Saturday, March 11th, 2006.

Medicinski Pregled. 2005 Mar-Apr;58(3-4):196-9. [Link]

Fenjvesi A, Zivkovic S.

Zdravstveni centar Dr Gere Istvan, Senta, Opsta bolnica, Odeljenje za patologiju.

Abstract

Introduction: The occurrence of ectopic decidua (deciduosis) has been observed most often in the ovaries, uterus, and cervix. It has been established in approximately 90% of patients who have undergone laparotomy during pregnancy. A peritoneal localization is less frequent and usually an asymptomatic incidental finding, but is occasionally associated with massive and potentially fatal hemoperitoneum, abdominal pain and dystocia. Ectopis decidua is a physiological phenomenon of pregnancy and arises from a progesterone-induced metaplasia of subserosal stromal cells.

Cast Report: A 32-year-old G1P1 female underwent cesarean section at 39 weeks gestation because of imminent fetal asphyxia. The laparotomy revealed a greyish-yellow soft nodule on the parietal peritoneum. On histologic examination the biopsy lesion was highly vascular and was composed of large polygonal decidualized cells with abundant eosinophilic, focally vacuolated cytoplasm. The nuclei were regular, with fine chromatin and inconspicuous nucleoli. Ectopic decidua was infiltrated by blood and surrounded with adipose tissue necrosis and mild chronic inflammation.

Discussion and Conclusion: The differential diagnosis of peritoneal deciduosis included deciduoid mesothelioma, metastatic carcinoma (especially if decidual cells have a vacuolated cytoplasm mimicking signet-ring cells), and metastatic melanoma. Decidual cells showed immunoreactivity for vimentin and progesteron receptors and focal positivity for desmin and smooth muscle actin. The presence of cellular atypia, mitotic activity, and immunoreactivity for cytokeratin 5/6 and calretinin will assist in making the diagnosis of deciduoid mesothelioma. The diagnosis of metastatic carcinoma is assisted by the nuclear features and cytokeratin immunoreactivity. A positive immunostain for S-100 and/or HMB-45 will assist in the diagnosis of metastatic melanoma.

Glossary

melanoma

(mel-uh-no-muh) a cancerous (malignant) tumor that begins in the cells that produce the skin coloring (melanocytes). Melanoma is almost always curable in its early stages. However, it is likely to spread, and once it has spread to other parts of the body the chances for a cure are much less.

lesion

(lee-zhun) a change in body tissue; sometimes used as another word for tumor.

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

carcinoma

(car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.

biopsy

(buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.

asymptomatic

(A-simp-toh-matic) not having any symptoms of a disease. Many cancers can develop and grow without producing symptoms, especially in the early stages. Screening tests such as mammograms help to find these early cancers, when the chances for cure are usually highest. (See also screening.)

tissue

a collection of cells, united to perform a particular function.

uterus

the womb. The pear-shaped organ in women that holds and nourishes the growing embryo and fetus. The uterus has three areas: the body or upper part, the isthmus or the narrowed central area, and the cervix, the lower portion.

mesothelioma

a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.

peritoneal

(pair-uh-tuh-nee-al) the serous membrane that lines the cavity of the abdomen. (More on Peritoneal Mesothelioma.)

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