Successful management of a leiomyomatosis peritonealis disseminata with an aromatase inhibitor. Obstet Gynecol. 2008;112:491-493. [PMID: 18669776 DOI: 10.1097/aog.0b013e318180219b]

Effect of medical treatments in disseminated peritoneal leiomyomatosis: a case report

Disseminated peritoneal leiomyomatosis (DPL) is a rare gynecologic disease involving multifocal proliferation of myomas. The pathogenesis remains unclear. Although there is no standard treatment, medical therapies have attempted to suppress estrogen levels by using gonadotrophin-releasing hormone agonist and aromatase inhibitor (AI) therapy with differing degrees of success. Surgery is also an option in symptomatic patients, and in the event of partial or no response to medical treatments. We report a case of DPL in a young woman with a previous history of myomectomy. She was treated sequentially with ulipristal acetate and AI.

Leiomyomatosis peritonealis disseminata in laparoscopic port site and abdomino-pelvic cavity: A case report

Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical condition characterized by the development of multiple smooth muscle-like nodules in the peritoneal or abdominal cavity. Here, we report a case of a patient who was diagnosed with LPD after laparoscopic myomectomy with power morcellation. Growing evidence has shown that LPD might develop after using power morcellation for hysterectomy or myomectomy, and this can worsen the prognosis if the spreading tissue contains malignancies, such as leiomyosarcoma. Thus, it is crucial to use laparoscopic morcellation for gynecologic procedures cautiously, and the use of a containment system is even better. If LPD develops without evidence of malignancy, the primary treatment is surgical intervention, and gonadotropin-releasing hormone agonists, aromatase inhibitors, and selective progesterone receptor modulators can be prescribed as adjuvant therapies for recurrent or refractory cases.

Treatment of leiomyomatosis peritonealis disseminata with goserelin acetate: A case report and review of the literature

BACKGROUND

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple pelvic and abdominal nodules, which are composed of smooth-muscle cells. To date, no more than 200 cases have been reported. The diagnosis of LPD is difficult and there are no guidelines on the treatment of LPD. Currently, surgical excision is the mainstay. However, hormone blockade therapy can be an alternative choice.

CASE SUMMARY

A 33-year-old female patient with abdominal discomfort and palpable abdominal masses was admitted to our hospital. She had undergone four surgeries related to uterine leiomyoma in the past 8 years. Computed tomography revealed multiple nodules scattered within the abdominal wall and peritoneal cavity. Her symptoms and the result of the core-needle biopsy were consistent with LPD. The patient refused surgery and was then treated with tamoxifen, ulipristal acetate (a selective progesterone receptor modulator), and goserelin acetate (a gonadotropin-releasing hormone agonist). Both tamoxifen and ulipristal acetate were not effective in controlling the disease progression. However, the patient achieved an excellent response when goserelin acetate was attempted with relieved syndromes and obvious shrinkage of nodules. The largest nodule showed a 25% decrease in the sum of the longest diameters from pretreatment to posttreatment. Up to now, 2 years have elapsed and the patient remains asymptomatic and there is no development of further nodules.

CONCLUSION

Goserelin acetate is effective for the management of LPD. The long-term use of goserelin acetate is thought to be safe and effective. Hormone blockade therapy can replace repeated surgical excision in recurrent patients.

Disseminated peritoneal leiomyomatosis and malignant transformation: A case series in a single referral center

OBJECTIVE

The aim of this study was to describe one of the largest series of disseminated peritoneal leiomyomatosis (DPL) and its malignant counterpart, evaluating possible risk factors for both the benign and malignant condition, and highlighting any differences between them in terms of surgical and clinical management.

STUDY DESIGN

Clinical, surgical and histopathological characteristics of patients diagnosed with DPL (group 1) and malignant-DPL (group 2), between July 2010 and July 2020, were retrospectively retrieved.

RESULTS

A total of 14 benign and 5 malignant cases were selected. The duration of preoperative hormonal therapy was significantly longer in the benign condition while malignant DPL showed significantly larger lesions (median nodule size: 12 cm). However, surgical procedures and surgical outcomes did not differ among the two conditions, with highly complex surgery and relatively high post-operative complications in both groups.

CONCLUSION

Preoperative discrimination between benign and malignant DPL is challenging. Given the high surgical complexity required in both cases, addressing patients to referral cancer centers is strictly recommend, in order to offer them the best possible treatment and allowing a continuous and accurate collection of clinical information that might be crucial for further studies.

Successful pregnancy after complete resection of leiomyomatosis peritonealis disseminate without recurrence:a case report with next-generation sequencing analysis and literature review

Background

Peritoneal leiomyomatosis disseminate (LPD) is a rare disease characterized by widespread dissemination of leiomyomas nodules throughout the peritoneal and omental surfaces. Reports of pregnancy with LPD are even rarer. Therefore, there is no clear consensus on the treatment of LPD on pregnancy, and the pathogenesis is still unclear.

Case presentation

We reported a case of LPD patient who developed during pregnancy. The patient underwent a cesarean section at 32 weeks of gestation while removing all visible tumors, and no LPD lesions were seen in the subsequent cesarean section at full term. NGS of LPD lesions detected 4 mutations with focal high-level amplifications of CDK4 (cyclin-dependent kinases 4), NBN (Nibrin), DAXX (death domain associated protein), and MYC (myelocytomatosis oncogene). Immunohistochemistry staining analysis among benign leiomyoma, LPD, and leiomyosarcoma verified that LPD was an unusual intermediate between benign and malignant uterine smooth muscle tumors. Besides, LPD is a hormonal-dependent leiomyoma. After a detailed literature search, we summarized the detailed clinical features and follow-up information of patients with LPD during pregnancy.

Conclusions

This is the first reported LPD case of successful term pregnancy without recurrence, following resection of all visible lesions in a prior pregnancy. LPD is an unusual intermediate between benign and malignant uterine smooth muscle tumors.

A clinicopathological and molecular analysis in uterine leiomyomas and concurrent/metachronous peritoneal nodules: New insights into disseminated peritoneal leiomyomatosis

Disseminated peritoneal leiomyomatosis (DPL) is a rare, benign entity, but DPL following morcellation has become a major concern recently. This study aimed to investigate the molecular relationship between uterine leiomyoma and DPL. We analyzed the clinicopathological and molecular features of 8 DPL patients including 6 (#3-8) with and 2 (#1 and 2) without antecedent morcellation. Patients 1 and 2 were characterized by numerous, small peritoneal nodules whereas patients 4-8 harbored less but larger peritoneal nodules. Patient 3 had a peritoneal carcinomatosis-like dissemination, but she has been alive with disease for 68 months. Histological examination confirmed the diagnosis of leiomyomas in the uterus and extra-uterine sites. Immunohistochemistry demonstrated that both uterine and extra-uterine tumors were invariably positive for HMGA2 and MED12. MED12 mutation (c.130 G > A, p.G44S) was found in original uterine (n = 3) and peritoneal (n = 11) tumors from patients 3, 6, 7 and 8. Microsatellite instability at TPOX and D19S433 was observed in the uterine leiomyoma (patient 2) whereas LOH at CSF1PO was found in the peritoneal tumors (patient 1). D13S317 LOH was present in both uterine and peritoneal tumors detected (patient 8). However, D3S1358 LOH and D19S433 LOH was only found in the peritoneal tumors (patient 8) and recurrent tumors (patient 3), respectively. We suggested that DPLs following morcellation might be closely associated with original uterine leiomyomas. DPLs with and without prior morcellation may harbor different pathogenetic pathways. These findings are critical for the clinical intervention and prevention of DPL patients.

Leiomyomatosis Peritonealis Disseminata with Sarcomatous Transformation: A Rare Case Report and Literature Review

Leiomyomatosis Peritonealis Disseminata (LPD) is an uncommon disease characterized by presence of Multiple Leiomyomas in the abdominal and pelvic cavity. Increasingly, literature supports that LPD is an iatrogenic condition. Malignant transformation of LPD is rarely reported. We hereby report a case of a middle-aged female patient who was diagnosed with malignant sarcomatous degeneration in LPD. Gynecologists may get inspiration from this case report.

Gastrointestinal stromal tumor coexisting with disseminated peritoneal leiomyomatosis

Background

A case of gastrointestinal stromal tumor (GIST) coexisting with disseminated peritoneal leiomyomatosis (DPL) is rare. We report a case of GIST coexisting with DPL.

Case presentation

A 50-year-old woman underwent exploratory laparoscopy under a preoperative diagnosis of gastric GIST with an ovarian tumor or peritoneal dissemination in the pelvic space. Laparoscopy showed multiple peritoneal masses in the pelvic space. Intraoperative frozen sectioning of the pelvic tumors showed multiple spindle cells, suggesting leiomyomas or retroperitoneal tumors; however, it was difficult to rule out peritoneal dissemination from GIST. No disseminated lesion was noted near GIST, and hence, we believed that GIST and pelvic lesions had different origins. We achieved R0 resection by partial resection of the stomach, total hysterectomy, and bilateral salpingo-oophorectomy. The postoperative immunohistopathological examination confirmed the final diagnosis of GIST and DPL. The patient has been recurrence free for 10 years.

Conclusions

Immunohistochemical examination is essential for correct diagnosis for GIST and DPL. R0 curative resection should be scheduled after immunohistochemical examination of specimens obtained from exploratory laparoscopy.

[Extra uterine leiomyomatosis: Review of the literature]

Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.

Leyomiomatosis peritonealis disseminata associated with ovarian endometriosis in a patient submitted to hysteroscopic myomectomy

OBJECTIVE

To describe laparoscopic management of a case of leyomiomatosis peritonealis disseminata associated with ovarian endometriosis.

DESIGN

Surgical video article.

SETTING

Academic hospital.

PATIENT

We present a case of a 30-year-old woman referred to our clinic for abdominal and pelvic pain and dyspareunia. A hysteroscopic myomectomy was reported as previous surgical history. At ultrasound examination, a left ovarian cyst of 4 cm suspected for typical endometrioma and a mild hydroureteronephrosis of left kidney were revealed. The patient was scheduled for laparoscopic surgery.

INTERVENTIONS

During laparoscopy, multiple nodules were found simulating widespread metastases involving colon, small bowel, omentum, right diaphragmatic dome, gastric surface, vesico-uterine area and abdominal peritoneum. Several biopsies and a peritoneal washing were performed, suspecting a peritoneal carcinomatosis. The histological frozen section examination revealed a possible benign disease, requiring further immunohistochemical study that diagnosed leiomyomatosis peritonealis. A second laparoscopy was then performed after one month. Enucleation of the left ovarian endometriotic cyst with classic stripping technique was performed. The left ureter was compressed by a fibrotic nodule of 5 cm that was isolated and removed. Operating time was 80 minutes. The postoperative course was uneventful and the patient was discharged on postoperative day 2.

MAIN OUTCOME MEASURES

Description of a case of leiomyomatosis peritonealis disseminata in a patient with no previous history of intra-abdominal morcellation.

RESULTS

The removal of the left ovarian endometriotic cyst and the periureteral nodule was successfully performed. The patient reported good health conditions without hydroureteronephrosis at six months follow up visit.

CONCLUSIONS

Leiomyomatosis peritonealis disseminata is a rare clinical disorder characterized by proliferation of nodules, consisted by smooth muscle cells. The association of this condition with endometriosis has been described in other studies. Despite several medical therapies have been proposed (chemotherapy, aromatase inhibitor, gonadotropin-releasing hormone agonist), surgical excision remains a good option, frequently performed for symptoms palliation. Laparoscopic approach might be considered the procedure of choice in case of symptomatic women with leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata: A case report of recurrent presentation and literature review

INTRODUCTION

Leiomyomatosis peritonealis disseminata (LPD) is an uncommon disease featured by the presence of multiple nodules of smooth muscle cells scattered in the abdominal cavity. To date only about 150 cases have been reported in literature. We report a case of recurrent LPD after laparotomy.

CASE PRESENTATION

In March 2016 a 36-year-old female, with a history of multiple previous laparoscopic myomectomies, consulted her gynaecologist complaining abdominal pain; a MRI was performed and reported multiple pelvic masses, subsequently excised during laparotomy. The patient refused a total hysterectomy with bilateral salpingo-oopherectomy so a close follow-up was recommended. In November 2017 when a new MRI revealed recurrency of the disease, a second laparotomy is performed and all visible nodules are excised. The histological exam confirms LPD diagnosis. On follow-up after three months the patients is completely asymptomatic.

DISCUSSION

Differential diagnosis of LPD is challenging due to its similarity to carcinomatosis and to other benign abdominal disorders. Malignant transformation is rare, but it may occur, so a close follow-up is necessary. Even if there is no consensus regarding the treatment, hormonal therapy is probably the best first line approach, while surgery should be the second choice.

CONCLUSIONS

LPD is an uncommon but potentially severe disease. In our opinion larger studies are necessary to improve our diagnostic effectiveness and to define the best therapeutic strategy.

Long-term efficacy and safety of aromatase inhibitor use for leiomyomatosis peritonealis disseminata

Leiomyomatosis peritonealis disseminata is a rare disease characterized by pelvic smooth-muscle nodules of various sizes. It is sometimes misdiagnosed as ovarian or peritoneal carcinoma metastasis; therefore, surgical excision for pathological diagnosis is required. Treatment options include bilateral salpingo-oophorectomy (BSO), gonadotrophin-releasing hormone agonist therapy, and aromatase inhibitor therapy. All of these suppress estrogen levels, but a standard treatment has not been established. A 40-year-old woman had multiple pelvic tumors, suspicious for ovarian cancer. She underwent laparotomy, where frozen sections of the nodules revealed leiomyomatosis peritonealis disseminata. After she completed gonadotrophin-releasing hormone agonist therapy, we performed a total abdominal hysterectomy and BSO with residual-nodule resection, but the nodules recurred 6 months after surgery. We then started letrozole, and 3 years have now elapsed without nodule enlargement or development of new lesions. The long-term use of aromatase inhibitor therapy is thought to be effective and safe for patients with recurrence after BSO.

A case of disseminated peritoneal leiomyomatosis after two laparoscopic procedures due to uterine fibroids

Disseminated peritoneal leiomyomatosis (DPL) is a rare disorder characterized by the presence of multifocal nodules and tumors composed of proliferating smooth muscle tissue, spread throughout the peritoneum. Estrogens and progesterone are considered to be the main factors initiating the formation of disseminated leiomyomatosis. Disseminated peritoneal leiomyomatosis is often asymptomatic, and acyclic vaginal bleeding or pain in the lower abdomen is associated with leiomyomatous rebuilt uterus corpus. Disseminated peritoneal leiomyomatosis can have other ambiguous presentation. The difficulty in DPL diagnosis is that it is not always accompanied by scattered leiomyomas and can occur after menopause. Some cases of DPL are associated with surgical procedures on uterine fibroids, especially with the use of a morcellator. We present the case of a 39-year-old woman with DPL who underwent laparoscopic myomectomy and laparoscopic supracervical hysterectomy before the final diagnosis of DPL. After the complete surgical treatment performed in our center the patient is free of symptoms.

Risk, risk reduction and management of occult malignancy diagnosed after uterine morcellation: a commentary

Minimally invasive surgical techniques compared with laparotomy offer the advantages of less intraoperative blood loss, shorter hospitalization, fewer wound complications and faster return to baseline activity for both hysterectomy and myomectomy. While morcellation allows for the laparoscopic removal of large specimens, it may result in intraperitoneal dissemination of benign disease or upstaging of occult malignancy leading to compromised survival. There has been heightened scrutiny over appropriate patient selection and preoperative assessment in light of recent warnings against power morcellation issued by the US FDA. This commentary therefore summarizes the magnitude of such risks associated with uterine morcellation, current national regulatory statements and potential merits of risk-reducing approaches such as contained morcellation. The importance of patient counseling is underscored.

Leiomyomatosis peritonealis disseminata positive for progesterone receptor

Patient: Female, 30

Final Diagnosis: Leiomyomatosis

Symptoms: Abnormal finding in abdominal-pelvic CT scan

Medication: —

Clinical Procedure: Surgical tumorectomy

Specialty: Oncology

A Novel Molecular Cytogenetic Finding of Leiomyomatosis Peritonealis Disseminata

BACKGROUND

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterised by the subperitoneal proliferation of smooth muscle cells that form benign nodules. A few studies have aimed to reveal the pathogenesis of LPD without reaching a clear explanation.

METHODS

Karyotype analysis and array-comparative genomic hybridization (aCGH) of a human LPD case were performed to evaluate the role of chromosomal abnormalities in LPD pathogenesis.

RESULTS

The LPD nodules showed a 45, XX, del(7p), t(11; 17) (q23;q25),-22 de novo karyotype, and the aCGH analysis confirmed these deletions at 7p22.3-p12.1 (1,862,362-52,766,911 bp) and 22q11.23-q13.33 (21,973,915-49,265,116 bp) with lengths of 50.9 Mb and 27.3 Mb, respectively.

CONCLUSION

In this study, we described two large novel aberrations - deletions in chromosome 7 and 22 - that might play an important role in LPD disease. These findings might contribute to new insights to unravel the pathogenesis of LPD and develop further clinical treatments. © 2015 S. Karger AG, Basel.

Leiomyomatosis peritonealis disseminata associated with endometriosis: A case report and review of the literature

Leiomyomatosis peritonealis disseminata (LPD) is a specific type of leiomyomatosis with an unclear pathogenesis that is rarely diagnosed by clinical evaluation. To date, <200 cases have been reported. The majority of the patients have a medical history of laparoscopic myomectomy for uterine fibroids. The use of laparoscopic power morcellation may be a contributor to the development of LPD, therefore, the specific surgical approach used in laparoscopic myomectomy should be carefully considered, and protective measures should be taken to prevent myoma fragments spreading if laparoscopic power morcellation is used. The present study reviewed and analyzed the medical history, diagnostic process and treatment strategy of a case of LPD to improve our understanding of the disease. In this report, the case of a 34 year-old female who underwent laparoscopic myomectomy to remove a uterine fibroid is presented. During the surgery, a myoma was resected using morcellators. Three years after surgery, exploratory laparotomy was performed due to uterine fibroid recurrence. During surgery, myoma was identified at the uterine bladder peritoneal reflection, where several unequally sized leiomyoma tubercles were identified on the uterine surface. Subsequently, myomectomy was performed. Postoperative pathology diagnosed leiomyoma. Two years later, gynecological ultrasound revealed a mass in the abdomen. Exploratory laparotomy was subsequently performed. During surgery, compact myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, and an endometriotic cyst was identified on the left ovary. As the myomas were too compact to remove completely, the majority of leiomyoma on the intestine and mesentery was resected. The endometriotic cyst on the left ovary was also resected. Considering the patient's medical history, observations during surgery and pathological results, the final diagnosis was LPD. Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

Selected case from the Arkadi M. Rywlin International Pathology Slide Series: Leiomyomatosis peritonealis disseminata: report of 3 cases with extensive review of the literature

We present the clinicopathologic features of 3 cases of leiomyomatosis peritonealis disseminata (LPD). The patients were 33, 34, and 41 years old at the time of diagnoses. The 3 women had undergone laparoscopic removal of multiple uterine leiomyomas between 1 and 6 years before the diagnoses of LPD. Laparoscopic uterine leiomyomectomies were performed on 3 occasions in patient 1, and once in patients 2 and 3 by the time a diagnosis of LPD was made. In patients 2 and 3, one of the multiple uterine leiomyomas had been qualified as mitotically active. Patients 1 and 2 received hormonal treatment before LPD was diagnosed. Malignancy was clinically and/or pathologically suspected in all the 3 cases. Patients 1 and 2 were managed conservatively. Patient 3 underwent radical hysterectomy with bilateral adnexectomy and omentectomy. Patients 1 and 2 belong to a rare subset of LPD that have fewer tumor nodules larger (5 to 10 cm) than typically seen. Patient 3 was classic in that she exhibited innumerable nodules measuring between a few millimeters and 1.5 cm, intraoperatively mimicking peritoneal carcinomatosis. Histopathologically, patients 1 and 2 were diagnosed as pure LPD, whereas patient 3 was diagnosed as LPD associated with endometriosis (adenomyosis type). Patients 1 and 3 had incipient foci of leiomyomatous changes in the blood vessel walls, at the site of the LPD tumors, supporting the hypothesis that these are de novo lesions arising locally and not migrated or disseminated from the previously excised or concurrent uterine smooth muscle tumors, usually seen in this context. Conceivably, laparoscopic leiomyomectomy with morcellation may play a role in the pathogenesis of this rare condition, at least in hormonally susceptible patients. Alternatively, LPD may derive from metaplastic submesothelial cells, a condition analogous to gliomatosis peritonei.

Mutation status of the mediator complex subunit 12 (MED12) in uterine leiomyomas and concurrent/metachronous multifocal peritoneal smooth muscle nodules (leiomyomatosis peritonealis disseminata)

AIMS

The pathogenesis and classification of multicentric smooth muscle tumours with benign appearance and concurrent/metachronous uterine and peritoneal involvement is controversial and may on occasion be diagnostically challenging. Leiomyomatosis peritonealis disseminata (LPD) is a rare condition affecting women of reproductive age, characterised by the occurrence of multiple small peritoneal smooth muscle nodules with bland histology.

METHODS

We investigated a total of 12 uterine and seven concurrent/metachronous peritoneal smooth muscle nodules with benign appearance from two females for mutations in the mediator complex subunit 12 (MED12), which has recently been identified as the most frequent genetic aberration in uterine leiomyomas.

RESULTS

The first case harboured different MED12 mutations in the peritoneal nodules. Mutational status of peritoneal nodules was discordant with that of the uterine leiomyomas. The second case displayed the same MED12 mutation in all five peritoneal nodules, but this mutation was not detected in her current uterine leiomyomas.

CONCLUSIONS

Our results suggest that smooth muscle neoplasms with benign appearance of the primary and secondary müllerian system share a similar genetic background of MED12 mutation in combination with oestrogen dependency. Analysis of MED12 mutation status might be a valuable adjunct tool for the future classification of these sometimes diagnostically challenging multicentric tumours.

Leiomyomatosis peritonealis disseminata in a Nigerian woman

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition. A 48-year-old multiparous woman was referred because of an incidental ultrasound finding suggestive of LPD. She had a 6-year past history of use of combined oral contraceptive pills. LPD was also suspected at laparotomy and confirmed by histology. She had total abdominal hysterectomy, bilateral salpingo ophorectomy and infracolic omentectomy. Patient was being followed-up. LSD is a rare gynecological condition which can pose a diagnostic challenge. Removal of estrogen sources as was done for the patient is the mainstay of treatment. Patient follow-up is very important because of the risk of malignant transformation.

Leiomyomatosis peritonealis disseminata associated with endometriosis and multiple uterus-like mass: report of two cases

Leiomyomatosis peritonealis disseminate (LPD) is a rare benign disease of unknown etiology of women in reproductive age. A few reported cases of association with endometriosis have been described suggesting a possible origin from submesothelial multipotential cells. We present two cases of LPD associated with endometriosis expressing smooth muscle metaplasia, and some of the nodules with aspects of uterus-like mass. Laparoscopy, gross findings, and the pathological and immunohistochemical study of the surgical specimens were described. Our findings suggest an endometriotic origin for the LPD and indicate that the therapeutic approach might contemplate the surgical reduction of the nodules and endometriosis treatment.

Follow-up in patients with disseminated peritoneal leiomyomatosis: a report of an unusual, high-risk case

Leiomyomatosis peritonei disseminata is a condition seen uncommonly in states of oestrogen hypersecretion in women of childbearing age. There are no clear guidelines for the primary management and follow-up of these patients. Here, a rare case in a postmenopausal woman with a normal hormonal state who may be considered higher risk is presented, with a review suggesting a management pathway in these patients.