Clear cell carcinoma of the vagina followed by breast cancer in a patient without prenatal diethylstilbestrol exposure

Clear cell carcinoma of the vagina or cervix and breast cancer are the only malignancies associated with prenatal diethylstilbestrol (DES) exposure. Clear cell carcinoma of the vagina develops mainly in young women, and rarely develops in elderly women without DES exposure. A 68-year-old woman, who had not experienced prenatal DES exposure or received hormone replacement therapy, presented with vaginal bleeding. Pelvic examination revealed a 3-cm polypoid solid mass in the posterior fornix. Biopsy showed clear cell carcinoma. She underwent radical hysterectomy with posterior vaginal wall resection. Thirty-four months after the surgery, she developed pulmonary metastasis and underwent video-assisted tumor resection. Forty-nine months after the initial surgery, screening mammography revealed an abnormal breast mass. Biopsy revealed invasive lobular carcinoma, and she underwent breast resection followed by radiation therapy. She remained well with no evidence of disease 89 months after the initial surgery.

Clear cell carcinoma; Vagina; Pulmonary metastasis; Breast cancer

[1] Troisi R., Hatch E.E., Titus­Ernstoff L., Hyer M., Palmer J.R., Rob­boy S.J., et al.: “Cancer risk in women prenatally exposed to di­ethylstilbestrol”. Int. J. Cancer, 2007, 121, 356.

[2] Soto A.M., Brisken C., Schaeberle C., Sonnenschein C.: “Does can­cer start in the womb? Altered mammary gland development and predisposition to breast cancer due to in utero exposure to endocrine disruptors”. J. Mammary Gland. Biol. Neoplasia, 2013, 18, 199.

[3] Newbold R.R.: “Lessons learned from perinatal exposure to diethyl­stilbestrol”. Toxicol. Appl. Pharmacol., 2004, 199, 142.

[4] Herbst AL.: “Behavior of estrogen­associated female genital tract cancer and its relation to neoplasia following intrauterine exposure to diethylstilbestrol (DES)”. Gynecol. Oncol., 2000, 76, 147.