Abstract
We present a 69-year-old woman with a chief complaint of postmenopausal bleeding. She was diagnosed as having an endometrioid adenocarcinoma by biopsy, and underwent a total abdominal hysterectomy. At the time of surgery, granulation tissue-like nodules were found on the peritoneal serosa of the uterus. In the intraoperative cytology of peritoneal washing, atypical cells were noted. The intraoperative frozen section of the peritoneal nodule revealed granulation tissue with proliferating mesothelial cells. Microscopic examination of the permanent section showed keratin granulomas without viable adenocarcinoma cells on the serosal surface of the ovaries, fallopian tubes and broad ligaments. Postoperative chemotherapy was administered. She has been alive with no evidence of recurrence for 6 months postoperatively. It should be noted that the prognosis of cases in peritoneal keratin granuloma without viable cancer cells is favorable, and that the histological examination is essential for its diagnosis.
Highlights
Peritoneal keratin granuloma has been described in cases of endometrioid adenocarcinoma with squamous differentiation of the uterus, ovary and atypical polypoid adenomyoma, the number is limited [1,2,3,4,5,6,7,8,9]
In 1961, Montes et al reported a case of well differentiated adenocarcinoma of the uterine corpus with foreign body keratin granulomas, and named it “cholesteatomatous endometriosis” [3]
Peritoneal keratin granulomas have been reported in cases of endometrioid adenocarcinoma with squamous differentiation of the uterine corpus, ovary, and atypical polypoid adenomyoma [1,2,3,4,5,6,7,8,9]
Summary
Peritoneal keratin granuloma has been described in cases of endometrioid adenocarcinoma with squamous differentiation of the uterus, ovary and atypical polypoid adenomyoma, the number is limited [1,2,3,4,5,6,7,8,9]. Granulomas were observed on the serosal surface of the bilateral ovaries, fallopian tubes and broad ligaments, and contained eosinophilic laminated keratin deposits with ghost squamous cells. They were surrounded by epithelioid cells, foreign body type giant cells, neutrophils, lymphocytes and plasma cells (Figure 3). Postoperative chemotherapy was administered, and she has been alive with no evidence of recurrence for 6 months postoperatively
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