself similarly to columnar epithelium on the cervix, assisted with lugol's solution application for diagnosis.[3][9] It can be discovered as nodules or cysts on the vaginal tube, with biopsy needed for further diagnosis. As seen cytologically, epithelial and stromal cells in vaginal adenosis show characteristic fusion through the basal lamina or with stromal fibroblasts.[10] Adenosal cells can be distinguished as mucinous, tuboendometrial, and embryonic. Its mucinous cells resemble the normal cervical lining, while its tuboendometrial cells resemble the lining of normal fallopian tubes or endometrium.[11]

It is sometimes considered a precancerous lesion, given clear-cell adenocarcinoma patients present these lesions in close proximity to atypical tuboendometrial glands,[12] and microglandular hyperplasia has been seen to arise from these lesions.[13]

References
  1. Newbold, R. R.; McLachlan, J. A. (May 1982). "Vaginal adenosis and adenocarcinoma in mice exposed prenatally or neonatally to diethylstilbestrol". Cancer Research. 42 (5): 2003–2011. PMID 7066910.
  2. Sandberg, E. C. (June 1968). "The incidence and distribution of occult vaginal adenosis". American Journal of Obstetrics and Gynecology. 101 (3): 322–334. doi:10.1016/0002-9378(68)90058-6. PMID 4172394.
  3. Sherman, A. I.; Goldrath, M.; Berlin, A.; Vakhariya, V.; Banooni, F.; Michaels, W.; Goodman, P.; Brown, S. (October 1974). "Cervical-vaginal adenosis after in utero exposure to synthetic estrogens". Obstetrics & Gynecology. 44 (4): 531–545. PMID 4412373.
  4. Kranl, C.; Zelger, B.; Kofler, H.; Heim, K.; Sepp, N.; Fritsch, P. (July 1998). "Vulval and vaginal adenosis". The British Journal of Dermatology. 139 (1): 128–131. doi:10.1046/j.1365-2133.1998.02329.x. PMID 9764164.
  5. Sharp, Gerald B.; Cole, Philip (1990). "Vaginal bleeding and diethylstilbestrol exposure during pregnancy: Relationship to genital tract clear cell adenocarcinoma and vaginal adenosis in daughters". American Journal of Obstetrics and Gynecology. 162 (4): 994–1001. doi:10.1016/0002-9378(90)91303-T. ISSN 0002-9378. PMID 2327468.
  6. Kurman, Robert J.; Scully, Robert E. (1974). "The incidence and histogenesis of vaginal adenosis". Human Pathology. 5 (3): 265–276. doi:10.1016/S0046-8177(74)80111-5. ISSN 0046-8177.
  7. Herbst, Arthur L.; Scully, Robert E. (1970). "Adenocarcinoma of the vagina in adolescence.A report of 7 cases including 6 clear-cell carcinomas (so-called mesonephromas)". Cancer. 25 (4): 745–757. doi:10.1002/1097-0142(197004)25:4<745::AID-CNCR2820250402>3.0.CO;2-2. ISSN 0008-543X.
  8. Stafl, A.; Mattingly, R. F. (November 1974). "Vaginal adenosis: a precancerous lesion?". American Journal of Obstetrics and Gynecology. 120 (5): 666–677. doi:10.1016/0002-9378(74)90610-3. PMID 4422247.
  9. Stafl, A.; Mattingly, R. F.; Foley, D. V.; Fetherston, W. C. (January 1974). "Clinical diagnosis of vaginal adenosis". Obstetrics & Gynecology. 43 (1): 118–128. PMID 4808952.
  10. Roberts, Daniel K.; Walker, Nola J.; Parmley, Tim H.; Horbelt, Douglas V. (1988). "Interaction of epithelial and stromal cells in vaginal adenosis". Human Pathology. 19 (7): 855–861. doi:10.1016/S0046-8177(88)80270-3. ISSN 0046-8177.
  11. Robboy, Stanley J.; Hill, Edward C.; Sandberg, Eugene C.; Czernobilsky, Bernard (1986). "Vaginal adenosis in women born prior to the diethylstilbestrol era". Human Pathology. 17 (5): 488–492. doi:10.1016/S0046-8177(86)80039-9. ISSN 0046-8177.
  12. Robboy, Stanley J.; Young, Robert H.; Welch, William R.; Truslow, Geri Y.; Prat, Jaime; Herbst, Arthur L.; Scully, Robert E. (1984). "Atypical vaginal adenosis and cervical ectropion. Association with clear cell adenocarcinoma in diethylstilbestrol-exposed offspring". Cancer. 54 (5): 869–875. doi:10.1002/1097-0142(19840901)54:5<869::AID-CNCR2820540519>3.0.CO;2-I. ISSN 0008-543X.
  13. Robboy, S. J.; Welch, W. R. (April 1977). "Microglandular hyperplasia in vaginal adenosis associated with oral contraceptives and prenatal diethylstilbestrol exposure". Obstetrics & Gynecology. 49 (4): 430–434. PMID 857207.

Further reading
  • O'Brien, P. C.; Noller, K. L.; Robboy, S. J.; Barnes, A. B.; Kaufman, R. H.; Tilley, B. C.; Townsend, D. E. (March 1979). "Vaginal epithelial changes in young women enrolled in the National Cooperative Diethylstilbestrol Adenosis (DESAD) project". Obstetrics & Gynecology. 53 (3): 300–308. PMID 424101.
  • Laronda, Monica M.; Unno, Kenji; Butler, Lindsey M.; Kurita, Takeshi (2012). "The development of cervical and vaginal adenosis as a result of diethylstilbestrol exposure in utero". Differentiation. 84 (3): 252–260. doi:10.1016/j.diff.2012.05.004. ISSN 0301-4681. PMC 3443265. PMID 22682699. PMID 22682699.
  • Ganesan, R.; Ferryman, S. R.; Waddell, C. A. (1999). "Vaginal adenosis in a patient on Tamoxifen therapy: a case report". Cytopathology. 10 (2): 127–130. doi:10.1046/j.1365-2303.1999.00162.x. ISSN 0956-5507.
  • Laronda, M. M.; Unno, K.; Ishi, K.; Serna, V. A.; Butler, L. M; Mills, A. A.; Orvis, G. D.; Behringer, R. R.; Deng, C.; Sinha, S.; Kurita, T. (2013). "Diethylstilbestrol induces vaginal adenosis by disrupting SMAD/RUNX1-mediated cell fate decision in the Müllerian duct epithelium". Developmental Biology 381(1): 5-16. doi: 10.1016/j.ydbio.2013.06.024. PMID 23830984.
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