In the report by Prasad et al. [7], the tumor, whose features were found to be similar to those of small cell carcinomas arising elsewhere in the female genital tract, was studied by light and electron microscopy and immunohistochemistry; intracytoplasmic electron-dense neurosecretory-type granules were observed, and immunohistochemistry revealed chromogranin A. The current report describes the fourth case, in which a definite evolution from vaginal adenosis to atypical vaginal adenosis and ultimately to clear cell carcinoma was observed. Here, CHGA is linked to clear cell adenocarcinoma.