Keratin Granulomas in the Peritoneum on Frozen Section: A Case Report with Multiple Suspects and the Search for the Culprit

Levon Katsakhyan, Xiaoming Zhang, Maria C. Reyes, Lauren E. Schwartz, Ashley F. Haggerty, Kumarasen Cooper

Research output: Contribution to journalArticlepeer-review


Keratin granulomas in the peritoneum are a rare finding with multiple etiologies and can be especially challenging for both the pathologist and the surgeon when these lesions are grossly visible. We report a case of a unique frozen section diagnostic scenario of evaluation of keratin granulomas in the peritoneum of a 47-year-old woman in the setting of multiple potential culprits: endometrial endometrioid adenocarcinoma following fertility sparing treatment, and a concurrent dermoid cyst. We discuss the various etiologies of keratin granulomas in the peritoneum, mechanism of their formation, diagnostic significance, as well as implications of fertility sparing treatments. To the best of our knowledge, this is the only case of keratin granulomas in the peritoneum with multiple distinct potential pathologic culprits as well the only case following fertility sparing treatment.

Original languageEnglish (US)
Pages (from-to)46-49
Number of pages4
JournalInternational journal of surgical pathology
Issue number1
StatePublished - Feb 2022
Externally publishedYes


  • dermoid cyst
  • endometrial endometrioid adenocarcinoma
  • fertility sparing treatment
  • frozen section
  • keratin granulomas
  • peritoneal granuloma
  • shadow cells
  • squamous morules

ASJC Scopus subject areas

  • Surgery
  • Anatomy
  • Pathology and Forensic Medicine

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