title: Advanced primary clear cell carcinoma of the vagina not associated with diethylstilbestrol.
abstract: BACKGROUND
  Primary vaginal clear cell carcinoma occurs in young women exposed to diethylstilbestrol (DES) in utero. Primary vaginal clear cell carcinoma not associated with DES is very rare. We report the clinicopathologic and cytopathologic features of a patient with advanced, sporadic primary vaginal clear cell carcinoma with metastases to liver, lung and paraaortic lymph nodes.
  
  
  METHODS
  A postmenopausal, 63-year-old woman presented to our department with genital bleeding. A hemorrhagic tumor found in the vagina was diagnosed as a clear cell carcinoma by cytopathologic examination of the tumor smear and by histopathologic examination of a biopsy specimen. A chest radiograph revealed multiple lung metastases, and metastases to the liver and paraaortic lymph nodes were noted on computed tomography and magnetic resonance imaging. The tumor was diagnosed as primary clear cell carcinoma of the vagina, stage IVb (FIGO) based on a normal cytopathologic examination of the cervix, endometrium and ascites; normal appearance of the uterus, ovaries and kidneys on magnetic resonance imaging; and absence of detectable tumor in the urinary tract. The patient died of respiratory failure 31 days after hospitalization. The tumor demonstrated overexpression of p53 protein and did not show microsatellite instability.
  
  
  CONCLUSIONS
  This patient was the second reported Japanese woman with advanced primary vaginal clear cell carcinoma not associated with DES.
authors.affiliation: Department of Obstetrics and Gynecology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan. watanabe@med.kindai.ac.jp
authors.forename: Yoh
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ueda
authors.forename: Kouichi
authors.initials: K
authors.lastname: Nozaki
authors.forename: Akiko
authors.initials: A
authors.lastname: Kyoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshiai
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Noda
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary; D003937:Diagnosis, Differential; D004054:Diethylstilbestrol / Q000009:adverse effects; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016159:Tumor Suppressor Protein p53 / Q000276:immunology / Q000378:metabolism; D014625:Vaginal Neoplasms / Q000209:etiology / Q000378:metabolism / Q000473:pathology*
chemical_list: D016159:Tumor Suppressor Protein p53; D004054:Diethylstilbestrol