Adolf Stafl

Cancer risk in diethylstilbestrol-exposed offspring

The occurrence of columnar epithelium in the vagina (vaginal adenosis) in young women with intrauterine exposure to diethylstilbestrol (DES) during the first trimester of pregnancy was observed in 231 patients (82 per cent of 280 cases who underwent colposcopic study). Extension of columnar epithelium onto the portio of the cervix was present in the remaining 18 per cent of the cases. Abnormal colposcopic findings were present in the transformation zone in 96 per cent of the patients with vaginal adenosis. Directed biopsy revealed four cases of vaginal and/or cervical squamous carcinoma in situ (CIS), two cases of severe dysplasia, five cases of moderate, and 29 cases of mild dysplasia. The prevalence of CIS in DES-exposed girls (1.4 per cent) was nearly five times the prevalence rate of CIS in a control group of 5,808 DES-unexposed women (0.44 per cent). This finding correlates well with the hypothesis that the genesis of squamous intraepithelial neoplasia is specifically related to the extent and surface area of the vaginal transformation zone. An unusual case of invasive squamous carcinoma in a DES-exposed young girl is presented, which represents the initial observation of this association to date.

Ovarian function in uteroovarian homotransplantation

Abstract This study has defined the role of various laboratory methods in monitoring the viability of this endocrine organ including gonadotropins, arteriograms, routine microscopy, and histochemical studies. Six animals survived the autotransplant procedure and 2 animals became pregnant. Fifty homotransplant studies were performed with varying lengths of graft survival. Base-line urinary FSH bioassay and serum LH immunoassay studies for the dog have been developed and were utilized in determining graft survival or rejection. Histochemical studies for alkaline phosphatase activity in the capillary endothelium of the ovarian graft provide a sensitive method of evaluating the normal and abnormal microcirculation of the ovarian homograft and add a new dimension to the early identification of graft rejection.

Endometrial involvement by cervical intraepithelial neoplasia.

Two cases of cervical intraepithelial neoplasia (CIN) with superficial extension to the endometrium are presented, and the English literature is reviewed. The concept of the radial growth phase of CIN is presented and discussed. The radial growth phase may precede the vertical or invasive phase of neoplastic growth. The possibility of endometrial involvement in CIN points to the potential hazard of not evaluating the endocervix and endometrium before treatment of cervical CIN.

Clinical Diagnosis Of Vaginal Adenosis

Sixty-three patients whose mothers took diethylstilbestrol in the first trimester of pregnancy were studied colposcopically. Vaginal adenosis was found in 91% of patients, and the remaining 9% of cases had extensive eversion of columnar epithelium on the ectocervix. Gross examination was negative in 71% of the cases of vaginal adenosis. Vaginal adenosis produced the same colposcopic pattern as columnar epithelium on the cervix. Confirmation of the origin of vaginal adenosis from the columnar epithelium in the cervix was documented by histochemical correlation of the terminal vascular network. This study demonstrated that colposcopy was an accurate method for the diagnosis of vaginal adenosis, particularly in cases which were not apparent by other methods.

COLPOSCOPIC DIAGNOSIS OF CERVICAL NEOPLASIA

A total of 1410 patients were referred for colposcopic evaluation of the cervix. These included 1206 cases with abnormal cytology and 204 with a grossly suspicious cervical lesion. Diagnostic conization was performed in only 80 patients (5.6%). Two hundred and twentysix cases of severe dysplasia or carcinoma in situ were diagnosed by directed biopsy, while definitive surgical treatment of 181 cases, without conization, revealed no instance of invasive carcinoma. The recognized false-negative rate of directed biopsy in this study (more than 1histologic degree in the surgical specimen than the directed biopsy) was 2 cases among 659 patients (03%). In 160 patients with carcinoma in situ the referring cytology was only “atypical” in 21.2% and the diagnosis was established by colposcopy and a directed biopsy on the initial examination. Eighty-nine pregnant patients with abnormal cytology were referred for colposcopic evaluation and a diagnostic conization was avoided in all. In 25 with severe dysplasia or carcinoma in situ, diagnosed by directed biopsy during pregnancy-, definitive surgical treatment was postponed until after the puerperium, without advancement of the disease.

Squamous neoplasia in DES-exposed women.

The biological effect of DES (diethylstilbestrol) administered during the organogenetic period of pregnancy is teratogenic rather than carcinogenic. A series of 420 women exposed to DES during the 1st trimester of pregnancy were studied. Colposcopic examination revealed that the original squamocolumnar junction occurred in the vagina in 82% of the cases. During the process of squamous metaplasia, there is danger that neoplastic transformation by carcinogens may occur in the vagina or cervix. Reports of the incidence of squamous intraepithelial neoplasia in DES-exposed women vary widely due to differences in patient selection, numbers in the series, and histologic interpretations. Diagnostic accuracy may be improved through the use of spectrophotometric evaluation of DNA content. The possibility that DES-exposed women have a higher risk of squamous neoplasia should be considered.

LASER TREATMENT OF CERVICAL AND VAGINAL NEOPLASIA

The conservative management of cervical intraepithelial neoplasia (with electrodiathermocautery and cryosurgery) is unsuitable for the treatment of similar vaginal lesions because of complications of scarring, stenosis, and fistulas. A new modality of treatment with the use of a carbon dioxide laser beam was evaluated for the treatment of cervical and vaginal intraepithelial neoplasia. Histopathologic examination of cervical tissue after laser beam therapy showed that most of the tissue destruction resulted from evaporation of tissue and that the zone of tissue necrosis was much less than after cryosurgery or electrocautery. Laser therapy was used in 50 patients, 46 of whom had varying degrees of cervical and vaginal intraepithelial neoplasia. Treatment failures occurred in five patients (10 per cent). The experience of this study suggests that the major value of laser treatment of the lower genital tract will be in the management of vaginal intraepithelial lesions, while similar results in the treatment of cervical neoplasia may be achieved by much simpler methods.