Clear-Cell Adenocarcinoma of the Genital Tract in Young Females

Among 91 Registry cases of vaginal and cervical adenocarcinoma predominantly of the clear-cell type, the patients, eight to 25 years of age, were born throughout the United States and in three foreign countries. Pregnancy histories of 66 of the patients' mothers have been obtained; 49 received stilbestrol or related drugs, nine received unidentified drugs administered because of bleeding or prior pregnancy loss, and eight had a negative history. The dosage and duration of therapy varied widely. The frequent coexistence of vaginal adenosis and occasional presence of transverse vaginal or cervical ridges suggested abnormal development of müllerian epithelium in utero. Seventeen of 65 patients have died or had recurrences despite brief follow-up periods in many cases. Although these cancers are rare, the frequency of asymptomatic cases and the unreliability of vaginal cytology for detection support the value of screening postmenarchal females who have been exposed prenatally to stilbestrol or related drugs.