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Case of the Week #285
A 41 year old woman delivered a full term baby
without complications and underwent tubal ligation and greater omentum
sampling during a Caesarean section.
What is your diagnosis?
Extra uterine deciduosis
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 (). 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
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com