Primary clear cell adenocarcinomas most commonly involve the genitourinary system, including the vagina. Previously, primary clear cell adenocarcinomas of the vagina have been discussed within the context of prenatal exposure to diethylstilbestrol. Due to its widely proven role in the development of this carcinoma, administration of diethylstilbestrol is prohibited. We present two cases of non-diethylstilbestrol-associated primary clear cell adenocarcinoma of the vagina from the archives of the Anatomical Pathology Department at King Abdulaziz University in order to improve our understanding of its biological behavior. Our findings suggest that primary clear cell adenocarcinoma of the vagina may be unrelated to diethylstilbestrol exposure and that non-diethylstilbestrol-associated primary clear cell adenocarcinoma of the vagina, when present at a younger age, may have a worse prognosis.