VAGINAL COLUMNAR CELL METAPLASIA - AN ACQUIRED ADENOSIS ASSOCIATED WITH TOPICAL 5-FLUOROURACIL THERAPY

Vaginal adenosis, with columnar epithelium of endocervical or endometr ial type forming glands within the vagina, has been observed as a cong enitally acquired process, associated with in utero exposure to diethy lstilbestrol; approximately 20% of those women exposed in utero have a denosis. It has been observed that vaginal adenosis may occur in nonex posed women; the origin is thought to be acquired following puberty. T his study analyzed eight patients who, following topical vaginal thera py with 5-fluorouracil for vaginal intraepithelial, neoplasia, had unr esolving, reddened areas in the upper one-third of the vagina. Biopsy of these areas demonstrated columnar epithelium on the vaginal surface , where stratified squamous epithelium would be expected. Superficial vaginal glands (adenosis) lined with epithelium identical to the surfa ce columnar epithelium were also identified. This finding is consisten t with a metaplastic process in which stratified squamous epithelium i s replaced by columnar representing columnar cell metaplasia, or acqui red vaginal adenosis.