Diffuse peritoneal keratinization in endometrioid adenocarcinoma of ovary masquerading as metastatic deposit

Diffuse keratinization of peritoneum can be seen in various neoplastic and non-neoplastic diseases. This exuberant keratinization exhorts a granulomatous response with multinucleated giant cell reaction. In malignancy of ovary or endometrium they mimic tumor deposits, sometimes leading to erroneous upstaging. We report one such case of ovarian endometroid adenocarcinoma in 42-year multigravida with multiple nodules over peritoneum and pelvic tissue. The case was intraoperatively staged as FIGO stage III due to nodularity over momentum and pelvic areas. Hematoxylin and eosin-stained section from the ovary revealed endometroid adenocarcinoma (FIGO grade 1) with extensive squamous morales. Sections from the omentum showed diffuse keratinization with granulomatous response against keratin. There were no viable tumor cells in the multiple sections examined. The peritoneal fluid for cytology was negative for malignancy. Final stage was given as FIGO stage IB. This case highlights this rare presentation in Ovarian endometroid adenocarcinoma posing diagnostic dilemma to clinician and pathologist and emphasizes upon the importance of clinicopathological discussion, fluid cytology and extensive sampling for accurate staging.