Decidualized Stroma in Pelvic Lymph Nodes in a Pregnant Patient With Cervical Squamous Cell Carcinoma: A Case Report

Decidualized endometrial stroma is an uncommon finding in lymph nodes but is typically found in the setting of endometriosis where endometrial glands give a hint toward the diagnosis. On the other hand, endometrial stroma with no identifiable endometrial glands can be challenging to differentiate from metastatic squamous cell carcinoma. We report a case of a 22-year-old female who presented to our medical center as a known case of cervical squamous cell carcinoma. The patient desired future fertility and became pregnant. She was treated during her second trimester and underwent a radical cesarean hysterectomy at 37 weeks' gestation with bilateral pelvic lymph node dissection. Resection showed residual moderately differentiated squamous cell carcinoma of the cervix with lymphovascular invasion. Two pelvic lymph nodes were found to have decidualized stroma. Immunohistochemistry was done to rule out metastasis and no metastatic carcinoma was identified in any of the lymph nodes. It is necessary to be aware of the possibility of decidualized stromal changes in pelvic lymph nodes to avoid misdiagnosis.