{"paper_id":"cbda1440-6545-4506-87ad-d8cb4beefdf6","body_text":"WWW.KJOG.ORG 373\nA CASE OF OVARIAN DECIDUOSIS IN PREGNANCY \nJeong Hyeon Kim, MD, Ka Hyun Nam, MD, Ja Young Kwon, MD, Young-Han Kim, MD, Yong Won Park, MD\nDepartment of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea \nEctopic decidua (deciduosis) has been discovered in variable organs during pregnancy. Ovarian deciduosis, however, is a less \nfrequent event during pregnancy. Ectopic decidua is a physiological phenomenon of pregnancy and arises from a progesterone-\ninduced metaplasia of subserosal stromal cells. As we experienced a case of 21 weeks gestation who was diagnosed with ovarian \ndeciduosis that was suspicious for ovarian malignant tumor, we present it with a brief review of literature. \nKeywords: Decidua; Ovarian cyst; Pregnancy\nCASE REPORT\nReceived: 2011. 3. 2.   Revised: 2011. 5.12.  Accepted: 2011. 6. 2.\nCorresponding author: Y ong Won Park, MD\nDepartment of Obstetrics and Gynecology, Y onsei University \nCollege of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul \n120-752, Korea\nTel: +82-2-2228-2230  Fax: +82-2-364-7762\nE-mail: ywparkob@yuhs.ac\nTh is is an Open Access article distributed under the terms of the Creative Commons \nAttribution Non-Commercial License (http://creativecommons.org/licenses/\nby-nc/3.0/) which permits unrestricted non-commercial use, distribution, and \nreproduction in any medium, provided the original work is properly cited.\nCopyright © 2011. Korean Society of Obstetrics and Gynecology \nKorean J Obstet Gynecol 2011;54(7):373-376\ndoi: 10.5468/KJOG.2011.54.7.373\npISSN 2233-5188\n · eISSN 2233-5196\nThe occurrence of ectopic decidua (deciduosis) has been observed \nmost often in the cervix and appendix [1]. It has been established \nin approximately 90% of patients who have undergone laparot-\nomy during pregnancy [2]. Ovarian deciduosis, however, is a less \nfrequent in pregnancy. Ectopics decidua is a physiological phe-\nnomenon of pregnancy and arises from a progesterone-induced \nmetaplasia of subserosal stromal cells [2,3]. We experienced an \nunusual case of ovarian deciduosis found at 21 weeks gestation in \na primigravida with features of ovarian cyst.\nCase Report\nA 32-year-old woman, gravida 1, para 0, abortus 0 was referred to \nour institute because of an accidentally detected left ovarian cyst \nat 21 weeks gestation. She had no signifi  cant medical or gyneco-\nlogical history before. On admission, transvaginal ultrasound scan \nshowed 10.9 × 3.9 cm sized heterogenous cystic mass with solid \nportion. The peritoneal cavity was fi  lled with small amount of free \nfl  uid. Doppler utrasonogram image of the mass shows vasculariza-\ntion with pulsatility, a finding that is suggestive of a malignant \nmass (Fig. 1) [4,5]. The magnetic resonance imaging also showed \n10 × 7 × 4.8 cm sized mass lesion consisted of multicystic compo-\nnent and large amount of solid component, mainly along the cyst \nwall suggestive of left ovarian tumor, borderline to malignancy (Fig. \n2) [4,5].\nAs the result of the imaging studies was suspicious for malig-\nnancy, we thoroughly explained the natural history, prognosis of \ndisease, available treatment methods, and their possible risks and \ndiscussed with the patient and her family. At last, they decided to \nconserve pregnancy. An exploratory laparotomy was planned at \n21 weeks gestation. Through a midline incision, laparotomy was \nperformed in the supine position. Intraoperative fi  ndings revealed \nabout 12 × 6 × 8 cm sized multiloculated mass on the left ovary, \nwith mixed serous and solid portion. The tubes and uterus were \ngrossly normal. The left salpingo-oophorectomy was done. A piece \nof ovarian tissue was taken for histopathological examination. \nFrozen sections of the mass revealed a benign cyst that might be \na mucinous cystadenoma. The surgery has been completed suc-\ncessfully. Postoperatively patient was treated with antibiotics and \ntocolytics. After uneventful recovery she was discharged on 11\nst\n \npostoperative day with ongoing pregnancy. The rest of the preg-\nnancy was unremarkable. At 40 weeks gestation an uneventful \nvaginal delivery resulted in a 3,440 g normal male baby with Ap-\ngar of 7/10 and 8/10. She was doing well at the 6 month follow-\n\nWWW.KJOG.ORG374\nKJOG  Vol. 54, No. 7, 2011\nFig. 1. (A) Transvaginal utrasonogram image shows a 10.9 × 3.9 cm sized heterogenous cystic mass with 6.6 × 3.5 cm, 2.5 × 1.4 cm and 1.8 × 1.4 cm of \nsolid portion on left adnexa. (B) Doppler ultrasonogram image of the mass shows vascularization with pulsatility, a fi  nding that is suggestive of a malig-\nnant mass (resistance index [RI], RI=0.37). PSV , peak systolic velocity; EDV , end-diastolic velocity; S/D, systolic:diastolic ratio.\nAB\nFig. 2. Axial T2-weighted (A), coronal 2-weighted (B) and sagittal T2-weighted (C) images demonstrate late 2\nnd\n trimester pregnant state and about \n10 × 7 × 4.8 cm sized mass at left adnexa. The solid component along the cyst wall shows intermediate to high signal intensity on T2-wei ghted images \n(T2WI). The nodule (arrow) with low signal intensity on T2WI is possibility of paramagnetic component such as hemosiderin. Twen ty-one gestational \nweek sized fetus is noted in (C).\n \nA\nBC\n\nWWW.KJOG.ORG 375\nJeong Hyeon Kim, et al. Ovarian deciduosis in pregnancy\nup after delivery.\n1. Pathological fi ndings\nOn microscopic examination, nest of epithelioid cells in small \nislands were seen. These cells were large with abundant granular \ncytoplasm in the specimen from the ovary. These cells were identi-\nfied as decidual cells. The ovarian cyst was reported as ovarian \ndeciduosis in permanent pathologic examination (Fig. 3).\nDiscussion \nDecidual reaction is a well-documented physiological phenom-\nenon of pregnancy which arises from a progesterone-induced \nmetaplasia of subserosal stromal cells [3]. With increasing dura-\ntion of pregnancy, there is vacuolar degeneration and fragmenta-\ntion of the decidua cells as a manifestation of regressive changes. \nThe involution of the decidua takes place in four to six weeks post \npartum [6]. In the absence of pregnancy, it has been considered \nthat stimulation of appropriate cells by progesterone and pro-\ngesterone-like substances from the corpus luteum or the adrenal \ncortex causes ectopic decidual formations [7,8]. It has been ob-\nserved most often in the cervix and appendix [1,3]. Gross ovarian \ndeciduosis is a rare lesion. The intraoperative appearance suggests \nmucinous cystadenoma.\nDeciduosis is an incidental fi  nding that has not been associated \nwith clinical symptoms [3,9], however, rare life-threatening events \nhave been reported [10]. Deciduosis is usually an incidental mi-\ncroscopic finding, detected in biopsies taken during caesarian \nsections, postpartum tubal ligations, appendectomies and in-tubal \npregnancies [1]. The decidual cells on microscopy appear large \nwith abundant cytoplasm and a bland nucleus.\nWe experienced an unusual case of ovarian deciduosis in a primi-\ngravida that was suspicious for ovarian malignant tumor. Though \na rare event, it should be considered as a differential diagnosis in \ncases presenting as ovarian malignant tumor during pregnancy.\nReferences\n  1. Piccinni DJ, Spitale LS, Cabalier LR, Dionisio de Cabalier ME. \nDecidua in the peritoneal surface mimicking metastatic nod-\nules. Findings during cesarean section. Rev Fac Cien Med Univ \nNac Cordoba 2002;59:113-6.\n  2. Fenjvesi A, Zivkoviæ S. Deciduosis peritonei: a case report. Med \nPregl 2005;58:196-9.\n  3. Szopi ñski TR, Sudoł-Szopiñska I, Dzik T, Borówka A. Ectopic \ndecidual reaction in the urinary bladder presenting as a vesi-\ncal tumor. Urology 2009;74:1232-3.\n  4. Ghossain MA, Buy JN, Lignères C, Bazot M, Hassen K, Malbec L, \net al. Epithelial tumors of the ovary: comparison of MR and CT \nfi  ndings. Radiology 1991;181:863-70.\n  5. Troiano RN, McCarthy S. Magnetic resonance imaging evaluation \nof adnexal masses. Semin Ultrasound CT MR 1994;15:38-48.\nFig. 3. Histologic fi  ndings: ovary revealed a pinkish tan colored edematous stroma (A, H&E; ×40), deciduosis with hemosiderin laden ma crophage (B, \nH&E; ×100). \nAB\n\nWWW.KJOG.ORG376\nKJOG  Vol. 54, No. 7, 2011\n  6. Büttner A, Bässler R, Theele C. Pregnancy-associated ectopic \ndecidua (deciduosis) of the greater omentum. An analy-\nsis of 60 biopsies with cases of fibrosing deciduosis and \nleiomyomatosis peritonealis disseminata. Pathol Res Pract \n1993;189:352-9.\n  7. Tang LC, Cheung MY , Ma HK. Intraperitoneal bleeding from \nectopic decidua following hormonal contraception. Case re-\nport. Br J Obstet Gynaecol 1985;92:102-3.\n  8. Weller CV . The Ectopic Decidual Reaction and its Signifi  cance \nin Endometriosis. Am J Pathol 1935;11:287-90 1.\n  9. Papp Z, Petri I, Villányi E, Tiszlavicz L, Ugocsai G. Deciduosis \ncausing perforating appendicitis in the early postpartum pe-\nriod following caesarean section. Orv Hetil 2008;149:329-31.\n10. Shukla S, Pujani M, Singh SK. Ectopic decidual reaction mim-\nicking peritoneal tubercles: a report of three cases. Indian J \nPathol Microbiol 2008;51:519-20.\n임신 중 발견된 ovarian deciduosis 1예\n연세대학교 의과대학 산부인과학교실\n김정현, 남가현, 권자영, 김영한, 박용원\n이소성 탈락막(ectopic decidua)은 자궁 이외의 부위에 발생하는 것으로 특히 난소의 이소성 탈락막은 드문 질환이다. 이는 임신 중 난소호\n르몬과 태반의 호르몬, 그중에서도 특히 황체호르몬(progesterone)의 영향으로 변형된 자궁내막의 기질세포(stroma cell)로 구성된다. 우리\n는 임신 21주에 좌측 난소 낭종의 크기 증가를 주소로 내원한 임신부에서 개복수술 후 조직학적으로 이소성 탈락막의 존재 여부를 확인한 \n1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다. \n중심단어: 이소성 탈락막, 난소 낭종, 임신","source_license":"CC0","license_restricted":false}