Kim Hyun-Soo, Yoon Gun, Kim Byoung-Gie, Song Sang Yong
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, South Korea.
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, South Korea.
Int J Clin Exp Pathol. 2015 Jan 1;8(1):1025-30. eCollection 2015.
Here we describe an unusual case of decidualized endometriosis detected in pelvic lymph nodes. The presence of intranodal ectopic decidua in pregnant women has been described. A few cases of decidualization of endometriotic foci in the pelvic or para-aortic lymph nodes have also been associated with pregnancy. However, decidualized intranodal endometriosis occurring in a postmenopausal woman has not been described. A 52-year-old woman presented with a very large adnexal mass. Menopause occurred at the age of 47, and she had been treated with hormone replacement therapy. She received a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy for clear cell carcinoma of the right ovary. Histological examination revealed the presence of ectopic decidua in several pelvic lymph nodes. The deciduas consisted of sheets of loosely cohesive, large, uniform, round cells with abundant eosinophilic cytoplasm. Typical of decidualization of intranodal endometriosis, a few irregularly shaped, inactive endometrial glands lined by single layers of columnar to cuboidal epithelium were present within the decidua. An immunohistochemical study revealed that the decidual cells were positive for CD10, vimentin, estrogen receptor and progesterone receptor, which indicated that progestin-induced decidualization had occurred in the intranodal endometriotic stroma. To the best of our knowledge, this case represents the first report of decidualized intranodal endometriosis occurring in association with hormone replacement therapy in a postmenopausal woman. Misdiagnosis of this condition as a metastatic tumor can be avoided by an awareness of these benign inclusions, supported by immunohistochemical staining results.
在此，我们描述了一例在盆腔淋巴结中发现的蜕膜样化子宫内膜异位症的罕见病例。已有文献报道孕妇盆腔淋巴结内存在异位蜕膜。少数盆腔或腹主动脉旁淋巴结内子宫内膜异位灶的蜕膜样化病例也与妊娠有关。然而，绝经后妇女发生的淋巴结内蜕膜样化子宫内膜异位症尚未见报道。一名52岁女性因附件区巨大肿物就诊。她47岁绝经，曾接受激素替代治疗。因右侧卵巢透明细胞癌，她接受了全腹子宫切除加双侧输卵管卵巢切除及盆腔和腹主动脉旁淋巴结清扫术。组织学检查发现多个盆腔淋巴结内存在异位蜕膜。蜕膜由成片的松散黏附的大的、均匀的圆形细胞组成，胞质丰富且嗜酸性。典型的淋巴结内子宫内膜异位症蜕膜样化表现为，蜕膜内可见一些形状不规则、不活跃的子宫内膜腺体，内衬单层柱状至立方上皮。免疫组化研究显示，蜕膜细胞CD10、波形蛋白、雌激素受体和孕激素受体均呈阳性，这表明淋巴结内异位子宫内膜间质发生了孕激素诱导的蜕膜样化。据我们所知，该病例是绝经后妇女激素替代治疗相关的淋巴结内蜕膜样化子宫内膜异位症的首例报道。认识到这些良性包涵体，并结合免疫组化染色结果，可避免将这种情况误诊为转移性肿瘤。
