Fatma Bahar Cebesoy, MD; Irfan Kutlar, MD; and Abdullah Aydin, MD Gaziantep, Turkey
Vaginal adenosis, without a history of diethylstilbestrol (DES) exposure, is a rare condition with an unclear etiology. A 24year-old female presented with complaints of persistent vaginal discharge and dyspareunia. On examination, therewere red, patchy, diffuse lesions on the vaginal wall and cervix. Histopathologic examination of the lesions revealed vaginal adenosis with chronic inflammation. Due to a poor response to metronidazole and tetracycline treatments, unipolar cauterization was performed with successful removal of the lesions.
Key words: obstetrics/gynecology U vaginal adenosis a chronic inflammation C cauterization© 2007. From the Obstetric and Gynecology Department and Pathology Department (Abdullah Aydin, professor), Faculty of Medicine, Gaziantep University, Gaziantep, Turkey (Cebesoy assistant professor; Kutlar, associate professor). Send correspondence and reprint requests for J NatI Med Assoc. 2007;99:1 66-167 to: Dr. Fatma Bahar Cebesoy, Obstetric and Gynecology Department, Faculty of Medicine,Gaziantep University, Gaziantep, Turkey; phone: +90533 575 60 23; e-mail: email@example.com, fbcebesoy@ gmail.com
A 24-year-old nulliparous woman presented to the obstetrics/gynecology outpatient clinic with complaints of excessive vaginal discharge and dyspareunia. On speculum examination, the mucosa of the vaginal wall, with extension to the ectocervix, displayed extensive brightred, fragile, hyperemic, superficial erosions and ulcerations, which were sharply and irregularly demarcated (Figure 1). Further diagnostic studies were undertaken. A Pap smear was performed, which yielded a diagnosis of ASCUS (atypical cells of undetermined significance). Also, a wet mount was prepared, and it was determined that the patient had trichomonas. She was treated with metronidazole andtetracycline, but her symptoms did not improve. Multiple punch biopsies were taken from the lesions. The histopathological examination of the biopsy revealed chronic inflammation with vaginal adenosis (tuboendometrial-type, epithelium-lined glands throughout the lamina propria) (Figure 2). It was confirmed that patient's mother had not been treated with DES during her pregnancy. There was no historyof condyloma, 5-fluorouracil, C02 laser treatment or any dermatological disorder. We cauterized the cervical and vaginal lesions under local anesthesia because of incomplete regression, despite adequate treatment. No lesion, except minimal cervical erosion, was seen after three weeks ofcauterization.
x raginal adenosis is a rare pathology defined as the presence of Miilleriantype epithelium within the v vaginal wall, which is presumed to be derived from persistent Miillerian epithelium islets in postembryonic life.",2 Although little is known about the etiology, pathogenesis, symptomatology and medical management of this poorly understood condition, its association with in-utero exposure to diethylstilbestrol (DES) and a subsequent high risk of clear-cell vaginaladenocarcinoma is well known.3 Since the withdrawal of DES from the market, this condition is rarely described in the medical literature. Spontaneous vaginal adenosis appears to be fairly common (present in about 10% of adult women), but it is mostly an insignificant finding on physical examination.' However, it should be considered as a possible differential diagnosis in women with persistent vaginaldischarge. A 24-year-old nulliparous woman with vaginal adenosis without DES exposure is presented. Therapeutic and treatment options will also be discussed.
166 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
The clihical appearance of vaginal adenosis is varied: it may present as patchy or diffuse red stippling, granularity or nodularity, single or multiple cysts, erosions, ulcers...