Benign Lesions of the Vaginal Wall

Under normal circumstances, the vagina does not contain any glands. However, when the condition of adenosis exists (i.e., occurs spontaneously or as the result of antenatal diethylstilbestrol [DES] exposure), mucosal and submucosal mucus-secreting glands may be identified ( Fig. 58.1A and B ). These lesions appear as granulation-like tissue, clefts, holes, or cysts ( Fig. 58.2A and B ). Whenever adenosis is suspected, the lesion should be biopsied to ensure that adenocarcinoma does not exist within or around it. In addition, the risk of squamous intraepithelial neoplasia is increased because of the multiple squamocolumnar junctions exposed to environmental factors associated with coitus.

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A. The cervix and the vagina of this woman exposed to diethylstilbestrol (DES) reveal total absence of a squamous epithelial covering of the ectocervix. The vaginal fornices likewise contain only glandular tissue. B. Another DES-exposed woman’s cervix and vagina show extensive squamous metaplasia (pink) interspersed with glandular tissue (red) .

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A. Granulation-like glandular tissue located in the lateral vaginal fornix is diagnostic of adenosis. B. Clefts and gland openings are apparent in this patient’s vagina. A biopsy into this area will reveal mucous glands beneath the surface squamous metaplastic epithelium.

Biopsies

Vaginal biopsies are performed in a manner similar to that used for cervical disease (i.e., with a long-shanked biopsy forceps) ( Fig. 58.3 ). Exposure can be a problem for vaginal lesions, and the use of a manipulating hook allows the examiner to properly display the lesion to colposcopic vision ( Fig. 58.4A and B ).