Vaginal adenosis

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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]

Contents

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]

Related Research Articles

<span class="mw-page-title-main">Cervix</span> Lower part of the uterus in the human female reproductive system

The cervix or cervix uteri is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long and roughly cylindrical in shape, which changes during pregnancy. The narrow, central cervical canal runs along its entire length, connecting the uterine cavity and the lumen of the vagina. The opening into the uterus is called the internal os, and the opening into the vagina is called the external os. The lower part of the cervix, known as the vaginal portion of the cervix, bulges into the top of the vagina. The cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago.

<span class="mw-page-title-main">Pap test</span> Cervical screening test to detect potential cancers

The Papanicolaou test is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix or colon. Abnormal findings are often followed up by more sensitive diagnostic procedures and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was independently invented in the 1920s by the Greek physician Georgios Papanikolaou and named after him. A simplified version of the test was introduced by the Canadian obstetrician Anna Marion Hilliard in 1957.

<span class="mw-page-title-main">Cervical cancer</span> Cancer arising from the cervix

Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

<span class="mw-page-title-main">Bartholin's gland</span> Mucous glands located near the vaginal opening

The Bartholin's glands are two pea sized compound alveolar glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina.

<span class="mw-page-title-main">Colposcopy</span> Medical examination of the cervix

Colposcopy is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope. Numbing should be requested prior to procedure.

<span class="mw-page-title-main">Placenta praevia</span> Medical condition

Placenta praevia is when the placenta attaches inside the uterus but in a position near or over the cervical opening. Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Complications may include placenta accreta, dangerously low blood pressure, or bleeding after delivery. Complications for the baby may include fetal growth restriction.

<span class="mw-page-title-main">Cervical intraepithelial neoplasia</span> Medical condition

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. More specifically, CIN refers to the potentially precancerous transformation of cells of the cervix.

<span class="mw-page-title-main">Cervical canal</span> Canal of the uterine cervix

The cervical canal is the spindle-shaped, flattened canal of the cervix, the neck of the uterus.

Vaginal cancer is an extraordinarily rare form of cancer that develops in the tissue of the vagina. Primary vaginal cancer originates from the vaginal tissue – most frequently squamous cell carcinoma, but primary vaginal adenocarcinoma, sarcoma, and melanoma have also been reported – while secondary vaginal cancer involves the metastasis of a cancer that originated in a different part of the body. Secondary vaginal cancer is more common. Signs of vaginal cancer may include abnormal vaginal bleeding, dysuria, tenesmus, or pelvic pain, though as many as 20% of women diagnosed with vaginal cancer are asymptomatic at the time of diagnosis. Vaginal cancer occurs more frequently in women over age 50, and the mean age of diagnosis of vaginal cancer is 60 years. It often can be cured if found and treated in early stages. Surgery alone or surgery combined with pelvic radiation is typically used to treat vaginal cancer.

Gynecologic cancer is a type of cancer that affects the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer.

Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant neoplasm that originates from the fallopian tube.

Amnion nodosum is distinguished by plaques of squamous cells on the amnion's fetal surface. The condition was previously known as "Amnionknötchen" and was first described in 1850. Amnion nodosum is a placental hallmark of severe and prolonged oligohydramnios, and it is associated with a high risk of fetal and perinatal mortality. The cause and pathophysiology of nodule formation in Amnion nodosum are largely unknown.

Hyperthecosis, or ovarian hyperthecosis, is hyperplasia of the theca interna of the ovary. Hyperthecosis occurs when an area of luteinization occurs along with stromal hyperplasia. The luteinized cells produce androgens, which may lead to hirsutism and virilization in affected women.

Cervical cancer staging is the assessment of cervical cancer to determine the extent of the disease. This is important for determining disease prognosis and treatment. Cancer staging generally runs from stage 0, which is pre-cancerous or non-invasive, to stage IV, in which the cancer has spread throughout a significant part of the body.

Müllerian duct anomalies are those structural anomalies caused by errors in Müllerian duct development during embryonic morphogenesis. Factors that precipitate include genetics, and maternal exposure to teratogens.

Microglandular hyperplasia (MGH) of the cervix is an epithelial benign abnormality (lesion) associated with gland proliferation. It can terminate in mature squamous metaplasia, and it is suspected reserve cells are involved in this process, perhaps in the form of reserve cell hyperplasia with glandular differentiation.

<span class="mw-page-title-main">T-shaped uterus</span> Medical condition

A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter T. This is typically observed in DES-exposed women. It is recognised in the ESHRE/ESGE classification, and is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.

<span class="mw-page-title-main">Vaginal epithelium</span>

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

<span class="mw-page-title-main">Vaginal cysts</span> Benign growths of the vaginal epithelium

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Some cysts can be distinguished visually but most will need a biopsy to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.

Diethylstilbestrol (DES), a synthetic nonsteroidal estrogen which was previously used clinically to support pregnancy, has been linked to a variety of long-term adverse effects in women who were treated with it during pregnancy and in their offspring.

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. 1 2 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. S2CID   37183823.
  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. PMID   4829509.
  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. PMID   5443099. S2CID   71905296.
  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. PMID   3402975.
  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. PMID   3699812.
  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. PMID   6537153.
  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.

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