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.{{Cite journal

| last1 = Newbold

| first1 = R. R.

| last2 = McLachlan

| first2 = J. A.

| title = Vaginal adenosis and adenocarcinoma in mice exposed prenatally or neonatally to diethylstilbestrol

| journal = Cancer Research

| volume = 42

| issue = 5

| pages = 2003–2011

| date = May 1982

| pmid = 7066910

}}{{Cite journal

| last1 = Sandberg

| first1 = E. C.

| title = The incidence and distribution of occult vaginal adenosis

| journal = American Journal of Obstetrics and Gynecology

| volume = 101

| issue = 3

| pages = 322–334

| date = June 1968

| pmid = 4172394

| doi = 10.1016/0002-9378(68)90058-6

}}

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.{{Cite journal

| last1 = Kranl

| first1 = C.

| last2 = Zelger

| first2 = B.

| last3 = Kofler

| first3 = H.

| last4 = Heim

| first4 = K.

| last5 = Sepp

| first5 = N.

| last6 = Fritsch

| first6 = P.

| title = Vulval and vaginal adenosis

| journal = The British Journal of Dermatology

| volume = 139

| issue = 1

| pages = 128–131

| date = July 1998

| pmid = 9764164

| doi = 10.1046/j.1365-2133.1998.02329.x

| s2cid = 37183823

}} Risk is however still present in subsequent generations due to recent exposure.{{cite journal|last1=Sharp|first1=Gerald B.|last2=Cole|first2=Philip|title=Vaginal bleeding and diethylstilbestrol exposure during pregnancy: Relationship to genital tract clear cell adenocarcinoma and vaginal adenosis in daughters|journal=American Journal of Obstetrics and Gynecology|volume=162|issue=4|year=1990|pages=994–1001|issn=0002-9378|doi=10.1016/0002-9378(90)91303-T|pmid=2327468}}

It is thought steroid hormones play a stimulatory growth in adenosis formation.{{cite journal|last1=Kurman|first1=Robert J.|last2=Scully|first2=Robert E.|title=The incidence and histogenesis of vaginal adenosis|journal=Human Pathology|volume=5|issue=3|year=1974|pages=265–276|issn=0046-8177|doi=10.1016/S0046-8177(74)80111-5|pmid=4829509}} Vaginal adenosis is also often observed in adenocarcinoma patients.{{cite journal|last1=Herbst|first1=Arthur L.|last2=Scully|first2=Robert E.|title=Adenocarcinoma of the vagina in adolescence.A report of 7 cases including 6 clear-cell carcinomas (so-called mesonephromas)|journal=Cancer|volume=25|issue=4|year=1970|pages=745–757|issn=0008-543X|doi=10.1002/1097-0142(197004)25:4<745::AID-CNCR2820250402>3.0.CO;2-2|pmid=5443099|s2cid=71905296 |doi-access=free}}{{Cite journal

| last1 = Stafl

| first1 = A.

| last2 = Mattingly

| first2 = R. F.

| title = Vaginal adenosis: a precancerous lesion?

| journal = American Journal of Obstetrics and Gynecology

| volume = 120

| issue = 5

| pages = 666–677

| date = November 1974

| pmid = 4422247

| doi = 10.1016/0002-9378(74)90610-3

}}

Diagnosis

Colposcopically, it presents itself similarly to columnar epithelium on the cervix, assisted with lugol's solution application for diagnosis.{{Cite journal

| first1 = A. I.

| last1 = Sherman

| first2 = M.

| last2 = Goldrath

| first3 = A.

| last3 = Berlin

| first4 = V.

| last4 = Vakhariya

| first5 = F.

| last5 = Banooni

| first6 = W.

| last6 = Michaels

| first7 = P.

| last7 = Goodman

| first8 = S.

| last8 = Brown

| title = Cervical-vaginal adenosis after in utero exposure to synthetic estrogens

| journal = Obstetrics & Gynecology

| volume = 44

| issue = 4

| pages = 531–545

| date = October 1974

| pmid = 4412373

}}{{Cite journal

| last1 = Stafl

| first1 = A.

| last2 = Mattingly

| first2 = R. F.

| last3 = Foley

| first3 = D. V.

| last4 = Fetherston

| first4 = W. C.

| title = Clinical diagnosis of vaginal adenosis

| journal = Obstetrics & Gynecology

| volume = 43

| issue = 1

| pages = 118–128

| date = January 1974

| pmid = 4808952

}} 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.{{cite journal|last1=Roberts|first1=Daniel K.|last2=Walker|first2=Nola J.|last3=Parmley|first3=Tim H.|last4=Horbelt|first4=Douglas V.|title=Interaction of epithelial and stromal cells in vaginal adenosis|journal=Human Pathology|volume=19|issue=7|year=1988|pages=855–861|issn=0046-8177|doi=10.1016/S0046-8177(88)80270-3|pmid=3402975}} 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.{{cite journal|last1=Robboy|first1=Stanley J.|last2=Hill|first2=Edward C.|last3=Sandberg|first3=Eugene C.|last4=Czernobilsky|first4=Bernard|title=Vaginal adenosis in women born prior to the diethylstilbestrol era|journal=Human Pathology|volume=17|issue=5|year=1986|pages=488–492|issn=0046-8177|doi=10.1016/S0046-8177(86)80039-9|pmid=3699812}}

It is sometimes considered a precancerous lesion, given clear-cell adenocarcinoma patients present these lesions in close proximity to atypical tuboendometrial glands,{{cite journal|last1=Robboy|first1=Stanley J.|last2=Young|first2=Robert H.|last3=Welch|first3=William R.|last4=Truslow|first4=Geri Y.|last5=Prat|first5=Jaime|last6=Herbst|first6=Arthur L.|last7=Scully|first7=Robert E.|title=Atypical vaginal adenosis and cervical ectropion. Association with clear cell adenocarcinoma in diethylstilbestrol-exposed offspring|journal=Cancer|volume=54|issue=5|year=1984|pages=869–875|issn=0008-543X|doi=10.1002/1097-0142(19840901)54:5<869::AID-CNCR2820540519>3.0.CO;2-I|pmid=6537153|doi-access=free}} and microglandular hyperplasia has been seen to arise from these lesions.{{Cite journal

| first1 = S. J.

| last1 = Robboy

| first2 = W. R.

| last2 = Welch

| title = Microglandular hyperplasia in vaginal adenosis associated with oral contraceptives and prenatal diethylstilbestrol exposure

| journal = Obstetrics & Gynecology

| volume = 49

| issue = 4

| pages = 430–434

| date = April 1977

| pmid = 857207

}}

vaginal adenosis

Causes

Diagnosis

References

Further reading