Hypodermal decidualized endometrioma with aberrant cytokeratin expression. A lesion mimicking malignancy

José Fernando Val-Bernal, J. Fernando Val‐Bernal, Val D, Daniel Val, Fernando Gómez-Aguado, Fernando Gómez, María Teresa Corcuera, Corcuera MT, Garijo MF, María Francisca Garijo
The American Journal of dermatopathology · 2011 · vol. 33(5) , pp. e58–e62 · doi:10.1097/dad.0b013e3181f704f6 · PMID:21478729 · W2313912393
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This case report describes a hypodermal decidualized endometrioma, a benign lesion that presented as a nodule mimicking malignancy due to aberrant cytokeratin expression.

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This case report describes a 36-year-old woman who developed a subcutaneous nodule beneath a previous cesarean section scar during the immediate postpartum period. Histological examination revealed large monomorphic epithelioid cells with aberrant cytokeratin expression, human placental lactogen positivity, and CD10 staining, which initially raised concern for malignant conditions such as trophoblastic neoplasia or deciduoid mesothelioma. The authors emphasize that recognizing the presence of atrophic endometrial glands lining lumens is crucial for distinguishing this benign decidualized endometrioma from malignancy, noting that immunohistochemical stains alone can be misleading. This paper is centrally about endometriosis — specifically, it details a rare presentation of hypodermal decidualized endometrioma mimicking cancer in a cesarean scar.

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Abstract

Decidualized endometrioma is a pseudoneoplastic lesion that may appear as a solitary nodule in the hypodermis, simulate a malignant epithelioid tumor, and can represent a diagnostic challenge. A 36-year-old woman delivered a full-term baby by cesarean. At the immediate puerperium, she complained of a subcutaneous nodule measuring 2.5 cm, underneath a previous caesarean scar from the former full-term delivery 3 years earlier. Histologic features included a nodular growth pattern of large monomorphic epithelioid cells showing diffuse positivity for cytokeratin (AE1/AE3, 18), human placental lactogen, and CD10 and focal positivity for inhibin alpha. The main differential diagnoses include trophoblastic neoplasia and deciduoid mesothelioma. Good clinicopathological correlation is essential for the correct diagnosis. Immunohistochemical stains can be misleading. An important clue is the combination of large decidualized cells and lumens lined by flat or low cuboidal cells that are atrophic endometrial glands. This lesion has a benign behavior.
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Hypodermal Decidualized Endometrioma With Aberrant Cytokeratin Expression. A Lesion Mimicking Malignancy - José Fernando Val-Bernal - Daniel Val - Fernando Gómez-Aguado - María Teresa Corcuera - María Francisca Garijo Abstract: Decidualized endometrioma is a pseudoneoplastic lesion that may appear as a solitary nodule in the hypodermis, simulate a malignant epithelioid tumor, and can represent a diagnostic challenge. A 36-year-old woman delivered a full-term baby by cesarean. At the immediate puerperium, she complained of a subcutaneous nodule measuring 2.5 cm, underneath a previous caesarean scar from the former full-term delivery 3 years earlier. Histologic features included a nodular growth pattern of large monomorphic epithelioid cells showing diffuse positivity for cytokeratin (AE1/AE3, 18), human placental lactogen, and CD10 and focal positivity for inhibin alpha. The main differential diagnoses include trophoblastic neoplasia and deciduoid mesothelioma. Good clinicopathological correlation is essential for the correct diagnosis. Immunohistochemical stains can be misleading. An important clue is the combination of large decidualized cells and lumens lined by flat or low cuboidal cells that are atrophic endometrial glands. This lesion has a benign behavior.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Keratins Skin Adult Adult Diagnosis, Differential Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Female Gestational Trophoblastic Disease Gestational Trophoblastic Disease Gestational Trophoblastic Disease Humans Humans Immunohistochemistry Immunohistochemistry Keratins

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