Cutaneous Decidualized Endometriosis in a Nonpregnant Female

Abstract

Endometriosis is a disease process characterized by ectopic endometrial tissue. Involvement most commonly occurs in the lower pelvis, outside the uterine cavity, but can occur elsewhere, including the skin. Cutaneous endometriosis is a rare manifestation of this disease, with decidualization occurring in a very small minority of cases, almost always seen in pregnant females. Cutaneous involvement of endometriosis may present a diagnostic problem for the pathologist, particularly in the event of decidualization. Decidualization may mimic a malignancy and as a result may result in unnecessary diagnostic studies for the patient. We present a case of a nonpregnant patient with decidualized cutaneous endometriosis, discuss the histopathologic and immunohistochemical features of this entity, and review the pertinent literature on this subject. To our knowledge, this is the second reported case of cutaneous decidualized endometriosis in a nonpregnant female.

Cutaneous Inguinal Scar Endosalpingiosis and Endometriosis

“…35,39,44,54,[56][57][58] If stroma is decidualized, it shows positivity for CD10, human placental lactogen, and inhibin-alpha. 49,50,59,60 Pan-cytokeratin expression was also examined by several authors, and they showed that it is variable from absent to diffusely positive. 15,50,59,60 If stroma is decidualized, the Ki-67 labeling index is also increased.…”

“…3,5,9,[11][12][13]15,17,19,[22][23][24][25]29,30,32,34,36,39,40,[49][50][51]53,57,59,60 All cases of cutaneous endosalpingiosis were found on previously unaffected skin. 1,61-63 Endometriosis usually presented on scars after gynecological surgical procedures-cesarean section (119 cases), 3,5,9,11,12,15,17,19,24,25,29,30,32,34,36,39,40,[49][50][51]53,57,59,60 episiotomy (13 cases), …”

Histological features in abdominal wall endometriosis

“…Sometimes decidual cells may look like stony ring cells, but immunohistochemically, unlike carcinoma metastases, they are pancytokeratin-negative [2]. Decidual changes in AWE are also rare in the literature and are frequently reported as case reports [11,[13][14][15]. Decidual changes in our study were seen in 1 case.…”

“…Decidual changes usually occur in the presence of pregnancy [14,16]. However, such changes have been reported in patients who have not had previous pregnancy stories [15]. In our case, there was a cesarean story 3 years ago.…”

“…With the increase in the number of cases of AWE in recent years, it is necessary to keep in mind the histological changes in these cases in terms of the differentiation from malignancies [15][16][17].…”