In pregnant patients with a divided uterine cavity, the decidual tissue on the nonpregnant side may be discharged prior to the delivery of the fetus. The pregnancy can continue if the uterine contractions and vaginal bleeding are controlled and the fetus is not in distress.

Appendectomy is the most common non-obstetric surgical intervention in pregnant patients. In rare cases, deciduosis can develop during pregnancy in the appendix and cause inflammation through appendiceal occlusion by ectopic decidua tissue. We report a 28-year-old woman at 32 weeks of pregnancy, who presented at the emergency room with the diagnosis of an acute appendicitis. After successful appendectomy and histopathological examination of the appendectomy specimen, a diagnosis of appendiceal deciduosis with acute appendicitis was established. Here, we discuss the origin of appendiceal deciduosis, as well as its clinical and histopathological presentation.

暂无摘要。

A 30-year-old woman with a bicorporeal uterus complained of abdominal pain and vaginal hemorrhage at 28 weeks and 5 days of gestation. There were no signs of placenta previa with echography in the second trimester; however, the echography showed a highly echoic area (91 × 85 mm), indicating placenta previa. Thereafter, abdominal pain and vaginal bleeding increased. Thus, we suspected placental abruption and performed cesarean section. After cesarean section, discharge of placenta-like tissue into the vagina was confirmed and pathological examination of the tissue showed only the decidua. In cases of uterine malformations, in which the uterine cavity is divided into pregnant and nonpregnant sides, the decidua on the nonpregnant side can be discharged before the onset of delivery. In addition, at the time of decidual discharge, echography findings are similar to those of placenta previa and the clinical symptoms are similar to those of placental abruption.

Peritoneal lipofuscinosis is a very rarely recognized condition occurring during pregnancy characterized by brown pigmentation of the omentum and peritoneum, a decidual reaction and benign mesothelial cells. The iron negative pigment, which is likely to be confused with hemosiderin in the hematoxylin and eosin stain, is lipofuscin. The seminar case, apparently the third published, arose in a 37-year-old woman who presented in October 2015 at 24 weeks pregnancy with abdominal pain. Investigations revealed a ruptured left ovarian cyst and rising serum carcinoembryonic antige levels. At laparotomy, there was no free intraperitoneal blood but the omentum and uterine serosa were black. Histology showed lipofuscinosis and a decidual reaction. The patient delivered a normal baby in February 2016 and was clinically well after delivery. A left ovarian endometriotic cyst was removed in February 2017. The patient made a good recovery with no clinically apparent symptoms from the liposuscinosis. We postulate that the endometriotic cyst had ruptured and released blood into the peritoneal cavity in 2015. The iron from the red cells breakdown was then rapidly resorbed because of the pregnancy requirements for iron, leaving lipofuscin in peritoneal macrophages.

We report a case of decidual perivascular non-necrotizing granulomas in a placenta from a pregnancy complicated by severe preeclampsia with no evidence of infection. The mother was a 20-year-old primigravida with severe preeclampsia diagnosed in the third trimester with subsequent delivery of a healthy baby boy at 37 weeks 5 days gestation. Pathologic examination of the placenta showed scattered non-necrotizing granulomas in decidua, often adjacent to remodeled decidual arteries without fibrinoid necrosis. These were well-formed, non-necrotizing granulomas with scant lymphoid cuffs. Polarization microscopy did not show foreign material. There were no histopathologic or clinical findings suggestive of maternal-fetal infection or systemic vasculitis at the time of delivery, and the mother had no other reported conditions associated with granulomatous inflammation. Our case demonstrates that granulomatous reaction may be seen in the placenta from a pregnancy complicated by severe preeclampsia, although work-up for infection may be indicated.

Placental neoplasms involving the fetal membranes are exceptionally rare. In leiomyomas and endometrial stromal neoplasms, a uterine origin for nodules in the membranes is also a possibility. We present a case of an incidental endometrial stromal nodule found in the decidua of the free membranes and review the literature.

Clinical differentiation between decidualized endometrioma and malignant transformation still poses difficulties as both are intracystic vascularized excrescences of an endometrial cyst and exhibit similar characteristics on color-flow Doppler sonography. This is a characteristic sonographic finding associated with ovarian cancer, but MRI can provide further information about mural excrescences that can aid in their differential diagnosis; for example, the signal of decidualized endometriomas is isointense with the placenta within the uterus on all sequences and the apparent diffusion coefficient is higher than that of malignant mural nodules. Thus, MRI should be an aid in deciding whether to intervene during pregnancy. However, considering that it is not yet possible to clearly differentiate decidualized endometriomas from ovarian cancer, surgery or watchful observation may still be needed to exclude the possibility of malignancy.

BACKGROUND: Decidualization of uterine adenomyoma has not been reported, to the best of the author\'s knowledge.
OBJECTIVE: To report a case of uterine adenomyoma with decidualization.
METHODS: A 43-year-old pregnant woman with \"myoma\" underwent cesarean operation and \"myomectomy\" at 37 gestation weeks. The operation was successful, and the baby and mother were healthy. Grossly, the \"myoma\" measured 12 × 10 × 10 cm, and the consistency was firm. Microscopically, the tumor was adenomyoma consisting of smooth muscle bundles and endometrial islands. Characteristically, the endometrial stroma showed marked decidualization. An immunohistochemical study showed that the decidual cells were positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, cytokeratin (CK)7, CK18, vimentin, CA125, CD10, estrogen receptor (ER), progesterone receptor (PgR), and Ki-67 (labeling 1 %). They were negative for CK34βE12, CK5/6, CK8, CK14, CK19, CK20, EMA, p63, desmin, α-smooth muscle actin, S100 protein, CK34, CD68, and p53. These results show that marked decidualization occurs in adenomyoma during pregnancy, and that the decidual cells are positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, CK7, CK18, vimentin, CA125, CD10, ER, and PgR.
CONCLUSIONS: A rare case of uterine adenomyoma with decidualization is reported.

A case of a 27 year old G1P0 female with a dichorionic, diamniotic twin pregnancy presenting with premature rupture of membranes found to have omental caking and diffuse yellow-tan peritoneal nodules, clinically suspicious for carcinomatosis. The case work-up showed this to be an example of florid-diffuse peritoneal deciduosis mimicking carcinomatosis which has since resolved 4 months postpartum.