The Ovary at Term. I. Decidua-Like Reaction and Surface Cell Proliferation

Israel, Steffen; Rubenstone, Albert I.; Meranze, David R.

doi:10.1097/00006254-195502000-00003

Cited by 11 publications

(16 citation statements)

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“…The gross alteration consists of a network of pale reddish ridges over the surface of the ovary, which microscopically is shown to be a decidual reaction located just beneath the surface epithelium (5,9,11,12,13,14,16,17). The gross alteration consists of a network of pale reddish ridges over the surface of the ovary, which microscopically is shown to be a decidual reaction located just beneath the surface epithelium (5,9,11,12,13,14,16,17).…”

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confidence: 99%

Ovarian Morphology in Early and Late Human Pregnancy

Starup

Visfeldt

1974

Acta Obstet Gynecol Scand

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Representative ovarian biopsies were obtained from 30 pregnant women aged 15 to 40. Group I consisted of 6 women with pregnancies of a gestational age of 9 to 18 weeks, and group 11 consisted of 24 women with pregnancies of a gestational age of 36 to 42 weeks.The number of primordial follicles varied considerably in both groups, but seemed to be mainly dependent on the age of the individual woman. We did not examine the follicular development before the 9th week of pregnancy, but at least from that time a normal development of follicles up to the stage of Graafian follicles was observed in the great majority of women.A typical decidual reaction in the ovarian cortex was found in all women in group 11, but this reaction may also occasionally occur very early in pregnancy. For instance, we observed a marked decidual reaction in one woman in the 9th week of pregnancy. The decidual reaction was always located beneath or adjacent to the surface epithelium, and usually it was of the nodular form, but it might also occur as single cells or as more diffuse and confluent formations of decidual cells. In all cases of typical decidual reaction, the macroscopic appearance of the ovary was characteristic; the ovarian surface presented a gyriform appearance due to a network of thin, pale red ridges and small nodules. An interesting observation in group I was that the decidual reaction in all cases seemed to be preceded by the existence of nodules, or more confluent areas characterized by a loose, proliferative connective tissue containing many fibroblasts and capillaries.The most consistent finding in both groups was the proliferation and luteinization of the theca cells surrounding both the growing and atretic follicles. However, it should be emphasized that these luteinized theca cells were only found around antral and Graafian follicles and atretic follicles of similar size, but never around even the largest primary follicles.We are not convinced of the significance of the previously described so-called surface cell proliferation, even if similar changes were observed in 57% of the 30 women investigated. These changes were mainly observed in areas where the epithelium covered depressed or retracted parts of the ovarian stroma. On the other hand, the prominent decidual nodules were covered by a thin layer of flattened epithelial cells. We therefore believe that the changes in the surface epithelium is merely an unspecific phenomenon.

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confidence: 99%

Ovarian Morphology in Early and Late Human Pregnancy

Starup

Visfeldt

1974

Acta Obstet Gynecol Scand

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“…When it is located at places other than the endometrium, it is called ectopic decidua or deciduosis. The most common places for ectopic decidua are the cervix, vagina1 and the ovary,2 but other locations such as the appendix, omentum, diaphragm or peritoneum, have been reported 3. Deciduosis is generally an accidental finding during pregnancy and is mostly detected during a caesarean section, appendectomy, an ectopic pregnancy or during cytological follow-up of cervical premalignant dysplastic changes.…”

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confidence: 99%

Cervical deciduosis imitating dysplasia

Diepen¹,

Hellebrekers

Haaften

et al. 2015

BMJ Case Reports

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Ectopic cervical deciduosis is generally an accidental finding during pregnancy, and usually presents without any symptoms or need for therapeutic intervention. However, it can sometimes imitate dysplasia or carcinoma. We report a case of a 34-year-old G2P0, with a history of cervical dysplasia, presenting at 11 weeks of gestation, with vaginal blood loss. During examination, lesions mimicking dysplasia were found on the cervix. Histological examination reported cervical deciduosis. Deciduosis is a benign change during pregnancy and will resolve spontaneously. With the increasing use of cytology and colposcopy, the reported incidence is growing. When it is hard to differentiate between dysplasia and deciduosis, histological confirmation should be considered.

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“…Existem artigos que executam biópsias sistemáticas com o intuito de determinar a prevalência de DE, no entanto a metodologia e local exato de colheita das biópsias, o número total de casos estudados, os critérios de seleção da amostragem ou a descrição das técnicas de anatomia patológica utilizadas, não são descritas em todos os artigos, o que limita quer a valorização dos resultados quer a comparação destes com outros estudos. 15,19,20,24,25,36,37,42,43 Este artigo de revisão procura sensibilizar os médicos para esta entidade muitas vezes subdiagnosticada. O reconhecimento das suas características clínicas, bem como o seu elevado índice de suspeição tornam-se essenciais na conduta destas doentes, para a sua abordagem adequada e manutenção do seu perfil de bom prognóstico.…”

Section: Discussão E Conclusãounclassified

“…Contudo, deve ser cuidadosamente ponderada a biópsia dirigida a estas lesões e avaliado o elevado risco de hemorragia associado à biópsia versus o benefício relativo ao diagnóstico e exclusão de entidades malignas. 20,24,33,50 Na microscopia, a reação decidual surge na subserosa ou no tecido adiposo; 26,36,37,42,50 por vezes, associada a inflamação. 24 A presença de mitoses, necrose, pleomorfismo e hipercromasia nuclear não são frequentes.…”

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Decidualização Ectópica: Uma Entidade Esquecida

Mendes

Costa

2016

Acta Med Port

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Introduction: Although ectopic decidualization is an entity often underdiagnosed, it may have adverse clinical impact on maternal-fetal morbimortality. The objective of this study was to review the scientific evidence regarding the etiology, clinical features, diagnosis and therapeutic approach on this issue. Material and Methods:The search for this literature review was conducted in PubMed, Web of Science and Scopus, through the query ('deciduosis' OR 'ectopic decidualization' OR 'ectopic decidua' OR 'ectopic decidua reaction'), considering articles of all evidence levels published up to 31/06/2014. Results: Ectopic decidualization is, usually, a benign condition, asymptomatic and does not require therapeutic intervention. It occurs mostly during pregnancy, with complete regression in the postpartum period. The frequency of the diagnosis depends on the clinical suspicion and its location, being the omentum and the ovary the most common sites. When symptomatic, the main clinical manifestations are genital bleeding and hemoperitoneum. Differential diagnosis includes malignant disease and histopathological confirmation is essential in these situations. The low index of suspicion may lead to a biopsy, which can have serious adverse outcomes due to the high friability of these lesions. Discussion and Conclusion: The recognition of this entity and its clinical features are essential for the management of these patients. On one side this allows an early and proper medical approach in severe cases, on the other side (the majority of cases) maintaining an expectant attitude avoiding iatrogeny, does not compromise, in most cases, the favorable outcome of ectopic decidualization. Keywords: Decidua; Pregnancy; Pregnancy Complications. INTRODUÇÃOA célula decidual é uma célula mesenquimatosa embrionária, derivada do tecido conjuntivo laxo da mucosa uterina. 1A transformação decidual destas células da mucosa uterina ocorre durante a gravidez e, normalmente, abrange a mucosa do corpo uterino, poupando o colo e o istmo. Denomina-se decidualização ectópica (DE), quando este processo ocorre em qualquer outra localização fora do endométrio. 2Neste contexto, podem-se considerar três conceitos distintos 3 : (1) pré-decídua (reação celular do endométrio, que se forma entre o 23º e o 28º dia do ciclo menstrual normal e é citologicamente indistinguível da verdadeira decídua), (2) decídua e (3) DE ou deciduose. Esta última pode ocorrer, com decrescente frequência, em gestações evolutivas in utero, perturbações da gravidez inicial (gravidez ectópica, gestação tópica não evolutiva e doença neoplásica do trofoblasto), e em não grávidas. É debatido se a deciduose é um fenómeno fisiológico ou patológico. Na literatura existem vários casos clínicos descritos com desfecho adverso quer para a grávida e feto, quer para a mulher não grávida. [4][5][6][7][8][9]

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The Ovary at Term. I. Decidua-Like Reaction and Surface Cell Proliferation

Cited by 11 publications

References 0 publications

Ovarian Morphology in Early and Late Human Pregnancy

Ovarian Morphology in Early and Late Human Pregnancy

Cervical deciduosis imitating dysplasia

Decidualização Ectópica: Uma Entidade Esquecida

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