Title: In utero diethylstilbestrol exposure: structural and epithelial abnormalities.
Abstract: Soon after the reported association between diethylstilbestrol (DES) and clear-cell adenocarcinoma, large numbers of women exposed in utero to DES underwent screening examinations. Almost no cases of cancer were detected during this screening, but various epithelial abnormalities were found in many exposed women. Cervical and vaginal epithelial and structural abnormalities found in many DES-exposed women are described. Some of these abnormalities can be seen only with the aid of the colposcope, but many are visible to the naked eye. The identification of potentially exposed women should become a part of every physician's pelvic examination of women born since 1940. The 1st part of the examination of any DES-exposed women should be palpation of the vaginal vault with the index finger. This is done before speculum examination to identify any ridges, constrictions, or masses so that these can be visually inspected. Following vaginal palpation a bivalve speculum is introduced into the vagina in the routine fashion. At this point it is sometimes possible to observe a structural abnormality of the vagina and/or cervix. Any reddened area in the vagina or on the cervix is suspicious for the presence of glandular epithelium. Cytologic specimens should be obtained; it is important to sample all abnormal areas. Many DES-exposed women require sampling of the complete cervix, cervical side walls, vaginal fornices, and the vaginal vault to the point at which normal glycogenated squamous epithelium appears. The largest DES project in the US, "The DESAD Project," recommends taking 1 sample from the cervix wall and a separate sample from the vagina in those women who have vaginal abnormalities. These specimens should be handled in the usual way. It is recommended that whenever a cytologic sample from a DES-exposed woman is reported as being abnormal, the sample be sent to a DES center where it can be reviewed by a cytologist who has seen many samples from exposed women. Colposcopy has been a useful technique for the examination of DES-exposed women, but the findings are often confusing since many "abnormal" areas may be seen in women in whom no pathology is demonstrated. The 1st finding that will be seen by the colposcopist is a widened transformation zone. This may be located only on the cervix or may extend quite far into the vagina. When the glandular epithelium begins to mature, areas stimulating intraepithelial neoplasms may be seen. The areas of vaginal squamous metaplasia may mature with time.
Publication Year: 1983
Publication Date: 1983-05-01
Language: en
Type: article
Indexed In: ['pubmed']
Access and Citation
Cited By Count: 3
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