Decidualisation is a transformation of the endometrial stroma during pregnancy. Hormonal stimulation can induce decidualisation of stromal cells of other sites than endometrium. Nodules of decidualisation may form in the cervical stroma, but decidual cells appear in the smear in case of abrasion of the surface epithelium or decidual polyp. It can cause vaginal bleedings and even mimic a carcinoma at colposcopy.

Decidual cells have an abundant, polygonal, pale, eosinophilic or basophilic cytoplasm with heavier cell outlines than squamous metaplasia. Their nuclei is slightly enlarged, sometimes nucleolated, round or oval with vesicular chromatin. They can be a real pitfall and can easily be misdiagnosed as condyloma or mild or even moderate dysplasia. Especially when the nuclear staining is too dark, or with fixation artifacts.

29 year old wowan in early pregnancy (histology does not come from the same patient). Liquid medium (ThinPrep®) routine Pap smear.

  


 

 The cytoplasm is frankly basophilic, with sharp limits. Nuclei are enlarged but regular and chromatin is finely granular.  
       
  Cell outlines are marked and cytoplasm is eosinophilic.  
       
  Ulceration with abrasion of the cervical epithelium allowing to see the stroma and the decidual cells.  
       
 
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  Dernière mise à jour: le 31 janvier, 2004    
 

Pour en savoir plus:

Meisels A, Morin C: Cytopathology of the Uterine Cervix. ASCP Press, Chicago 1990.

Koss LG: Diagnostic Cytology and Its Histopathologic Bases. J:B: Lippincott Co, Philadelphia 1979 Murad TM, Terkhart K, Flint A: Atypical cells in pregnancy and postpartum smears. Acta Cytologica 25:623-630, 1981.

Schneider V, Barnes LA: Ectopic decidual reaction of the uterine cervix. Frequency ans cytologic presentation. Acta Cytologica 25:616-622, 1981.

Bégin LR: Florid soft-tissue decidual reaction. A potential mimic of neoplasia. Am. J. Surg. Pathol. 21(3):348-353, 1997.

Michael CW, Esfahani FM: Pregnancy-related changes: A retrospective review of 278 cervical smears. Diagn Cytopathol 17(2):99-107, 1997.