Female Genital Tract Changes Related to Prenatal Diethylstilbestrol Exposure
Diethylstilbestrol (DES) and the chemically related drugs hexestrol and dienestrol are synthetic, nonsteroidal estrogens that were frequently administered to mothers for high-risk pregnancies during the 1940s through the 1960s.12,30,36 In 1971, the rare development of clear cell adenocarcinoma of the vagina in young women was linked to their exposure in utero to these drugs.25 Subsequently a number of non-neoplastic changes were identified in the genital tract of DES-exposed daughters, such as adenosis (glandular epithelium or its secretory products in the vagina), cervical ectropion, various types of cervicovaginal ridges, and structural abnormalities of the uterine corpus and fallopian tube. This chapter describes the pathology and pertinent clinical aspects of clear cell adenocarcinoma of the vagina and cervix as well as the non-neoplastic changes associated with, or possibly related to, DES exposure. Recommendations for the identification and management of exposed daughters,44 possible sequelae in mothers6,7 and sons,51,532,51 animal models for the study of DES exposure,34,39 and general reviews12,18 are presented elsewhere.
KeywordsObstet Gynecol Lamina Propria Clear Cell Carcinoma Squamous Metaplasia Glandular Epithelium
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