Complications of prenatal therapy with diethylstilbestrol

The possibility that adenosis of the vagina is a premalignant lesion was discussed. Vaginal adenosis had been recorded prior to the availability of diethylstilbestrol. Transverse vaginal ridges, which occur as a consequence of prenatal diethylstilbestrol exposure, may occur even without exposure. Although vaginal adenosis and squamous metaplasia occur in diethylstilbestrol-treated females with vaginal carcinoma and are the source of the ultimate cancer, they are not truly premalignant. Untreated, they will not invariably progress to carcinoma. Adenosis is usually a consequence of exposure to diethylstilbestrol prior to the 17th week of gestation, in those those girls who develop carcinoma, exposure has occurred prior to the 20th week. Radical surgical treatment of adenosis is unwarranted. Contraceptive techniques in these women should be mechanical rather than hormonal. Estrogens increase mucous discharge from the glands and thus increase vaginal discharge in girls with adenosis. Adenosis has been observed by 13 years of age, but carcinoma of the vagina has been reported in a 7-year-old girl exposed to diethylstilbestrol prenatally. After surgery of early vaginal (stage I) carcinoma, preliminary data suggest a 75% overall survival rate.

Duke Scholars

Author Stanley J. Robboy Pathology