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      Ectopic decidua of the greater omentum: a case report

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          Abstract

          Ectopic decidua is defined as extrauterine deposits of decidual stromal cells. It occurs in 85-100% of pregnancies. Focal sites can be present in various locations, yet a peritoneal location is rare. A 24- year- old woman underwent a cesarean section in 39 th week of her first pregnancy, during which adhesions of the omentum to the fundus, entire left side of the uterus, and a part of the right front abdominal wall were found. An operative specimen was taken for a pathohistological analysis under the assumption of being fibrous adhesive tissue. The analysis revealed ectopic decidual tissue composed of large, polygonal cells with eosinophilic cytoplasm, and large nuclei with conspicuous nucleoli infiltrated with mature fatty cells and lymphocytes. Strong staining for vimentin was observed in the decidual cell cytoplasm and for a progesterone- receptor in the cell nuclei, medium staining was detected for S-100, and negative staining for CK 5/6, HMB-45, desmin, smooth muscle actin, estrogen and androgen- receptors. We present this case in order to educate clinicians and pathologists about the phenomenon of ectopic deciduosis. Although it can exist as asymptomatic condition, we point out the importance of considering this condition since it can result in serious pathology, like intraperitoneal hemorrhage and labour obstruction, if remains unrecognized. Another pitfall is possible confusion of this entity with other conditions. A resemblance to adhesions of the omentum and malignant neoplastic lesions, like squamous cell and metastatic carcinoma, metastatic melanoma, malignant decidual mesothelioma, metastatic mucin -producing adenocarcinoma, can be deceiving. These obstacles may present a pitfall to clinicians and pathologists, with a negative impact on patient treatment and outcome.

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          Most cited references 15

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          Ectopic decidualization causing massive postpartum intraperitoneal hemorrhage.

          Spontaneous intraperitoneal hemorrhage during pregnancy or in the postpartum period is a rare but dangerous phenomenon.
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            Pregnancy-associated ectopic decidua (deciduosis) of the greater omentum. An analysis of 60 biopsies with cases of fibrosing deciduosis and leiomyomatosis peritonealis disseminata.

            Ectopic decidua (deciduosis) of the omentum was investigated in biopsies taken during cesarean sections and in tubal pregnancies in 60 cases. An ectopic decidua of various abdominal organs was present in 48 further cases. All omentum biopsies showed decidual reactions:focal deciduosis in 97% and diffuse deciduosis in 3%. With increasing duration of pregnancy, there was vacuolar degeneration and fragmentation of the decidua cells as a manifestation of regressive changes. Co-expression of antibodies to vimentin, desmin and actin can be detected immunohistochemically. Ectopic decidua is a physiological phenomenon of pregnancy and arises from a progesterone-induced metaplasia of the pluripotential cells of the "subcelomic mesenchyma". The involution of the decidua takes place in the fourth to sixth week post partum. A fibrosing deciduosis of the omentum with development of a collagenous connective tissue at its surface is described as metaplasia of the hormone-dependent "subcelomic" mesenchyma. Immunohistochemically, a second case with leiomyomatosis peritonealis disseminata from the same investigation material shows the transformation of desmin- and actin-positive decidual cells into myofibroblasts and leiomyocytes in the form of a direct metaplasia. As pregnancy-associated mesenchymal metaplasias, ectopic decidua, fibrosing deciduosis and leiomyomatosis peritonealis disseminata depend on hormone and may regress post partum.
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              Ectopic Decidual Reaction: A Case Report

               P Kinra,  A sen,  JC Sharma (2006)
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                Author and article information

                Journal
                J. Health. Sci
                Journal of Health Sciences
                University of Sarajevo Faculty of Health Studies (Bosnia )
                2232-7576
                1986-8049
                2016
                : 6
                : 1
                : 72-75
                Affiliations
                [1 ]Department of Pathology, Citology, and Forensic Medicine, Varaždin General Hospital, Varaždin, Croatia
                [2 ]Educational Institute of Emergency Medicine of City of Zagreb, Zagreb, Croatia
                Author notes
                [* ]Corresponding author: Biserka Pigac, Department of Pathology, Citology, and Forensic Medicine, Varaždin General Hospital, Ivana Meštrovića b.b., 42 000 Varaždin, Croatia, Tel.: +385 42 393 565, E-mail: varosanka1@ 123456gmail.com
                Article
                JHS-6-72
                10.17532/jhsci.2016.335
                Copyright: © Biserka Pigac and Silvija Mašić

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                CASE REPORT

                Nursing, General medicine, Medicine, Molecular medicine, Life sciences

                greater omentum, Ectopic, decidua

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