Robboy S J, Young R H, Welch W R, Truslow G Y, Prat J, Herbst A L, Scully R E
Cancer. 1984 Sep 1;54(5):869-75. doi: 10.1002/1097-0142(19840901)54:5<869::aid-cncr2820540519>3.0.co;2-i.
Knowledge of the evolution of clear cell adenocarcinomas of the vagina and cervix in diethylstilbestrol-exposed progeny has remained elusive despite the known topographical association of these tumors with the tuboendometrial form of vaginal adenosis and cervical ectropion. Twenty radical hysterectomy or radical hysterectomy and vaginectomy specimens of clear cell adenocarcinoma of the vagina or cervix were serially blocked in toto; tuboendometrial epithelium was found in the vagina in 19 (95%) of the cases, usually in greatest concentration at the margin of the tumor, particularly inferiorly. Foci of atypical tuboendometrial epithelium were identified in 16 (80%) of the cases, almost always immediately adjacent to the tumor. Twenty-five of a second group of 47 specimens in which only substantial portions of the vagina or cervix adjacent to a clear cell adenocarcinoma were available for examination also had foci of atypical tuboendometrial epithelium. The frequency with which atypical tuboendometrial glands in the vagina and cervix were associated with the carcinomas and the proximity of the former to the latter provide strong evidence that atypical vaginal adenosis and atypical cervical ectropion of the tuboendometrial type are precursors of clear cell adenocarcinoma.
尽管已知这些肿瘤在地形学上与阴道腺病的输卵管子宫内膜型和宫颈外翻有关，但对于己烯雌酚暴露后代中阴道和宫颈透明细胞腺癌的演变情况仍不清楚。对20例阴道或宫颈透明细胞腺癌的根治性子宫切除术或根治性子宫切除术加阴道切除术标本进行了连续整体包埋；19例（95%）病例的阴道中发现了输卵管子宫内膜上皮，通常在肿瘤边缘尤其是下部浓度最高。16例（80%）病例中发现了非典型输卵管子宫内膜上皮灶，几乎总是紧邻肿瘤。在另一组47个标本中，有25个标本仅能检查与透明细胞腺癌相邻的阴道或宫颈的大部分组织，这些标本也有非典型输卵管子宫内膜上皮灶。阴道和宫颈中非典型输卵管子宫内膜腺与癌的关联频率以及前者与后者的接近程度提供了有力证据，表明输卵管子宫内膜型非典型阴道腺病和非典型宫颈外翻是透明细胞腺癌的前驱病变。
