Hart W R, Townsend D E, Aldrich J O, Henderson B E, Roy M, Benton B
Cancer. 1976 Feb;37(2):763-75. doi: 10.1002/1097-0142(197602)37:2<763::aid-cncr2820370224>3.0.co;2-t.
A total of 98 colposcopically directed biopsies were obtained from the vagina, cervix, and cervicovaginal ridge (hood) of 80 young women believed to have had intrauterine exposure to stilbestrol (DES). Specific investigation of the patient's medical records corroborated the history of maternal stilbestrol administration in 36 patients (45%), while in the remainder the drug history was regarded as presumptive since medical records were unavailable for review. The findings did not differ significantly in those biopsies taken from patients with confirmed or presumptive drug histories. Histologic evidence of vaginal adenosis was detected in vaginal biopsies from 43 patients. In 30 cases (70%) benign Müllerian-type glandular epithelium was in the superficial vaginal wall, residing on the mucosal surface and/or in the lamina propria. The glandular epithelium predominantly was of endocervical type, but in six instances it resembled endometrial or fallopian tubal epithelium. The glands were accompanied by varying degrees of squamous metaplasia in 22 cases. When extensive the metaplasia produced transformation zones similar to those seen in the normal cervix. Vaginal biopsies of adenosis from the other 13 patients (30%) revealed squamous metaplasia without demonstrable glands due to complete transformation of all antecedent glandular epithelium by squamous metaplasia. Our studies indicate that squamous metaplasia is a component of major importance in the natural history of adenosis and that the concept of adenosis should be broadened to include those examples comprised exclusively of metaplastic epithelium. In such examples metaplasia is identified by the immaturity and poor glycogenation of the squamous cells and their accompanying squamous pegs which often contain residual gland openings or squamous "eddies." Similar findings were present in biopsies of seven cervicovaginal ridges and in cervical biopsies from 37 patients, except for the absence of endometrial or tubal type glands in the latter site. Although no adenocarcinomas were detected, six patients had squamous dysplasia of the vagina and/or cervix. In no case were premalignant or dysplastic changes of glandular cells found. Our findings support the thesis that stilbestrol-associated adenosis represents anomalous embryologic localization of the original squamocolumnar junction in the vagina rather than in the cervix. It is closely related to so-called cervical "erosions." The development of squamous metaplasia accounts for modifications in the clinical and histologic appearances by producing transformation zones which then may be subject to the same oncogenic stimuli for squamous neoplasia as are their counterparts in the cervix.
从80名被认为子宫内曾接触己烯雌酚（DES）的年轻女性的阴道、宫颈和宫颈阴道嵴（阴唇）处共获取了98份阴道镜引导下活检样本。对患者病历的详细调查证实，36名患者（45%）有母亲服用己烯雌酚的病史，而其余患者的用药史因无法查阅病历被视为推测性的。在有确诊或推测性用药史的患者所取活检样本中，结果无显著差异。在43名患者的阴道活检中发现了阴道腺病的组织学证据。在30例（70%）中，良性苗勒氏型腺上皮位于阴道壁浅层，存在于黏膜表面和/或固有层。腺上皮主要为宫颈内膜型，但有6例类似子宫内膜或输卵管上皮。22例中腺体伴有不同程度的鳞状化生。当化生广泛时，会产生类似于正常宫颈所见的转化区。另外13名患者（30%）的阴道腺病活检显示，由于所有先前的腺上皮完全被鳞状化生取代，未见明显腺体，仅有鳞状化生。我们的研究表明，鳞状化生是腺病自然病程中的一个重要组成部分，腺病的概念应扩大到包括那些仅由化生上皮组成的病例。在这些病例中，化生表现为鳞状细胞不成熟、糖原化不良及其伴随的鳞状上皮钉突，后者常含有残留的腺体开口或鳞状“漩涡”。在7例宫颈阴道嵴活检以及37例宫颈活检中也有类似发现，只是宫颈活检中没有子宫内膜或输卵管型腺体。虽然未检测到腺癌，但有6名患者出现了阴道和/或宫颈的鳞状发育异常。未发现腺细胞的癌前或发育异常改变。我们的研究结果支持这样的观点，即与己烯雌酚相关的腺病代表原始鳞柱交界在阴道而非宫颈的异常胚胎定位。它与所谓的宫颈“糜烂”密切相关。鳞状化生的发展通过产生转化区改变了临床和组织学表现，这些转化区随后可能受到与宫颈对应区域相同的鳞状肿瘤致癌刺激。
