Vaginal Adenosis: Analysis of 325 Biopsy Specimens from 100 Patients

Abstract

Biopsy-proven vaginal adenosis was found in 88% of a group of 100 asymptomatic young women with known or suspected to have histories of intrauterine diethylstilbestrol (DES) exposure. Histologic features were roughly quantitated and were found to vary markedly from patient to patient, but the following proved to be the most consistent features: (1) variation in glandular configuration (simple, complex, cystic); (2) the presence of epithelium recapitulating all parts of the mullerian duct system (endocervical, endometrial and tubal); (3) limited involvement of the vaginal mucosa (no surface involvement in 23.8% of the patients); (4) extensive squamous metaplasia; (5) submucosal inflammation. There was no glandular dysplasia or coexistent adenocarcinoma. The squamous epithelium in many specimens contained little or no glycogen, and in some manifested cellular activity consistent with a regenerative response to inflammation. Sufficient atypicality to implicate vaginal adenosis as a premalignant lesion was not found in any biopsy specimen.