PMC7533791_01
(a) A diagnostic laparoscopy demonstrates numerous ectopic decidual nodules covering the small bowel and imitating peritoneal carcinomatosis. There is a moderate amount of purulent-appearing fluid in the pelvis. (b) A diagnostic laparoscopy shows 3-5 mm nodules of ectopic deciduosis on the abdomen wall peritoneum.
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The performed diagnostic laparoscopy revealed numerous 3-5 mm yellow peritoneal nodules on the small bowel and cecum serosa (Figure 1(a)). Similar lesions covered the surface of the uterus, enlarged ovaries and fallopian tubes, and partially the peritoneum of the abdominal wall and pelvis (Figure 1(b)). Purulent-appearing fluid was seen in the RLQ and pelvis and between inflamed and dilated bowel loops (Figure 1(a)).
(a) Microscopic examination of the peritoneum sample shows several foci of atypical tissue growth (H&E, magnification x50). (b) Microscopic examination of the peritoneal lesion demonstrates nodes and fields of large spindle and oval cells with uniform nuclei and a moderately developed cytoplasm, forming bundles and swirls (H&E, magnification x400). H&E: hematoxylin and eosin.
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The final pathology of sampled tissues did not reveal any signs of malignancy and reported submesothelial fields of spindle and oval cells, forming bundles and swirls suspicious of decidual transformation (Figures 2(a) and 2(b)).
(a) The diffuse nuclear PR expression in decidually transformed cells (magnification x400). (b) The mild nuclear ER expression in decidually transformed cells (magnification x400). PR: progesterone receptors; ER: estrogen receptors.
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The immunohistochemical (IHC) assay demonstrated coexpression of progesterone (PR) and estrogen receptors (ER) (Figures 3(a) and 3(b)), vimentin, desmin, and the cluster of differentiation 10 (CD10) (Figures 4(a)-4(c)), but there was no staining for calretinin, cytokeratin 5, smooth muscle actin (SMA), c-kit (CD117), human melanoma black 45 (HMB-45), and S-100 protein, which is consistent with deciduosis criteria.
(a) The intensive diffuse cytoplasmic expression of vimentin in decidually transformed cells (magnification x400). (b) The diffuse cytoplasmic desmin expression in decidually transformed cells (magnification x400). (c) The intensive membrane and cytoplasm expression of CD10 in decidually transformed cells (magnification x400). CD10: cluster of differentiation 10.
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The immunohistochemical (IHC) assay demonstrated coexpression of progesterone (PR) and estrogen receptors (ER) (Figures 3(a) and 3(b)), vimentin, desmin, and the cluster of differentiation 10 (CD10) (Figures 4(a)-4(c)), but there was no staining for calretinin, cytokeratin 5, smooth muscle actin (SMA), c-kit (CD117), human melanoma black 45 (HMB-45), and S-100 protein, which is consistent with deciduosis criteria.
(a) A control diagnostic laparoscopy 6 weeks after cesarean delivery shows a full regression of ectopic deciduosis that covered small bowel loops. (b) A control diagnostic laparoscopy 6 weeks after cesarean delivery shows an entire regression of ectopic deciduosis that used to cover the terminal ileum and cecum completely.
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The patient underwent a control diagnostic laparoscopy six weeks after surgery that showed the complete regression of peritoneal nodules (Figures 5(a) and 5(b)).