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Usenko O, Sydiuk A, Voitiv Y, Varga A, Popov O, Makarov V. Disseminated peritoneal leiomyomatosis after laparoscopic myomectomy - A case report. Int J Surg Case Rep 2024; 122:110185. [PMID: 39153339 PMCID: PMC11378259 DOI: 10.1016/j.ijscr.2024.110185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease, characterized by intraperitoneal dissemination of smooth-muscle tumor masses. CASE PRESENTATION The patient, a 40-year-old, female - presented with complaints of periodic back pain. During the initial workup, a tumor mass was visualized in the pelvis on ultrasound. Further clinical workup included computer tomography (CT) scan and ultrasound-guided fine-needle biopsy. A tumor mass in the right adrenal gland was identified on CT. Pathological examination revealed no signs of malignancy. The multidisciplinary team decided on surgical treatment. Tumor masses were removed from the pelvic cavity, the anterior abdominal wall, and the projection of the right adrenal gland with preservation of the uterus and ovaries due to the patient's wishes. Pathological examination with immunohistochemistry of surgical specimen confirmed diagnosis of DPL. CLINICAL DISCUSSION Due to the rarity of DPL there are no standard guidelines for diagnostics and treatment. In many cases, on initial workup, DPL may look like a malignant tumor with intraperitoneal spread, which may lead to an inappropriate choice of treatment. CONCLUSION Differential diagnosis of DPL may be a challenge due to its appearance as a disseminated peritoneal malignancy on CT scans and at laparotomy. A multidisciplinary approach is key to choosing the right clinical course for such patients.
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Affiliation(s)
- Olexandr Usenko
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrii Sydiuk
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Yaroslav Voitiv
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Anita Varga
- Chief medical officer Shalimov's National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Oleh Popov
- Department of Intensive Care and Anaesthesiology, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Vladyslav Makarov
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
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Bucuri CE, Ciortea R, Malutan AM, Oprea V, Toma M, Roman MP, Ormindean CM, Nati I, Suciu V, Simon-Dudea M, Mihu D. Disseminated Peritoneal Leiomyomatosis-A Challenging Diagnosis-Mimicking Malignancy Scoping Review of the Last 14 Years. Biomedicines 2024; 12:1749. [PMID: 39200214 PMCID: PMC11351519 DOI: 10.3390/biomedicines12081749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 09/02/2024] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention-with a focus on minimizing iatrogenic risks-conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL.
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Affiliation(s)
- Carmen Elena Bucuri
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
- Clinical Department of Surgery, “Constantin Papilian” Emergency Clinical Military Hospital, 22 G-ral Traian Mosoiu, 400132 Cluj-Napoca, Romania;
| | - Razvan Ciortea
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Andrei Mihai Malutan
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Valentin Oprea
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
- Clinical Department of Surgery, “Constantin Papilian” Emergency Clinical Military Hospital, 22 G-ral Traian Mosoiu, 400132 Cluj-Napoca, Romania;
| | - Mihai Toma
- Clinical Department of Surgery, “Constantin Papilian” Emergency Clinical Military Hospital, 22 G-ral Traian Mosoiu, 400132 Cluj-Napoca, Romania;
| | - Maria Patricia Roman
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Cristina Mihaela Ormindean
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Ionel Nati
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Viorela Suciu
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Marina Simon-Dudea
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
| | - Dan Mihu
- 2nd Department of Obstetrics and Gynaecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.E.B.); (A.M.M.); (V.O.); (M.P.R.); (C.M.O.); (I.N.); (V.S.); (M.S.-D.); (D.M.)
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Sanchez Diaz E, Rendon Pereira GJ, Pareja R, Palacios Rodriguez OG, Serna Ortíz CA, Huertas Duran CP. Recurrent leiomyomatosis peritonealis disseminata. Int J Gynecol Cancer 2023; 33:827-832. [PMID: 37127328 DOI: 10.1136/ijgc-2023-004409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
| | | | - Rene Pareja
- Gynecologic Oncology, Clinica ASTORGA and Instituto Nacional de Cancerología, Medellín and Bogotá, Colombia
| | | | - Carlos Andres Serna Ortíz
- CES University CES Clinic, Medellin, Colombia
- Pathology Department, Clinica Las Américas AUNA, Medellín, Colombia
| | - Claudia Patricia Huertas Duran
- Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Radiology, Clinica Las Américas AUNA, Medellín, Colombia
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Schaas CM, Lozneanu L, Titianu M, Schaas S, Schaas B, Bujor IE, Ursache A, Matasariu DR. Intravascular leiomyoma‑A rare case in the context of Covid‑19 outbreak: A case report. Exp Ther Med 2022; 25:38. [PMID: 36569434 PMCID: PMC9764289 DOI: 10.3892/etm.2022.11737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
The present study reported a case of a uterine leiomyoma with an unusual growth pattern featuring areas of intravascular leiomyomatosis, rarely described in the international literature available in English. It presented the case of a 44-year-old woman who, fearing the Covid-19 outbreak, postponed the recommended surgical intervention to remove a uterine leiomyoma. The two-year delay worsened the symptoms, doubled the size of the tumor, and facilitated the development of intravascular leiomyomatosis. It was possible to establish the correct diagnosis only after the histopathological examination of the excised uterine myoma, as it was not suspected prior to surgery. No other vascular tumors were identified via magnetic resonance imaging and computed tomography imaging investigations. The careful follow-up of recovering patients is essential because of the high recurrence rate of such tumors and their potential to behave aggressively, possibly even fatally. Clinicians should be aware of this rare condition and its cardiovascular implications to improve the initial and long-term management of such cases.
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Affiliation(s)
- Carmina Mihaiela Schaas
- Department of Obstetrics and Gynecology, Cuza-Voda Hospital of Obstetrics and Gynecology, 700398 Iași, Romania,Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ludmila Lozneanu
- Department of Morpho-Functional Sciences I - Histology, Pathology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania,Department of Pathology, Sf. Spiridon Clinical Emergency County Hospital, 700111 Iași, Romania,Correspondence to: Dr Alexandra Ursache, Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania
| | - Monica Titianu
- Department of Obstetrics and Gynecology, Cuza-Voda Hospital of Obstetrics and Gynecology, 700398 Iași, Romania
| | - Sabina Schaas
- Department of Obstetrics and Gynecology, Cuza-Voda Hospital of Obstetrics and Gynecology, 700398 Iași, Romania
| | - Bogdan Schaas
- Department of Obstetrics and Gynecology, Cuza-Voda Hospital of Obstetrics and Gynecology, 700398 Iași, Romania
| | - Iuliana Elena Bujor
- Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandra Ursache
- Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania,Correspondence to: Dr Alexandra Ursache, Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania
| | - Daniela Roxana Matasariu
- Department of Mother and Child, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
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Léiomyomatose péritonéale disséminée : bénigne, elle peut mimer une maladie maligne. IMAGERIE DE LA FEMME 2022. [DOI: 10.1016/j.femme.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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