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Findings:The ring-like opacity seen on the radiograph represents the right side of the patient. A hysterosalpingogram was performed with contrast administration into the uterine cavity following cannulation of the cervix. The uterus filled with contrast material and was T-shaped and irregular in appearance. Irregular contour may be explained by the patient's phase of menstrual cycle. There was subsequent filling bilaterally of the fallopian tubes with spillage into the peritoneal cavity.

Diagnosis:Diethylstilbestrol (DES) exposure.

Discussion: DES is a nonsteroidal synthetic estrogen. It affects release of pituitary gonadotropins and inhibits ovulation. Some of its uses are for atrophic vaginitis, in menopause, as postcoital contraception (so-called "morning after" pill), for hypogonadism, for primary ovarian failure, and in some cases of prostate cancer.

In utero exposure to DES has been associated with abnormal development of the uterus. In approximately 15% of the women exposed to diethylstilbestrol in utero, a T-shaped uterine cavity may be found. As seen in this patient, the fundal area is thinner than the cervix and there is a low uterine volume.

DES has also been associated with certain types of tumors. Clear cell carcinoma of the vagina is a type of adenocarcinoma found in young women who are exposed to diethylstilbestrol in utero. Approximately 0.14% of diethylstilbestrol exposures have gone on to develop clear cell adenocarcinoma of the vagina. These tumors are usually discovered between the ages of 15 and 20 and are composed of glycogen-containing vacuolated cells - the so-called clear cells. Clear cell carcinoma may also be present in the cervix.

References:
Beckman C, et al: Obstetrics and Gynecology. Williams and
Wilkins 1992.

Dahnert W: Radiology Review Manual. Williams and Wilkins 1991.

Langman J: Medical Embryology. Williams and Wilkins 1990.

Robbins S, et al: Robbins Pathological Basis of Disease. Fourth
Edition, W.B. Saunders, Co. 1989.

Smith S, et al: Textbook of Pharmacology. First Edition, W.B.
Saunders 1992.

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