Öz
AMAÇ: Endometrium dışındaki desidual hücre grupları olan "ektopik desidua" veya "desiduozis" over ve servikste yaygın görülür. Ancak peritoneal lokalizasyon nadirdir. Periton yerleşimli desiduozis genellikle tüberküloza benzeyen beyaz sarı nodüller şeklinde rastlantısal histolojik bulgulardır. Periton yerleşimli desiduozis makroskopik olarak peritoneal karsinomatozis ve peritoneal tüberküllerle benzerdir, mikroskobik olarak desiduoid mezotelyoma, metastatik karsinom ve metastatik malign melanom ile tanısal zorluk oluşturabilir. Bu olgu sunumunun amacı kliniğimizde yapılan sezaryen ameliyatı sırasında periton ve omentumda tesadüfi bir bulgu olarak saptanan ektopik desidua olgusunun maligniteyi taklit edebilmesi nedeniyle klinik, histopatolojik özelliklerinin değerlendirilmesidir.
OLGU: Laparotomide mesane peritonu ve omentumda en büyüğü 1 cm.lik multipl gri-beyaz renkli yüzeyden kabarık nodüller izlendi. Histopatolojik inceleme için periton ve omentumdan biyopsiler alındı. Patolojik tanı desiduozis olarak raporlandı.
SONUÇ: Laparotomilerimiz sırasında karşılaşabildiğimiz bu lezyonlar makroskobik olarak metastatik malign lezyonlara ve periton-omental tüberküllere benzese de, gebeliğe bağlı ektopik desidual doku benign bir lezyondur ve postpartum dönemde herhangi bir tedaviye gerek kalmadan düzelir ve bu nedenle bu tarz lezyonlar ile karşılaştığımızda ayırıcı tanıda akılda tutulması gerekir.
Anahtar Kelimeler
Kaynakça
- 1. Erdem, H., & Yaşar, E. (2016). Ektopik Desiduozis; Nadir Yerleşimli. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 6(1), 71-73.
- 2. Jadhav, T., & Doshetty, R. (2022). Deciduosis in a cesarean scar. Autopsy & case reports, 12, e2021383. https://doi.org/ 10.4322/acr.2021.383
- 3. Erzurumluoğlu N, Sargan A, Özekinci S, Yıldız F (2016). Peritoneal Karsinomatozisi Taklit Eden Florid Diffüz Peritoneal Desiduozis: Olgu Sunumu. Haseki Tıp Bülteni, 54(2), 120 - 123.
- 4. Bolat, F., Canpolat, T., & Tarim, E. (2012). Pregnancy-related peritoneal ectopic decidua (deciduosis): morphological and clinical evaluation. Turk patoloji dergisi, 28(1), 56–60. https://doi.org/ 10.5146/tjpath.2012.01098
- 5. Piccinni, D. J., Spitale, L. S., Cabalier, L. R., & Dionisio de Cabalier, M. E. (2002). Decidua en la superficie peritoneal imitando nódulos metastásicos. Hallazgo durante una intervención cesárea [Decidua in the peritoneal surface mimicking metastatic nodules. Findings during cesarean section]. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina), 59(1), 113–116.
- 6. Kinra, P., Sen, A., & Sharma, J. C. (2006). Ectopic Decidual Reaction: A Case Report. Medical journal, Armed Forces India, 62(3), 280–281. https://doi.org/10.1016/S0377-1237(06) 80022-5
- 7. Fenjvesi, A., & Zivković, S. (2005). Medicinski pregled, 58(3-4), 196–199. https://doi.org/10.2298/mpns0504196f
- 8. Shukla, S., Pujani, M., & Singh, S. K. (2008). Ectopic decidual reaction mimicking peritoneal tubercles: a report of three cases. Indian journal of pathology & microbiology, 51(4), 519–520. https://doi.org/10.4103/0377-4929.43746
- 9. Büttner A, Bässler R, Theele C: Pregnancy-associated ectopic decidua (deciduosis) of the greater omentum. Analysis of 60 biopsies with cases of fibrosing deciduosis and leiomyomatosis peritonealis disseminata. Pathol Res Pract 1993, 189:352-359.
- 10. Reis-Filho JS, Pope LZ, Milanezi F, Balderrama CM, Serapião MJ, Schmitt FC: Primary epithelial malignant mesothelioma of the pericardium with deciduoid features: cytohistological and immunohistochemical study. Diagn Cytopathol 2002, 26:117-122.
- 11. Mangla, M., Nautiyal, R., Shirazi, N., & Pati, B. (2021). Ectopic Cervical Deciduosis: A Rare Cause of Antepartum Hemorrhage in Mid Trimester. The Eurasian journal of medicine, 53(2), 152–154. https://doi.org/10.5152/ eurasianjmed. 2021.20163
- 12. Adhikari, L. J., & Shen, R. (2013). Florid diffuse peritoneal deciduosis mimicking carcinomatosis in a primigravida patient: a case report and review of the literature. International journal of clinical and experimental pathology, 6(11), 2615–2619.
- 13. Israel SL, Rubenstone A, Meranze Dr: Ovary at term. I. Decidua-like reaction and surface cell proliferation. Obstet Gynecol 1954, 3:399-407.
- 14. Clement PB: Diseases of the Peritoneum. Kurman RJ. (Ed): Blaustein's Pathology of the Female Genital Region. 5th ed. New York, Springer, 2002, 729-789
- 15. Lesaffer J, Feryn T, Proot L: Pregnancy-associated ectopic decidua of the appendix. Acta Chir Belg 2009, 109:93-94.
- 16. Bettinger HF: Ectopic decidua in the renal pelvis. J Pathol Bacteriol 1947, 59:686.
- 17. Massi D, Susini T, Paglierani M, Salvadori A, Giannini A: Pregnancy-associated ectopic decidua. Acta Obstet Gynecol Scand 1995, 74:568-571.
- 18. O'Leary SM: Ectopic decidualization causes massive postpartum intraperitoneal hemorrhage.Obstet Gynecol 2006, 108:776-769.
- 19. Suster S, Moran CA: Deciduosis of appendicitis. Am J Gastroenterol 1990, 85:841-845
Öz
AİM: Decidual cell groups outside the endometrium, "ectopic decidua" or "deciduosis", are commonly seen in the ovary and cervix. However, peritoneal localization is rare. Peritoneal deciduosis is usually an incidental histological finding in the form of white-yellow nodules resembling tuberculosis. Peritoneal deciduosis is macroscopically similar to peritoneal carcinomatosis and peritoneal tubercles, and microscopically may pose diagnostic difficulties with deciduoid mesothelioma, metastatic carcinoma and metastatic malignant melanoma. The purpose of this case report is to evaluate the clinical and histopathological features of ectopic decidua, which was detected as an incidental finding in the peritoneum and omentum during a cesarean section in our clinic, as it may mimic malignancy.
CASE: Multiple gray-white colored, raised nodules, the largest of which was 1 cm, were observed in the bladder peritoneum and omentum during laparotomy. Biopsies were taken from the peritoneum and omentum for histopathological examination. The pathological diagnosis was reported as deciduosis.
CONCLUSION: Although these lesions that we encountered during our laparotomies resemble metastatic malignant lesions and peritoneomental tubercles macroscopically, ectopic decidual tissue due to pregnancy is a benign lesion and resolves without any treatment in the postpartum period, and therefore should be kept in mind in the differential diagnosis when we encounter such lesions.
Anahtar Kelimeler
Deciduosis peritonei Differential Diagnosis Ectopic decidua.
Kaynakça
- 1. Erdem, H., & Yaşar, E. (2016). Ektopik Desiduozis; Nadir Yerleşimli. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 6(1), 71-73.
- 2. Jadhav, T., & Doshetty, R. (2022). Deciduosis in a cesarean scar. Autopsy & case reports, 12, e2021383. https://doi.org/ 10.4322/acr.2021.383
- 3. Erzurumluoğlu N, Sargan A, Özekinci S, Yıldız F (2016). Peritoneal Karsinomatozisi Taklit Eden Florid Diffüz Peritoneal Desiduozis: Olgu Sunumu. Haseki Tıp Bülteni, 54(2), 120 - 123.
- 4. Bolat, F., Canpolat, T., & Tarim, E. (2012). Pregnancy-related peritoneal ectopic decidua (deciduosis): morphological and clinical evaluation. Turk patoloji dergisi, 28(1), 56–60. https://doi.org/ 10.5146/tjpath.2012.01098
- 5. Piccinni, D. J., Spitale, L. S., Cabalier, L. R., & Dionisio de Cabalier, M. E. (2002). Decidua en la superficie peritoneal imitando nódulos metastásicos. Hallazgo durante una intervención cesárea [Decidua in the peritoneal surface mimicking metastatic nodules. Findings during cesarean section]. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina), 59(1), 113–116.
- 6. Kinra, P., Sen, A., & Sharma, J. C. (2006). Ectopic Decidual Reaction: A Case Report. Medical journal, Armed Forces India, 62(3), 280–281. https://doi.org/10.1016/S0377-1237(06) 80022-5
- 7. Fenjvesi, A., & Zivković, S. (2005). Medicinski pregled, 58(3-4), 196–199. https://doi.org/10.2298/mpns0504196f
- 8. Shukla, S., Pujani, M., & Singh, S. K. (2008). Ectopic decidual reaction mimicking peritoneal tubercles: a report of three cases. Indian journal of pathology & microbiology, 51(4), 519–520. https://doi.org/10.4103/0377-4929.43746
- 9. Büttner A, Bässler R, Theele C: Pregnancy-associated ectopic decidua (deciduosis) of the greater omentum. Analysis of 60 biopsies with cases of fibrosing deciduosis and leiomyomatosis peritonealis disseminata. Pathol Res Pract 1993, 189:352-359.
- 10. Reis-Filho JS, Pope LZ, Milanezi F, Balderrama CM, Serapião MJ, Schmitt FC: Primary epithelial malignant mesothelioma of the pericardium with deciduoid features: cytohistological and immunohistochemical study. Diagn Cytopathol 2002, 26:117-122.
- 11. Mangla, M., Nautiyal, R., Shirazi, N., & Pati, B. (2021). Ectopic Cervical Deciduosis: A Rare Cause of Antepartum Hemorrhage in Mid Trimester. The Eurasian journal of medicine, 53(2), 152–154. https://doi.org/10.5152/ eurasianjmed. 2021.20163
- 12. Adhikari, L. J., & Shen, R. (2013). Florid diffuse peritoneal deciduosis mimicking carcinomatosis in a primigravida patient: a case report and review of the literature. International journal of clinical and experimental pathology, 6(11), 2615–2619.
- 13. Israel SL, Rubenstone A, Meranze Dr: Ovary at term. I. Decidua-like reaction and surface cell proliferation. Obstet Gynecol 1954, 3:399-407.
- 14. Clement PB: Diseases of the Peritoneum. Kurman RJ. (Ed): Blaustein's Pathology of the Female Genital Region. 5th ed. New York, Springer, 2002, 729-789
- 15. Lesaffer J, Feryn T, Proot L: Pregnancy-associated ectopic decidua of the appendix. Acta Chir Belg 2009, 109:93-94.
- 16. Bettinger HF: Ectopic decidua in the renal pelvis. J Pathol Bacteriol 1947, 59:686.
- 17. Massi D, Susini T, Paglierani M, Salvadori A, Giannini A: Pregnancy-associated ectopic decidua. Acta Obstet Gynecol Scand 1995, 74:568-571.
- 18. O'Leary SM: Ectopic decidualization causes massive postpartum intraperitoneal hemorrhage.Obstet Gynecol 2006, 108:776-769.
- 19. Suster S, Moran CA: Deciduosis of appendicitis. Am J Gastroenterol 1990, 85:841-845
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Sistemleri, Tıp Eğitimi |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2024 |
| Gönderilme Tarihi | 7 Ekim 2024 |
| Kabul Tarihi | 16 Aralık 2024 |
| Yayımlandığı Sayı | Yıl 2024Cilt: 46 Sayı: 4 |
