Leiomyomatosis peritonealis disseminata associated with appendiceal endometriosis: a case report

Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution

Objectives: To investigate the clinical characteristics, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD) following laparoscopic surgery with uncontained morcellation and to summarize clinical features of iatrogenic LPD based on published literature together with our own experience.

Methods: A cohort of 13 cases with iatrogenic LPD diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2020 was reported focusing on clinical characteristics, treatment and prognosis.

Results: All the patients had a history of laparoscopic myomectomy with uncontained morcellation. The average age was 35.6 (range 25–47) years. The interval between initial laparoscopic surgery and first diagnosis of LPD was 6.08 years on average (range 1–12). Most of the patients had no obvious symptoms. The accuracy of pre-operative diagnosis was low. Two patients had been treated with gonadotropin-releasing hormone agonist (GnRH-a) before surgery without obvious effect. The nodules of LPD are usually located in the lower half of the peritoneal cavity. The most commonly involved site was the pouch of Douglas. The number of nodules ranged from 3 to over 10, and they ranged in size ranged from 0.3 to 22 cm. All patients underwent surgical treatment: six patients underwent laparoscopy and seven underwent laparotomy. Pathology results confirmed LPD. The immunohistochemical profile indicated LPD tends to be positive strongly for desmin, caldesmon, ER, PR and SMA. Only one patient underwent post-operative treatment with GnRH-a. All patients were followed for an average period of 49 months without recurrence.

Conclusion: Iatrogenic LPD is a relatively rare condition. Patients usually exhibit no hormonal stimulation factors. Surgery is the main method of treatment, and hormone suppressive therapy is only rarely used. The nodules are usually large and less numerous, and most involve the pelvis. The prognosis of iatrogenic LPD seems good.

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.

Large leiomyomatosis peritonealis disseminata after laparoscopic myomectomy: A case report with literature review

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Leiomyomatosis peritonealis disseminata (LPD) is a rare disease.

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LPD is associated with power morcellation during previous laparoscopic myomectomy.

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Long-term follow-up is necessary to detect LPD, which is not always symptomatic.

Introduction

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease in which multiple leiomyomas are formed intraperitoneally. Several LPD cases were associated with laparoscopic myomectomy using power morcellators; however, LPD with a large tumor size remains extremely rare. We present a case of large LPD occurring after laparoscopic surgery.

Presentation of case

A 26-year-old woman, gravida 0, underwent laparoscopic myomectomy with power morcellation in our institution. After 5 years, follow-up examination revealed pelvic tumors. Although we recommended resection, she refused and only wanted to be followed up. After 9 years from the first surgery, the tumors became symptomatic and were increasing in number (>10 nodules) and size (>15 cm). Needle biopsy detected leiomyoma. Computed tomography angiography showed that omental and mesenteric arteries were feeding the tumors. We performed laparotomy, and all the 19 tumors emerging from the omentum and mesenterium and weighing 7647 g in total were removed without injuring other organs. The maximum diameter of the largest tumor was 34 cm. The pathological diagnosis was nonmalignant LPD with leiomyoma.

Discussion

Among all reported cases, our case had the largest LPD size. The tumors reached such a huge size because of two possible reasons: (1) they gradually grew asymptomatically over a long period from the time of diagnosis, and (2) they were fed by particularly large vessels, including the omental and mesenteric arteries.

Conclusion

A large LPD is not always symptomatic. After a laparoscopic myomectomy, especially with power morcellation, long-term follow-up is necessary to detect LPD.

Leiomyomatosis Peritonealis Disseminata: A Clinical Analysis of 13 Cases and Literature Review

Objective. Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease that is characterized by numerous small muscle nodules disseminated in the abdominal and pelvic cavity. This study analyzed the clinical features, pathologic characteristics, and prognosis of LPD. Methods. We retrospectively analyzed the clinical data of 13 patients with pathologically diagnosed LPD in Shengjing Hospital of China Medical University from January 2001 to January 2018. Results. Overall, 13 cases were collected. The mean age of the 13 patients was 42.23 years (range = 26-51 years). In all 13 female patients, 11 had a surgical history related to uterine leiomyoma, and only 2 had no history of treatment. Most of them were asymptomatic. Thirteen patients underwent resections of the tumors by laparoscopy or laparotomy. Pathological reports of 13 cases indicated LPD. Twelve cases were followed up, and 1 case was lost to follow-up. The median follow-up time was 65.67 months, and 2 patients showed evidence of recurrence. Conclusions. LPD is a rare disease in women of reproductive age. LPD manifests atypical symptoms, which can be easily misdiagnosed and confirmed by the pathological diagnosis. Surgery is the main treatment. Although LPD is a benign disease, a few patients had a tendency for recurrence or malignancy. Therefore, strict follow-up is needed.

Leiomyomatosis peritonealis disseminata: A case report and meticulous review of the literature

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Differential diagnosis of LPD from leiomyosarcoma or benign metastasizing leiomyoma remains difficult.

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Ample history of the patient, clinical evaluation, preoperative guided FNA and histopathologic analysis of the FNA tissue and of the tumor resection are essential for differential diagnosis.

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Prompt diagnosis of LPD is crucial because, although benign in nature, LPD may degenerate into malignancy.

Introduction

Leiomyomatosis peritonealis disseminata (LPD) is a peculiar benign clinical disorder characterized by proliferation of peritoneal and subperitoneal nodules. LPD is a difficultly diagnosed benign disease that rarely degenerates into malignancy.

Presentation of case

A 40-year-old Caucasian female with vaginal bleeding proceeded to our institution for elective excision of abdominal and pelvic masses which were firstly considered as leiomyosarcomas. The histologic diagnosis of the mass lesions revealed smooth muscle benign cells. This is the first case of LPD reported in Greece. A meticulous review of the literature was conducted as well.

Discussion

The differential diagnosis of LPD is difficult due to its clinical resemblance with peritoneal carcinomatosis or metastatic lesions and with benign metastasizing leiomyoma (BML) as well. Etiological factors, pathophysiology and clinical manifestations which lead to a safe diagnosis of LPD are adequately described.

Conclusion

Surgeons’ thorough knowledge concerning this rare clinical condition is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate treatment and the minimization of the probability of malignant transformation of LPD.

Diffuse peritoneal leiomyomatosis status post laparoscopic hysterectomy with power morcellation: A case report with review of literature

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Leiomyomatosis following laparoscopic hysterectomy with morcellation is reported.

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Parasitic myomas grow in a benign fashion but may be fatal depending on location.

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Fibroids are a contraindication for laparoscopic hysterectomy with morcellation.

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Containment bags may address intraperitoneal spillage of malignant tissue.

Leiomyomatosis peritonealis disseminata in postmenopausal women: a case report with review of literature

Background

Leiomyomatosis peritonealis disseminata is an exceedingly rare benign disorder characterized by multiple vascular leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum. It is commonly described in women of reproductive age and is rarely seen in men and postmenopausal women.

Case details

A 65-year-old female patient with a history of abdominal surgery for gastrointestinal stromal tumor presented with abdominal pain, weakness, weight loss, and vomiting. An examination revealed a chronically sick looking, emaciated patient with a long midline abdominal scar, and tenderness on deep palpation all over the abdomen. Ultrasound revealed diffuse intra-abdominal masses and a big liver mass. On laparotomy, innumerable masses were found to arise from the outer walls of whole small intestine and mesentery, and there was a soft, 8×10 cm size liver mass. Histology showed highly cellular interlacing bundles of proliferating smooth muscle cells not associated with nuclear atypia or mitotic figures, and there was no necrosis seen, suggesting cellular leiomyoma.

Conclusion

Leiomyomatosis peritonealis disseminata is a very rare condition, especially in men and postmenopausal women. It should be considered as a differential in patients with disseminated intra-abdominal masses arising in mesentery, peritoneum, and on walls of the intestine.