Diffuse ectopic peritoneal deciduosis

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Abstract

Relevance: Ectopic deciduosis rarely presents with definite symptoms and complications, and regresses soon after delivery. However, rare cases have been reported, in which the condition may present a different clinical picture. We present a clinical case of diffuse ectopic deciduosis in a 37-year-old patient who presented with an acute abdomen with peritonitis that simulated peritoneal carcinomatosis. During the long-term follow-up, she developed right-sided ureterohydronephrosis, which led to obstruction of urine outflow.

Case report: On the second day after delivery, the patient developed a clinical picture of an acute abdomen and underwent diagnostic laparoscopy, which revealed multiple miliary lesions in the parietal and visceral peritoneum. Histological examination of the laparoscopic biomaterial showed changes consistent with diffuse ectopic decidualization.

Conclusion: Ectopic deciduosis can be masked by various pathological conditions. Our case demonstrates the importance of using histological and immunohistochemical studies to make a diagnosis and guide appropriate patient management strategy.

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About the authors

Viktoria V. Misnik

Moscow Multidisciplinary Clinical Centre "Kommunarka"

Author for correspondence.
Email: vikamisnik@yandex.ru
ORCID iD: 0000-0002-9352-7578

PhD, Head of Maternity Department

Russian Federation, Moscow

Marina A. Oleneva

Moscow Multidisciplinary Clinical Centre "Kommunarka"

Email: vikamisnik@yandex.ru

PhD, Deputy Chief Physician for Obstetric and Gynecological Care

Russian Federation, Moscow

Alexander P. Raksha

Moscow N.I. Pirogov City Clinical Hospital No.1, Moscow Health Department

Email: vikamisnik@yandex.ru

Dr. Med. Sci., Professor, Pathologist

Russian Federation, Moscow

Natalia S. Chernotalova

City Clinical Oncological Hospital No. 1, Moscow Health Department

Email: vikamisnik@yandex.ru
ORCID iD: 0000-0003-2411-5083

Pathologist

Russian Federation, Moscow

Zhiraslan S. Semenov

Moscow N.I. Pirogov City Clinical Hospital No.1, Moscow Health Department

Email: vikamisnik@yandex.ru

PhD, Surgeon

Russian Federation, Moscow

Artem A. Ilyichev

Moscow N.I. Pirogov City Clinical Hospital No.1, Moscow Health Department

Email: averi.ilich@yandex.ru
ORCID iD: 0000-0001-9116-9941

Resident Physician

Russian Federation, Moscow

Igor S. Lebedev

Moscow Multidisciplinary Clinical Centre "Kommunarka"

Email: vikamisnik@yandex.ru
ORCID iD: 0000-0001-7956-3807

Dr. Med. Sci., Deputy chief physician for surgery

Russian Federation, Moscow

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Supplementary files

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2. Fig.1,2. Multiple millet-like nodules in the subphrenic space

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3. Fig.3,4. Millet-like rash in the ileocecal angle

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4. Fig. 5 Millet-like rashes on the ovary and fallopian tube

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5. Fig.6. Compactly located large decidua-like cells, which are predominantly oval in shape with eosinophilic cytoplasm and a regular-shaped nucleus with somewhat dispersed chromatin (staining - gem.eosin, x400 magnification)

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6. Fig.7. Extensive fields of decidua-like cells located among the retroperitoneal adipose tissue, with small-focal perifocal reactive inflammatory infiltration (staining - gem.eosin, x200 magnification)

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7. Fig.8. Small groups of decidua-like cells among subperitoneal adipose tissue (staining - gem.eosin, x400 magnification)

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8. Fig.9. Deciduoid-like tissue with a compact arrangement of cellular elements in the presence of moderately pronounced inflammatory infiltration (staining - gem.eosin, x400 magnification)

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9. Fig.10. Intense diffusion cytoplasmic expression of Vimentin in decidua-like cells (x400 magnification)

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10. Fig.11. Intense membrane expression of CD10 in decidua-like cells among subperitoneal adipose tissue (200x magnification)

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11. Fig.12. Intense nuclear expression of progesterone receptors in decidua-like cells among subperitoneal adipose tissue (200x magnification)

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12. Fig.13. Nuclear expression of Ki67 in decidua-like cells (200x magnification)

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