Hyaline globules in ectopic decidua in a pregnant woman with cervical squamous cell carcinoma

Abstract

Decidual reaction in pelvic lymph nodes has been increasingly documented during pregnancy. This may pose diagnostic difficulty during intraoperative frozen section (FS) and cytological consultation in women undergoing surgical procedures for cervical Squamous cell carcinoma (SCC). A 34-year-woman diagnosed to have invasive SCC (stage IB1) of the cervix at 14th week of her first pregnancy underwent abdominal radical trachelectomy and pelvic lymphadenectomy at 22 weeks of gestation. Cytological smears of two of the lymph nodes from intraoperative FS revealed isolated eosinophilic hyaline globules (HG) measuring 45-50 microns, in addition to large polygonal cells with amphophilic cytoplasm and hypochromatic nuclei and occasional squamous-looking cells with atypical hyperchomatic nuclei. These findings posed a diagnostic dilemma at intraoperative consultation and no definitive diagnosis was rendered. The formlin-fixed, paraffin-embedded histological sections of the same lymph nodes showed ectopic decidua with no evidence of metastatic SCC. Decidual cells are a cause of concern for both cytologists and histopathologists. In pregnant women complicated by cervical cancer intraoperative evaluation of pelvic lymph nodes is of utmost importance in order to adopt the optimal conservative treatment modality. In the absence of clear cut evidence of malignancy, a diagnosis of metastatic SCC should not be rendered.