Leiomyomatosis peritonealis disseminata positive for progesterone receptor

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.

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.

Successful maternal and perinatal outcomes in a term pregnancy with giant abdominopelvic leiomyomatosis

A 30-year-old second gravida with history of laparoscopic myomectomy and one previous caesarean section was admitted at 31 weeks and 2 days period of gestation (POG) with a diagnosis of diffuse abdominopelvic leiomyomatosis and moderate anaemia. After correction of anaemia with intravenous iron and erythropoietin, laparotomy was performed at 37 weeks POG. A healthy female baby weighing 2.9 kg was delivered by classical caesarean section followed by hysterectomy in view of multiple fibroid uterus with uncontrolled bleeding. Debulking surgery was performed, and multiple large intraperitoneal leiomyomata with encasing blood vessels were removed. There was another 15×15 cm leiomyoma arising from the diaphragm which was excised. She received 4 units of packed red blood cells and fresh frozen plasma intraoperatively. The postoperative course was uneventful, both mother and baby were healthy and discharged 7 days after surgery.

Post-hysterectomy intravenous leiomyomatosis: A case of successful multidisciplinary surgery under non-extracorporeal circulation

Intravenous leiomyomatosis is a rare benign disease. We here in present the case of a 39-year-old woman with a history of hysterectomy who presented with intermittent abdominal pain, palpitations and tightness of the chest. Physical examination revealed the presence of a pelvic mass of regular shape. Gynecological ultrasonography, computed tomography scans and three-dimensional (3D) cardiac ultrasonography were used to evaluate the imaging characteristics of the mass and reach a final diagnosis. The mass appeared to extend to the iliac veins, renal veins and inferior vena cava on imaging examination. The mass was successfully excised under non-extracorporeal circulation in one stage. Pathological examination of tumor samples indicated intravenous leiomyomatosis. After the operation, the symptoms were dissipated and no abnormal echo was observed in the inferior vena cava or the right atrium on 3D-cardiac ultrasonography. The patient is currently followed up without signs of recurrence. The aim of the present study was to describe in detail the diagnostic procedure and treatment in order to improve our current understanding of this disease.

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.