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11 September 2013 - Case of the Week #285

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Thanks to Dr. Samir Ghani, Wexham Park Hospital (United Kingdom), for contributing this case and the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.


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Case of the Week #285

Clinical History

A 41 year old woman delivered a full term baby without complications and underwent tubal ligation and greater omentum sampling during a Caesarean section.

Micro images:


What is your diagnosis?































Diagnosis:
Extra uterine deciduosis

Discussion:
The omentum and the peritoneal surface of the fallopian tube show exaggerated Extra-Uterine Deciduosis (EUD) / decidual reaction, with single / cell aggregates displaying vacuolated cytoplasm with mucoid-like material and bland nuclear morphology. No mitotic figures are seen. There are only a few cells with eosiophilic cytoplasm, which provide the clue to the nature of the lesion, in addition to the clinical presentation.

Immunohistochemistry showed strong progesterone receptor nuclear staining in the lesional cells. The vimentin stain was diffusely positive. Other markers such as EMA and Calretinin were negative (not shown).

Left: PR, right: vimentin



Extra-uterine deciduosis (EUD) is a benign condition which can be mistaken macroscopically for malignancy and resembles peritoneal carcinomatosis (The Internet Journal of Gynecology and Obstetrics 2005;5(1)). EUD can be discovered accidentally in pregnancy during caesarean sections and during pelvic surgery in women taking oral contraceptives (Am J Surg Pathol 1987;11:526).

Deposits are found mainly on the ovary and cervix, but also on abdominal serosal surfaces of the fallopian tubes, bowel, peritoneum and vagina, as well as lungs, pleura, retroperitoneal lymph nodes and rarely skin. Most lesions do not require further treatment and spontaneously involute within 4-6 weeks of delivery.

Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com