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Vaginal Adenosis


Presentation

  • Eight cases of microglandular hyperplasia arising in vaginal adenosis are presented.[ncbi.nlm.nih.gov]
  • Argentaffin cells were present within these areas, a feature not previously reported in benign vaginal adenosis.[ncbi.nlm.nih.gov]
  • The first case presented a problem of atypical columnar epithelium with simple gland architecture, while the second showed a pseudoinfiltrative pattern of small glands, but without cytological atypia.[ncbi.nlm.nih.gov]
  • Risk is however still present in subsequent generations due to recent exposure.It is thought steroid hormones play a stimulatory growth in adenosis formation. Vaginal adenosis is also often observed in adenocarcinoma patients.[en.wikipedia.org]
  • Biopsy-proved vaginal adenosis was present in 35% of the exposed population as compared with only 1% of the control subjects.[ncbi.nlm.nih.gov]
Localized Pain
  • ., is very rare. [4] Patients with small cell carcinoma of female genital tract may be asymptomatic but usually present with localized pain, vaginal bleeding, abdominal bloating or a mass.[cancerjournal.net]
Withdrawn
  • Once bowel sounds are auscultated and the patient passes flatus, then oral feeding is initiated; the TPN is withdrawn when oral intake is adequate. Intermittent, pneumatic calf compression is continued until the patient is fully ambulatory.[emedicine.medscape.com]
Vaginal Discharge
  • A 24-year-old female presented with complaints of persistent vaginal discharge and dyspareunia. On examination, there were red, patchy, diffuse lesions on the vaginal wall and cervix.[ncbi.nlm.nih.gov]
  • However, it should be considered as a possible diagnosis in girls with persistent vaginal discharge.[ncbi.nlm.nih.gov]
  • The development of the intestinal metaplasia coincided with the onset of a vaginal discharge so severe that, after 7 years, a vaginal resection was performed.[ncbi.nlm.nih.gov]
  • As a result, abnormally heavy vaginal discharge can occur. Because heavy vaginal discharge can also indicate infection, it is important that you work with a medical professional to be sure the issue is vaginal adenosis.[hystersisters.com]
  • A 40year-old female presented with complaints of persistent excessive watery vaginal discharge. On examination, there was red, patchy, diffuse lesion all over the vaginal wall and cervix.[semanticscholar.org]
Profuse Vaginal Discharge
  • Plouffe L, Hansen K, Hanly M: Vaginal adenosis following transverse vaginal septum resection as a cause of profuse vaginal discharge. Fertil Steril 1997;68(suppl 1):180–181. Herbst AL: Diethylstilbestrol and adenocarcinoma of the vagina.[karger.com]
Cervical Enlargement
  • Other cervicovaginal abnormalities observed after prenatal DES exposure included structural alterations, cervical enlargement, squamous metaplasia in the endocervical canal, excess keratinization of the ectocervix and vagina, transverse folds and basal[ncbi.nlm.nih.gov]

Workup

  • Otherwise, the antibiotic is changed according to the fever workup and cultures are obtained. If the cultures are negative for infection, then the antibiotics should be changed to cover anaerobic and gram-negative organisms.[emedicine.medscape.com]
Lymphocytic Infiltrate

Treatment

  • We report an unusual long-term consequence of treatment.[ncbi.nlm.nih.gov]
  • The pathogenesis, treatment and risk of malignant transformation are discussed.[ncbi.nlm.nih.gov]
  • Vaginal adenosis and clear cell adenocarcinoma of the vagina occurred in a 44-year-old woman after treatment for condylomata acuminata. She had no known exposure to diethylstilbestrol (DES) in utero.[ncbi.nlm.nih.gov]
  • Treatment of vaginal adenosis with the carbon dioxide laser did not significantly reduce the incidence of development of new dysplasia in the DES-exposed offspring.[ncbi.nlm.nih.gov]
  • Due to a poor response to metronidazole and tetracycline treatments, unipolar cauterization was performed with successful removal of the lesions.[ncbi.nlm.nih.gov]

Prognosis

  • Primary neuroendocrine carcinoma of the female genital tract is a rare entity with aggressive clinical behavior and a poor prognosis. This kind of malignancy arising in the vagina is extremely rare.[ncbi.nlm.nih.gov]
  • Until the natural history of sufficient numbers of these variants of vaginal adenosis have been studied, the analogous cervical condition may serve as a guide to prognosis.[ncbi.nlm.nih.gov]
  • Prognosis It is expected that the vast majority of patients will have squamous metaplasia and epithelialization with complete resolution of the adenosis.[tipsdiscover.com]
  • Flats Phase-4 Ashok Vihar Delhi-110052 India Source of Support: None, Conflict of Interest: None DOI: 10.4103/0973-1482.113422 Primary neuroendocrine carcinoma of the female genital tract is a rare entity with aggressive clinical behavior and a poor prognosis[cancerjournal.net]

Etiology

  • Vaginal adenosis, without a history of diethylstilbestrol (DES) exposure, is a rare condition with an unclear etiology. A 24-year-old female presented with complaints of persistent vaginal discharge and dyspareunia.[ncbi.nlm.nih.gov]
  • The cervical and vaginal CCACs are generally negative for human papilloma virus (HPV) infection, and their etiology is not understood.[grantome.com]
  • ETIOLOGY/PATHOGENESIS Spontaneous (Developmental Anomaly) Postembryonic persistence of müllerian-type epithelium Environmental Exposure In utero exposure to diethylstilbestrol (DES) If 8th week gestation, 100% develop adenosis If 15th week gestation,[basicmedicalkey.com]
  • Nasrin Akhter and Sakti Das and Afroza Kutubi}, year {2013} } Shamsun Nahar Begum Hena , Nasrin Akhter , 1 author Afroza Kutubi Published 2013 Vaginal adenosis, without a history of diethylstilbestrol (DES) exposure, is a rare condition with an unclear etiology[semanticscholar.org]
  • In DES-exposed females, the incidence of adenosis is higher; the etiology presumably is from the effect of the DES on the developing embryologic system.[tipsdiscover.com]

Epidemiology

  • Epidemiology Incidence Although the cumulative incidence of vaginal adenosis is unknown, the incidence of cloacal malformations is 1/20,000 to 1/25,000 live births.[unboundmedicine.com]
  • Epidemiology Incidence While the incidence of vaginal adenosis is unknown, the incidence of cloacal malformations is 1/20,000 to 1/25,000 live births. Predominant age: Teenage years: Epithelialization occurs from puberty to 20 years of age.[tipsdiscover.com]
  • In 1971 a retrospective epidemiologic study showed a close association of this therapy with occurrence of vaginal and cervical adenocarcinoma in young women (mean age 19 years).[desdaughter.com]
  • Diagnostic criteria and microbial and epidemiologic associations. Am J Med. ‎ Seite 193 - Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States.[books.google.de]
  • Therefore, epidemiological knowledge of this disease, which occurs spontaneously, such as in our Figure 2. Histology of part of the fistula.[file.scirp.org]
Sex distribution
Age distribution

Pathophysiology

  • Predominant age Age Prepubertal: typically absent Age 13 to 25 years: 13% Age 25 years: decreasing prevalence, uncommon beyond age 30 years ( 2 ) Etiology and Pathophysiology In most young females, the etiology is incomplete squamous metaplasia or epithelialization[unboundmedicine.com]
  • General Prevention None: Last DES exposure in the 1970s Pathophysiology In the vast majority of young females, the etiology is incomplete squamous metaplasia or epithelialization. This occurs as a natural phenomenon and resolves with age.[tipsdiscover.com]
  • Anomalies of the uterus Anomalies of Müllerian duct fusion Anomalies of Müllerian duct fusion Types of fusion anomalies Relative frequency Pathophysiology Müllerian agenesis (Class I ) Rare Both the Müllerian ducts fail to develop absent or hypoplastic[amboss.com]
  • […] in 2 - 10% of nonexposed females Sites Involves the upper third of the vagina (34% of DES exposed cases), with the anterior wall more frequently involved than the posterior wall Middle third (9% of cases) and lower third (2% of cases) may be involved Pathophysiology[pathologyoutlines.com]

Prevention

  • DES, an orally active synthetic estrogen, was believed to prevent adverse pregnancy outcome and thus was routinely given to selected pregnant women from the 1940s to the 1960s.[ncbi.nlm.nih.gov]
  • This presentation is a narrative about diethylstilbestrol (DES) which was first synthesized in 1938 and prescribed from the 1940s to 1971 to try to prevent complications of pregnancy.[iupui.edu]
  • DES was last used to prevent spontaneous abortion in the US in 1971; therefore, it is decreasing in clinical significance.[tipsdiscover.com]
  • DES is a synthetic, nonsteroidal estrogen used to prevent miscarriage or premature deliveries from 1938 to 1971 ( 3 ). An estimated 5 million women were prescribed DES during this period ( 4 ).[unboundmedicine.com]
  • Oestrogen supplementation, mainly diethylstilbestrol, for preventing miscarriages and other adverse pregnancy outcomes. Cochrane Database Syst Rev . 200...[5minuteconsult.com]

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