Clear Cell Carcinoma of the Vagina. A Clinical, Pathologic and Electron Microscopic Study

Abstract

Four clear cell carcinomas of the vagina are reported; two (from women of 17 and 78 years of age, respectively) were studied with the electron microscope. The younger patient was a product of a pregnancy supported by administration of diethylstilbestrol. Ultrastructurally, both tumors showed glands with short, thick microvilli in the lumina, and cells attached by desmosomes and interdigitating cytoplasmic processes. The cytoplasm was packed with glycogen granules, and also featured many small, uniform mitochondria and "stacked" parallel rows of granular endoplasmic reticulum. These findings are compared with those in ovarian and cervical clear cell carcinomas previously reported, and confirm the identity of the tumors in different sites in the female genital tract. Ultrastructural and other evidence supports a miillerian origin of these tumors. All four tumors have shown an excellent response to radiation therapy.E RECENTLY REPORTED A CASE OF ENDOdermal sinus tumor of the vagina in an infant, and reviewed the world literature pertaining to so-called vaginal "mesonephromas."l I t was clear that, on both clinical and histopathologic grounds, these tumors could be separated into two distinct groups. Endoderma1 sinus tumors (also known as yolk sac carcinomas,l7 "Schiller-type" mes~nephrornas,~~ and "carcinomas of the infant vagina"p4) are predominantly tumors of infancy, are usually found in the posterior vaginal wall or in the fornices, and carry a very poor prognosis, while clear cell carcinomas usually occur in adolescents and mature women, are generally found in the anterior or lateral vaginal wall, and are associated with a relatively satisfactory prognosis. Herbst and scull^'^ have recently presented evidence that this latter tumor is of miillerian derivation, and Herbst et a1. 16 have postulated a relationship between the occurrence of this tumor in adolescents and young women and maternal stilbestrol therapy during the pregnancy at risk. Within the past 3 years, we have diagnosed four vaginal clear cell carcinomas histologically (in women of 22, 78, 17, and 22 years of age, respectively), and have studied material from two patients with the electron microscope. Our ultrastructural observations (the first reported for this tumor) are the basis of the present report. CLINICAL DATAThe pertinent clinical information for our four cases is summarized in Table 1. The mother of one of the three young women stated that she had taken diethylstilbestrol during pregnancy, while the mothers of the other young women denied any such therapy. All four women were obese, but none was diabetic or hypertensive. T w o tumors arose from the posterior vaginal wall and two were anterior. Three were described as polypoid, and three also infiltrated the underlying vaginal wall. All four women were treated by a combination of intravaginal radium and external radiation therapy, although one patient discontinued treatment before it could be completed. Complete tumor regression was noted during the course of treatment in all cases, and th...

Clear Cell Adenocarcinoma of the Vagina: Case Report and Review of the Literature

“…Changes in the DES-exposed male, especially the genital system, have also been described. 8,[16][17][18][19][20][21][22][23][24][25][26][27][28] Owing to the late presentation of our case with evidence of local and distant spread, it was not possible to assess the presence of any of the other lesions reportedly associated with DES exposure.…”

“…[10][11][12][13][14] To our knowledge, this is the first case of clear cell adenocarcinoma of the vagina to be reported in the Eastern Province of Saudi Arabia. Since the initial documentation of association between DES exposure and clear cell adenocarcinoma of the female genital tract by Herbst et al in 1971, 15 subsequent studies on the pathogenesis [16][17][18][19][20][21][22] and other morphologic changes in the female genital system [23][24][25][26][27] have been reported extensively. Changes in the DES-exposed male, especially the genital system, have also been described.…”

Reduplicated Basal Lamina in Clear-Cell Carcinoma of the Ovary: An Immunohistochemical and Electron Microscopic Study

“…In the cervicovaginal tumors that we examined, hyaline material was rarely observed and at most was present only in very small amounts. Both Silverberg and DeGiorgi [7] and Roth [6] reported that well-formed basement membranes without evidence of reduplication were only occasionally seen in vaginal clear-cell carcinomas.…”