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Clinical History:

41 year old pregnant female with invasive cervical squamous cell carcinoma underwent cesarean section delivery, hysterectomy and lymph node dissection. Sections from the cervix confirmed the presence of invasive squamous cell carcinoma. Right obturator lymph node shows the following.

 Choose the correct diagnosis:

  1. Squamous metaplasia
  2. Decidual reaction
  3. Squamous cell carcinoma, metastatic
  4. Mucinous carcinoma, metastatic

The answer is “B”  Decidual reaction

Discussion:

Age:  Reproductive age (pregnancy) 
Clinical features: Visible/non visible gross lesion 
Etiology: Progestogens secreted by corpus luteum
Histology:  Decidual reaction can be mistaken for invasive squamous cell carcinoma (which was present in this patient). However decidual reaction lacks significant nuclear atypia or mitotic activity. Similar decidual reaction was also present in the cervix next to carcinoma in this patient.
 IHC: Pancytokeratin and p63 were negative
 Prognosis:  Benign (resolves after pregnancy)

Sources:

The Internet Journal of Gynecology and Obstetrics, Volume 5, Number 1
Ectopic Decidua Suspicious Of Malignancy In Pregnancy: A Case Report
D Gopinath, C Panayotidis, T Onon


Contributed by Lea Novak, M.D.