Misdiagnosis of adenocarcinoma in pregnancy – literature review and case report

Abstract

Introduction: physiological and reversible endometrial changes during pregnancy and in some cases of hormone replacement therapy include the Arias-Stella reaction, secondary to non-ovarian pro-gestational inflow (mainly of chorionic tissue in the placenta). Its atypical appearance leads to a misinterpretation as adenocarcinoma. Objectives: to discuss the case of a patient with pregnancy endometriosis and AriasStella reaction where a diagnosis of adenocarcinoma in the peritoneal serosa is wrongly suggested, and to review the literature on the presentation and differential diagnosis of this condition. (Arias-Stella reaction). Materials and methods: analysis of a 23-year-old patient, at term pregnancy undergoing cesarean section. During the procedure some nodular lesions are identified and the pathology report is suggestive of malignancy (adenocarcinoma of the peritoneal serosa). Further on, immunohistochemical studies and analyses were completed at our laboratory that confirmed an Arias-Stella reaction, ruling-out a tumor lesion. A search in Scielo and PubMed databases using the MeSH terms “Arias-Stella Reaction”, “endometriosis” and “adenocarcinoma” was done. Results: 4 articles were selected of which 1 corresponds to a case series and the remaining three were literature reviews. Conclusion: this case emphasizes the importance of the treating physician awareness with regards to this condition, when identifying extra-uterine nodules in patients with a recent history of pregnancy or abortion and the need for histopathological confirmation.