Abstract
Ectopic decidua is defined as extrauterine deposits of decidual stromal cells. It occurs in 85-100% of pregnancies. Focal sites can be present in various locations, yet a peritoneal location is rare. A 24- year- old woman underwent a cesarean section in 39th week of her first pregnancy, during which adhesions of the omentum to the fundus, entire left side of the uterus, and a part of the right front abdominal wall were found. An operative specimen was taken for a pathohistological analysis under the assumption of being fibrous adhesive tissue. The analysis revealed ectopic decidual tissue composed of large, polygonal cells with eosinophilic cytoplasm, and large nuclei with conspicuous nucleoli infiltrated with mature fatty cells and lymphocytes. Strong staining for vimentin was observed in the decidual cell cytoplasm and for a progesterone- receptor in the cell nuclei, medium staining was detected for S-100, and negative staining for CK 5/ 6, HMB-45, desmin, smooth muscle actin, estrogen and androgen- receptors. We present this case in order to educate clinicians and pathologists about the phenomenon of ectopic deciduosis. Although it can exist as asymptomatic condition, we point out the importance of considering this condition since it can result in serious pathology, like intraperitoneal hemorrhage and labour obstruction, if remains unrecognized. Another pitfall is possible confusion of this entity with other conditions. A resemblance to adhesions of the omentum and malignant neoplastic lesions, like squamous cell and metastatic carcinoma, metastatic melanoma, malignant decidual mesothelioma, metastatic mucin -producing adenocarcinoma, can be deceiving. These obstacles may present a pitfall to clinicians and pathologists, with a negative impact on patient treatment and outcome.
Highlights
Ectopic decidua has been described as a physiological phenomenon of pregnancy which is a result of subserous stromal metaplasia due to progesterone
We present a case of ectopic decidua in the greater omentum to point out the importance of recognizing this condition, since unrecognized ectopic decidua can result in serious consequences for the patient
The occurrence of ectopic deciduosis has been observed in many areas of the body
Summary
The medical history showed no abnormalities in the patient’s menstrual cycle (28/5) She was hospitalized at the age of 19 because of acute pain in the left lower quadrant of the abdomen, and underwent a surgical procedure which showed the pain was caused by a hemorrhagic ovarian cyst. Resection of her left ovary was performed. Strong staining for the vimentin was observed in the decidual cell cytoplasm (Figure 1B). The decidual cell nuclei showed strong immunohistochemical staining for the progesterone- receptor (Figure 1D), but negative staining for the estrogen and androgen- receptors. Positivity for S-100 and HMB- 45 favors the diagnosis of metastatic melanoma [5]
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