Successful Pregnancy after Radical Surgery for Diethylstilboestrol lpar;DESrpar;hyphen;Related Vaginal Adenocarcinomaperiod; Case Report

摘要

In 1983, a 24-year-old woman presented with a clear-cell vaginal adenocarcinoma. She had been exposedin uteroto maternally ingested diethylstilbestrol, taken from the 9th to the 16th week of pregnancy for threatened miscarriage. Treatment consisted of removal of the vagi-naand the vaginal portion of the cervix, together with the adjacent segment of the bladder and urethral wall. The pouch of Douglas was opened so that the supravaginal cervix could be divided above the vaginal fornices. This perineal procedure was accompanied by bilateral extra-peritoneal pelvic lymphadenectomy. One week later, reconstruction of the vagina was performed with a split-skin graft taken from the thigh (Mclndoe-Jayes technique). The apex of the graft was fenestrated for opposition to the supravaginal cervix.Following surgery, the patient was kept under regular surveillance, without evidence of recurrence of the malignancy. Some contraction of the neovagina occurred, and the donor site was afflicted with a ldquo;flare-uprdquo; of preexisting psoriasis. It was extremely difficult to identify the site of the ldquo;cervix,rdquo; but regular menstruation occurred, and it was possible to locate a pinpoint aperture communicating with the uterus.A period of primary infertility, to which a male factor contributed, ensued. Diagnostic curettage was carried out at a later stage. It was eventually decided that the couple might be suitable for gamate intrafallopian transfer. Conception, however, occurred without further intervention in 1986.Pregnancy proceeded uneventfully until the 36th week of gestation. Elective cesarean section had been chosen as the method of delivery, and consideration was given to prophylactic measures against midtrimester miscarriage. It was recognized that the uterine abnormalities associated with maternal diethylstilbestrol ingestion might, if present, predispose to early pregnancy loss. The complete absence of the vaginal portion of the cervix precluded cerclage except by the abdominal route, and a decision was made, by agreement with the patient, to await events. Spontaneous premature labor began at 36 weeks, and a female infant was born by emergency cesarean section. The baby thrived.