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[Deciduosis peritonei--a case report]
Atila Fenjvesi1, Slobodan Zivković
1Zdravstveni centar Dr Gere Istvan, Senta, Opsta bolnica, Odeljenje za patologiju.
Medicinski Pregled
|March 11, 2006
Summary
Ectopic decidua, a pregnancy phenomenon, can occur on the peritoneum. This case highlights its histological features and differential diagnosis, emphasizing its benign nature despite potential complications.
Area of Science:
- Obstetrics and Gynecology
- Surgical Pathology
- Reproductive Endocrinology
Background:
- Ectopic decidua (deciduosis) commonly affects pelvic organs but can present on the peritoneum.
- Peritoneal deciduosis is usually asymptomatic but can rarely cause severe hemoperitoneum, abdominal pain, or dystocia.
- This physiological phenomenon results from progesterone-induced metaplasia of subserosal stromal cells during pregnancy.
Observation:
- A 32-year-old pregnant patient presented for cesarean section due to fetal distress.
- Laparotomy revealed a greyish-yellow nodule on the parietal peritoneum.
- Histological examination showed a vascular lesion with large decidualized cells, consistent with ectopic decidua.
Findings:
- The ectopic decidua was infiltrated by blood and surrounded by adipose tissue necrosis and inflammation.
- Immunohistochemistry revealed vimentin and progesterone receptor positivity, with focal desmin and smooth muscle actin.
- Differential diagnoses included deciduoid mesothelioma, metastatic carcinoma, and melanoma, distinguished by specific cellular and immunohistochemical markers.
Implications:
- Accurate diagnosis of peritoneal deciduosis is crucial to differentiate it from malignant conditions.
- Understanding the histological and immunohistochemical profile aids in correct diagnosis.
- This case underscores the importance of considering ectopic decidua in pregnant patients with peritoneal lesions.