Afzal Anoshia, Mingola Phillip, Quinton Michael, Zhang Roy
Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Cureus. 2020 Nov 28;12(11):e11741. doi: 10.7759/cureus.11741.
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.
蜕膜化的子宫内膜间质在淋巴结中是一种不常见的表现，但通常见于子宫内膜异位症的情况下，此时子宫内膜腺体有助于诊断。另一方面，没有可识别的子宫内膜腺体的子宫内膜间质可能难以与转移性鳞状细胞癌区分开来。我们报告一例22岁女性病例，该患者作为已知的宫颈鳞状细胞癌患者前来我们的医疗中心就诊。患者希望未来能够生育并怀孕。她在孕中期接受了治疗，并在妊娠37周时接受了根治性剖宫产子宫切除术及双侧盆腔淋巴结清扫术。切除标本显示宫颈残留中度分化鳞状细胞癌伴淋巴管浸润。发现两个盆腔淋巴结有蜕膜化的间质。进行了免疫组织化学检查以排除转移，在任何淋巴结中均未发现转移性癌。有必要意识到盆腔淋巴结中存在蜕膜化间质改变的可能性，以避免误诊。
