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Case Reports
. 2020 Nov 28;12(11):e11741.
doi: 10.7759/cureus.11741.

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

Anoshia Afzal  1 , Phillip Mingola  1 , Michael Quinton  1 , Roy Zhang  1
Affiliations
Case Reports

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

Anoshia Afzal et al. Cureus. .

Abstract

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.

Keywords: decidualized; immunohistochemistry; pelvic lymph nodes; stroma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Hematoxylin and eosin staining (A: 4x and B: 10x) of sections of the cervix showed residual moderately differentiated squamous cell carcinoma.
Figure 2
Figure 2. Hematoxylin and eosin staining (A: 4x, B-C: 10x and D: 20x) of pelvic lymph nodes showed clusters of large, polygonal cells with well-defined cell borders and abundant eosinophilic cytoplasm and round nuclei. No atypia was identified.
Figure 3
Figure 3. Immunohistochemical staining showed the cells to be positive for ER (Fig A), PR (Fig B) and CD10 (Fig C), thus confirming these clusters to be endometrial stromal cells. p63 (Fig D) was negative and ruled out metastatic squamous cell carcinoma.
ER - estrogen receptor PR - progesterone receptor CD - cluster of differentiation p63 - transformation-related protein 63
See this image and copyright information in PMC

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