A 26-year-old woman, whose mother took diethylstilbestrol during pregnancy with her, is found to have a polypoid vaginal mass. Biopsy shows malignant glands lined by hobnail-shaped cells with abundant clear cytoplasm growing in tubulocystic and solid patterns. What is the diagnosis?

• A Squamous cell carcinoma of the vagina
• B Vaginal melanoma
• C Embryonal rhabdomyosarcoma
• D Clear cell adenocarcinoma of the vagina ✓

Explanation

Clear cell adenocarcinoma of the vagina and cervix occurs in daughters exposed in utero to diethylstilbestrol, which was used until 1971 for threatened abortion. DES also causes vaginal adenosis, the ectopic müllerian-type epithelium thought to be the precursor. The hobnail clear cells in tubulocystic and solid patterns are diagnostic. Squamous carcinoma is HPV related and unrelated to DES exposure.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.