Cytologic problems in diagnosis of endocervical atypia in young females with and without maternal history of diethylstilbestrol exposure.

Sixteen cytologic endocervical atypias are reported with corroborative tissue analysis. Maternal diethylstilbestrol (DES) history was positive in three patients, one with clear cell adenocarcinoma, one with colposcopy and biopsy proven benign vaginal adenosis, and one with squamous carcinoma in situ of the cervix. Colposcopy was performed in two cases, one with adenosis and one with clear cell adenocarcinoma.In three patients, aged 19, 17, and 25, respectively, clear cell adenocarcinomas were found with unknown DES history and positive cytology. In five other cytologically positive cases, endocervicitis was found in three, atypical endocervical hyperplasia in one, and severe squamous dysplasia in one. This represents a cytologic false positive or specificity reading error of 37 percent in this type of material. One case of clear cell adenocarcinoma was linked with DES exposure.In the six suspicious and borderline cytologic reports, one vaginal adenosis, one condyloma acuminata, and one squamous carcinoma in situ were found. This represents a false positive or specificity reading error rate of 43 percent.Cytology is clinically valuable in Proven cases of vaginal adenosis or adenocarcinoma. It is not a diagnostic modality, with a high sensitivity error (false-negative rates) of 50 percent and higher, as reported in the literature and high specificity error (false-positive rates) as herein reported.