474 Obstetrics and Gynecology Board Review •••
❍ What is the histologic finding associated with clear cell adenocarcinomas?
Hobnails.
❍ Where are clear cell adenocarcinomas of the genital tract in the female most commonly located?
These tumors appear to arise equally in the ectocervix and upper anterior wall of the vagina.
❍ What is the treatment of sarcoma botryoides in a young child?
Surgery and adjuvant chemotherapy consisting of a combination of vincristine, actinomycin, and
cyclophosphamide that can be used up front permitting more conservative surgery.
❍ What association has been described between the risk of developing vaginal cancer and the time of first
exposure in utero to DES?
The risk was greatest for those exposed in the first 16 weeks in utero and declined for those whose exposure began
in the 17th week or later.
❍ What is the incidence of clear cell adenocarcinoma in women prenatally exposed to DES?
0.14 to 1.4 per 1000.
❍ What is the frequency of recurrence in vaginal cancer by stage?
Stage I—10% to 20% pelvic recurrence.
Stage II—35% pelvic recurrence/22% distant metastasis.
Stage III—35% pelvic recurrence/23% distant metastasis.
Stage IV—58% pelvic recurrence/30% distant metastasis.
❍ What is the classical gross appearance of adenosis of the vagina?
Red, velvety grapelike clusters in the vagina.
❍ Name the different types of vaginal cancers.
Epithelial Squamous cell
Verrucous Small cell
Malignant melanoma Malignant lymphoma
Smooth muscle tumors Rhabdomyosarcoma
Clear cell adenocarcinoma❍ Has chemotherapy been proven to be a useful adjuvant therapy in vaginal cancer?
No. It has been used only as a salvage agent with poor results.
❍ What is the survival rate with locally recurrent vulvar cancer?
Recurrence-free survival can be obtained in up to 75% of cases when the recurrence is local and limited to the
vulva and can be resected with a gross clinical margin.