Severe Maternal Pre- and Postpartum Intra-Abdominal Bleeding due to Deciduosis

Lüdders, D.; Henke, Rolf‐Peter; Saba, M.; Raddatz, L.; Soliman, Amr A.; Malik, Eduard

doi:10.1055/s-0035-1545876

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…However, exuberant decidualized tissue, especially when it occurs in combination with endometriosis, may endanger the mother and/or the fetus by causing pregnancy complications or being mistaken for neoplasia. 1,18,20 Stroma of endometriosis lesions and endometrium with hormonal stimulation from high progesterone may transform into decidualized cells. The typical microscopic appearance of the transformed endometrial stroma within the myometrium (internal), peritoneum, thoracic cavity, or skin (external) is seen as islands of large polygonal cells with abundant eosinophilic cytoplasm frequently containing intracytoplasmic droplets.…”

Section: Discussionmentioning

confidence: 99%

“…33 For humans, the medical literature contains many reports of ectopic deciduae mimicking metastatic lesions. 20,23,25,26 Endometrial decidualization, while not a neoplastic process, appears both grossly and microscopically similar to malignant neoplastic lesions. The lesion infiltrates the serosal surface of all abdominal viscera, as occurs in carcinomatosis from metastatic adenocarcinomas, squamous cell carcinomas, and malignant deciduoid mesothelioma.…”

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confidence: 98%

“…9 Rarely, decidualized aberrant stroma or endometriosis tissue may also directly complicate pregnancy through hemoperitoneum, intestinal perforation, or pneumothorax. 11,19,20 …”

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confidence: 99%

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Decidualization of Endometriosis in Macaques

et al. 2016

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The decidua is the superficial portion of endometrium that transforms, or decidualizes, under the influence of progesterone to nourish the early embryo during pregnancy. Deciduae outside of the uterus are found in nearly 100% of human pregnancies. This condition known as deciduosis may mimic malignancy, resulting in additional diagnostic procedures that place the mother or baby or both at risk. Deciduosis has been described in both Old and New World nonhuman primates in conjunction with pregnancy and after treatment with exogenous progestins. Here the authors present 6 cases of deciduosis associated with endometriotic lesions in female rhesus and cynomolgus macaques (Macaca mulatta and Macaca fascicularis). Full diagnostic necropsies with histological analyses were performed on all animals. Deciduae were stained with hematoxylin & eosin and by immunohistochemistry for vimentin, CD10, progesterone receptor, estrogen receptor, desmin, cytokeratin, kermix P8, chorionic gonadotropin, human placental lactogen, and calretinin. The most common clinical signs were abdominal pain (4 of 6) and anorexia (2 of 6). At necropsy, macaque uteri were often enlarged or disfigured (4 of 6) with abundant fibrous adhesions (5 of 6). Affected tissue consisted of epithelial-lined cysts and decidualized stroma with scattered gamma/delta T cells. Decidualized stromal cells were large and polyhedral with abundant cytoplasm and round, vesicular nuclei. They stained positive for vimentin, CD10, progesterone and estrogen. In summary, these cases illustrate deciduosis in 6 nonhuman primates with endometriosis. Understanding decidualization in nonhuman primates will aid in elucidating the pathophysiology of deciduosis during pregnancy or endometriosis and potentially lead to new interventions.

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Section: Discussionmentioning

confidence: 99%

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confidence: 98%

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Decidualization of Endometriosis in Macaques

et al. 2016

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“…The location of decidual deposits within the subcapsular or paratrabecular sinuses, and their presence within lymphatic space, supports the credibility of this theory (8). Besides these, another way of the pathogenesis is a decidual change of the endometriotic sites in pregnant women (8,10). This is supported by the similarity in the distribution of endometriosis and ectopic decidua, although most cases report a stromal decidual change without the histologic evidence of the presence of glands.…”

Section: Discussionmentioning

confidence: 73%

“…After histological diagnosis, most lesions do not require therapeutic intervention and spontaneously involute within the first 4-6 weeks post partum. However, in some cases, incomplete involution of ectopic decidual changes results in late bleeding (10).…”

Section: Discussionmentioning

confidence: 99%

Ectopic decidua of the greater omentum: a case report

Pigac

Mašić²

2016

JHSCI

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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 39th 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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Deciduoma, a Large Intrauterine Mass of Deciduosis

Dasani

Lee

Rijhsinghani

2019

AJP Rep

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Deciduosis is the presence of ectopic decidual tissue outside the uterus, pelvic, or abdominal organs usually associated with pregnancy. It usually presents as smaller lesions but can be larger vascular lesions. Typically, these masses are detected incidentally during operative procedures. Our patient was referred at 14 weeks for a large intrauterine mass detected on ultrasound examination that was initially thought to be an acardiac twin. The mass was highly vascularized. However, since the patient was asymptomatic, she strongly desired to continue the pregnancy. The pregnancy was followed closely from 14 to 39 weeks with serial ultrasound examinations. The vascularity was documented to diminish overtime and the mass appeared to convolute as well. Due to the decrease in vascularity of the mass, the patient was allowed spontaneous vaginal delivery at term. Following delivery of the fetus and the placenta, the mass was easily extracted manually without any complications.

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Severe Maternal Pre- and Postpartum Intra-Abdominal Bleeding due to Deciduosis

Cited by 5 publications

References 12 publications

Decidualization of Endometriosis in Macaques

Decidualization of Endometriosis in Macaques

Ectopic decidua of the greater omentum: a case report

Deciduoma, a Large Intrauterine Mass of Deciduosis

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