Vaginal Adenosis
Marisa R. Nucci, MD
Key Facts
Terminology
Müllerian-type epithelium replacing squamous mucosa or forming glands in lamina propria
Etiology/Pathogenesis
Prenatal exposure to diethylstilbestrol (DES) in utero
Clinical Issues
DES-related (90%); non-DES-related (10%)
May be associated with VAIN and clear cell carcinoma
Microscopic Pathology
Mucosal surface or superficial lamina propria
Simple or cystic glands ± papillary infoldings
Endocervical > tuboendometrioid > “embryonic”
Squamous, microglandular, and intestinal metaplasia can occur
Top Differential Diagnoses
Endometriosis
Clear cell carcinoma
 Adenosis typically involves the mucosal surface or lamina propria as smoothly contoured glands that may be cystic  . It may be focal or extensive (as seen here). |
 In adenosis, the glands are most commonly lined by bland endocervical-type epithelium  ; however, tuboendometrioid or “embryonic” (low columnar to cuboidal cells) epithelium may be seen. |
TERMINOLOGY
Definitions
Presence of müllerian-type epithelium replacing squamous mucosa or forming glands in lamina propria of vagina
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, 6% develop adenosis
DES alters p63 expression, potentially resulting in persistence of müllerian-type epithelium into adulthood
Other
Potentially secondary to CO2 laser vaporization, 5-fluorouracil therapy, or prior surgery
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