Symposium on Adolescent Gynecology and Endocrinology. Part II: Secondary amenorrhea, hirsutism in adolescents and the clinical consequences of stilbestrol exposure in utero. The clinical consequences of stilbestrol exposure in utero.

The Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Women contains pathologic data on more than 300 women who were exposed to diethylstilbestrol (DES) in utero. The patients range in age from 7 to 29 years; most tumors appear from 14 to 23 years of age. Clear cell carcinoma is not the msot frequent sequela of maternal DES treatment; other, but benignant, sequelae may be vaginal adenosis, cervical ectropion, gross vaginal and cervical deformities, microglandular hyperplasia, and cervical or vaginal ridges. Alterations can be detected also in exposed males. The pathogenesis of DES related lesions is still not very clear. All women exposed to antenatal DES must be examined starting either at the time of menarche, or by age 14; examination should include visualization, palpation, and cytological tests. Approximately 1/4 of women with clear cell carcinoma of the vagina and cervix will not survive. Both radical surgical procedures and radiation have been used effectively; results with chemotherapy treatment have been disappointing.