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Keratin Granulomas in the Peritoneum on Frozen Section: A Case Report with Multiple Suspects and the Search for the
Levon Katsakhyan1, Xiaoming Zhang1, Maria C Reyes1
121798Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract:
Keratin granulomas in the peritoneum are a rare finding with multiple etiologies and can be especially challenging for both the pathologist and the surgeon when these lesions are grossly visible. We report a case of a unique frozen section diagnostic scenario of evaluation of keratin granulomas in the peritoneum of a 47-year-old woman in the setting of multiple potential culprits: endometrial endometrioid adenocarcinoma following fertility sparing treatment, and a concurrent dermoid cyst. We discuss the various etiologies of keratin granulomas in the peritoneum, mechanism of their formation, diagnostic significance, as well as implications of fertility sparing treatments. To the best of our knowledge, this is the only case of keratin granulomas in the peritoneum with multiple distinct potential pathologic culprits as well the only case following fertility sparing treatment.
Insights
Keratin granulomas in the peritoneum are rare and diagnostically challenging. This case highlights unique diagnostic scenarios involving fertility-sparing treatment and concurrent ovarian dermoid cysts.
Area of Science:
- Surgical pathology
- Gynecologic oncology
- Diagnostic challenges in frozen section analysis
Background:
- Keratin granulomas in the peritoneum are uncommon, presenting diagnostic difficulties for pathologists and surgeons.
- Differential diagnoses include metastatic disease, particularly from endometrial adenocarcinoma, and benign conditions like dermoid cysts.
Observation:
- A unique case of peritoneal keratin granulomas in a 47-year-old woman is presented.
- The patient had undergone fertility-sparing treatment for endometrial endometrioid adenocarcinoma and had a concurrent ovarian dermoid cyst.
Findings:
- This is the first reported case of peritoneal keratin granulomas with multiple distinct potential pathologic culprits.
- It is also the only reported case associated with fertility-sparing treatment, posing a complex diagnostic scenario for frozen section evaluation.
Implications:
- Understanding the etiologies and formation of keratin granulomas is crucial for accurate diagnosis.
- The implications of fertility-sparing treatments on the development of peritoneal lesions require further consideration.
- This case underscores the importance of comprehensive evaluation in complex gynecologic pathology cases.
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