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Zhang G, Fan R, Yang H, Su H, Yu X, Wang Y, Feng F, Zhu L. Safety and efficacy of sirolimus in recurrent intravenous leiomyomatosis, pulmonary benign metastatic leiomyomatosis, and leiomyomatosis peritonealis disseminata: a pilot study. BMC Med 2024; 22:119. [PMID: 38481209 PMCID: PMC10938730 DOI: 10.1186/s12916-024-03344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Intravenous leiomyomatosis (IVL), pulmonary benign metastatic leiomyomatosis (PBML), and leiomyomatosis peritonealis disseminata (LPD) are leiomyomas with special growth patterns and high postoperative recurrence rates. We report the safety and efficacy of a pilot study of sirolimus in the treatment of recurrent IVL, PBML, and recurrent LPD. METHODS This was a pilot study to evaluate the safety and efficacy of sirolimus in the treatment of leiomyomatosis (ClinicalTrials.gov identifier NCT03500367) conducted in China. Patients received oral sirolimus 2 mg once a day for a maximum of 60 months or until disease progression, intolerable toxicity, withdrawal of consent, or investigator decision to stop. The primary end point of this study was the objective response rate. Secondary end points included safety and tolerability, disease control rate, and progression-free survival. RESULTS A total of 15 patients with leiomyomatosis were included in the study, including five with recurrent IVL, eight with PBML and two with recurrent LPD. The median follow-up time was 15 months (range 6-54 months), nine patients (60%) had treatment-related adverse events (including all levels), and two patients had treatment-related grade 3 or 4 adverse events. The objective response rate was 20.0% (95% CI, 7.1-45.2%), and the disease control rate was 86.7% (95% CI, 62.1-96.3%). Partial response was achieved in three patients. The median response time in the three partial response patients was 33 months (range 29-36 months), and the sustained remission time of these three patients reached 0, 18, and 25 months, respectively. CONCLUSIONS Sirolimus was safe and effective in the treatment of recurrent IVL, PBML, and recurrent LPD. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03500367. Registered on 18 April 2018.
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Affiliation(s)
- Guorui Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Rong Fan
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Hao Su
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Xin Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Yutong Wang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Fengzhi Feng, No. 1, Shuaifuyuan, Beijing, 100730, Wangfujing, China.
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Hsieh YC, Kuo PY, Chiang YC. Leiomyomatosis peritonealis disseminata in laparoscopic port site and abdomino-pelvic cavity: A case report. Radiol Case Rep 2021; 17:293-297. [PMID: 34876953 PMCID: PMC8633832 DOI: 10.1016/j.radcr.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- Yun-Chiao Hsieh
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yen Kuo
- Department of Pathology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, Taiwan
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Yang JW, Hua Y, Xu H, He L, Huo HZ, Zhu CF. Treatment of leiomyomatosis peritonealis disseminata with goserelin acetate: A case report and review of the literature. World J Clin Cases 2021; 9:5217-5225. [PMID: 34307570 PMCID: PMC8283592 DOI: 10.12998/wjcc.v9.i19.5217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Jia-Wen Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yu Hua
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hai-Zhong Huo
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
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Huang SF, Wen CY, Liao CI, Lin JC, Tsai CC. Leiomyomatosis peritonealis disseminata mimicking peritoneal carcinomatosis 13 years after laparoscopic uterine myomectomy: A case report. Int J Surg Case Rep 2021; 81:105745. [PMID: 33743252 PMCID: PMC8010381 DOI: 10.1016/j.ijscr.2021.105745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical condition. It is challenging to diagnose because its clinical features mimic other conditions. LPD often mimics peritoneal carcinomatosis or metastatic lesions. LPD should be considered in women with disseminated intraabdominal or pelvic tumors. A history of gynecologic surgery, if present, may offer a pointer to the diagnosis.
Introduction Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical condition that can be challenging to diagnose because its clinical features mimic other conditions. We present a case of LPD mimicking peritoneal carcinomatosis 13 years after laparoscopic uterine myomectomy using a power morcellator. The aim of this paper is to report a rare case which surgeons can learn from and to provide more clinical information for further studies to investigate LPD. Presentation of Case A 49-year-old woman was referred to us because sonography revealed abnormal abdominal and pelvic nodules. Thirteen years previously, she had undergone laparoscopic uterine myomectomy using a power morcellator. An exploratory laparotomy revealed nodules on the peritoneum, greater omentum, intestinal mesentery, and terminal ileum. We surgically removed all visible nodules and performed bilateral salpingo-oophorectomy. LPD was confirmed based on the morphology and immunohistochemistry results. Discussion Diagnosing LPD preoperatively may be difficult because its clinical manifestations resemble peritoneal carcinomatosis or metastatic lesions. Abdominal pain due to diffuse tumor growth is a common manifestation. LPD degenerating into malignancy is rare, but possible. The probable etiological factors, clinical manifestations, and treatment options which may aid when dealing with LPD have been described in this report. Conclusion LPD should be considered in women, particularly those with a history of gynecologic surgery presenting with disseminated intraabdominal or pelvic tumors.
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Affiliation(s)
- Shih-Feng Huang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
| | - Chen-Yueh Wen
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Jung-Chia Lin
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Cheng-Chung Tsai
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
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Yoshino Y, Yoshiki N, Nakamura R, Iwahara Y, Ishikawa T, Miyasaka N. Large leiomyomatosis peritonealis disseminata after laparoscopic myomectomy: A case report with literature review. Int J Surg Case Rep 2020; 77:866-869. [PMID: 33395914 PMCID: PMC7725661 DOI: 10.1016/j.ijscr.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare disease. LPD is associated with power morcellation during previous laparoscopic myomectomy. 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.
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Affiliation(s)
- Yasunori Yoshino
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Naoyuki Yoshiki
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Reiko Nakamura
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Iwahara
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomonori Ishikawa
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
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.
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Affiliation(s)
- E Declas
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France.
| | - J P Lucot
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France
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Batton KA, Toskich BB, Legout JD, Bolan CW, Grove MT, Lewis JT, Mckinney JM, Brigham TJ, Mccomb BL. Disseminated Peritoneal Leiomyomatosis After Uterine Artery Embolization. Cardiovasc Intervent Radiol 2018; 41:1972-5. [PMID: 30088058 DOI: 10.1007/s00270-018-2044-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare variant of extrauterine leiomyomatosis with reported spontaneous and iatrogenic occurrences. It has been associated with hysterectomy and myomectomy. To our knowledge, reports have not yet substantiated occurrence following uterine artery embolization (UAE), which has become a routine minimally invasive alternative to surgery for the treatment of symptomatic leiomyomata. This report presents the case of a nulliparous premenopausal woman with no other contributory history who presented with DPL 3 years after UAE. The presentation of this patient suggests the potential for a causal relationship between UAE and DPL.
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Psathas G, Zarokosta M, Zoulamoglou M, Chrysikos D, Thivaios I, Kaklamanos I, Birbas K, Mariolis-Sapsakos T. Leiomyomatosis peritonealis disseminata: A case report and meticulous review of the literature. Int J Surg Case Rep 2017; 40:105-108. [PMID: 28965085 PMCID: PMC5633819 DOI: 10.1016/j.ijscr.2017.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 12/16/2022] Open
Abstract
Differential diagnosis of LPD from leiomyosarcoma or benign metastasizing leiomyoma remains difficult. 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. 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.
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Affiliation(s)
- Giannos Psathas
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece.
| | - Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Dimosthenis Chrysikos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Ioannis Thivaios
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Ioannis Kaklamanos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Konstantinos Birbas
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece; Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
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Abstract
Leiomyoma is the most common tumor seen affecting women mostly of reproductive age groups. It is composed of smooth muscle cells that are positive for smooth muscle actin on immunohistochemistry. Leiomyomata peritonealis disseminata (LPD) is characterized by nodules that stud the peritoneum. It is seen in association with hormone-producing ovarian tumors and coexisting leiomyomas of the uterus. Association with mesenteric leiomyomas has been reported. Ovarian leiomyomas are very rare tumors of the ovary and coexisting LPD with ovarian leiomyomas has not been reported before. We present this rare case of LPD and ovarian leiomyoma.
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Affiliation(s)
- Babita Khangar
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Varuna Mallya
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Poonam Sachdeva
- Department of Obstetrics and Gynecology, Lok Nayak Jai Prakash Hospital, MAMC, New Delhi, India
| | - Swati Kashyap
- Department of Obstetrics and Gynecology, Lok Nayak Jai Prakash Hospital, MAMC, New Delhi, India
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Nappi L, Sorrentino F, Angioni S, Pontis A, Barone I, Greco P. Leiomyomatosis Peritonealis Disseminata (LPD) ten years after laparoscopic myomectomy associated with ascites and lymph nodes enlargement: a case report. Int J Surg Case Rep 2016; 25:1-3. [PMID: 27280492 PMCID: PMC4972128 DOI: 10.1016/j.ijscr.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare pathology of unkown etiology. The relationship of LPD with myoma morcellation remains unclear. Ascites with lymph node enlargement can be present in LPD. Time of clinical presentation of LPD can be very long after laparoscopic myomectomy.
Introduction We report a case of leiomyomatosis peritonealis disseminata (LPD) arising 10 years after a laparoscopic myomectomy that was associated with ascites and lymph nodes enlargement. Presentation of case The patient presented with small uterine fibroids with a dominant posterior intramural fibroid measuring 9 cm in diameter and normal Doppler. Laparotomy revealed a uterus enlarged with fibroids, which was densely adhering to the urinary bladder, greater omentum, and sigmoid colon. Multiple tumors of different size were found attached to the peritoneum, omentum and bowel. The histopathologic examination was consistent with leiomyomatosis peritonealis disseminata. Discussion Pieces of smooth muscle cell lost in the abdominal cavity during electrical morcellation after laparoscopic myomectomy may progress to leiomyomatosis peritonealis disseminata even after many years (ten in our case) and it can be associated with ascites and lymph nodes enlargement. Conclusion This is the first case reported in literature of leiomyomatosis peritonealis disseminata with these particular features (time of clinical presentation, ascites, lymph nodes enlargement).
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Affiliation(s)
- Luigi Nappi
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Stefano Angioni
- Institute of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Pontis
- Institute of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Barone
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynaecology, University of Ferrara, Ferrara, Italy
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Toriyama A, Ishida M, Amano T, Nakagawa T, Kaku S, Iwai M, Yoshida K, Kagotani A, Takahashi K, Murakami T, Okabe H. Leiomyomatosis peritonealis disseminata coexisting with endometriosis within the same lesions: a case report with review of the literature. Int J Clin Exp Pathol 2013; 6:2949-2954. [PMID: 24294383 PMCID: PMC3843277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/29/2013] [Indexed: 06/02/2023]
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is an extremely rare condition, which is characterized by the presence of multiple peritoneal and subperitoneal nodules composed of bland smooth muscle cells. Albeit extremely rare, coexistence of endometriosis within LPD lesions has also reported. Herein, we report the seventh documented case of LPD coexisting with endometriosis within the same lesions and review the pathogenesis of this lesion. A 42-year-old Japanese female presented with an abdominal tumor. Computed tomography revealed a tumorous lesion in the right ovary and multiple small nodules in the abdominal cavity. Under a clinical diagnosis of ovarian cancer with peritoneal dissemination, resection of these lesions was performed. Histopathological study of the disseminated peritoneal nodules revealed proliferation of interlacing bundles of spindle cells with eosinophilic cytoplasm and bland cigar-shaped nuclei. Mitotic figures were hardly seen. The peritoneal nodules of the rectum had cystic cavities within the spindle cell bundles, and endometrial glands and stroma were present around the cystic cavities and spindle cells. The resected tissues of the ovary and cecum showed the same histopathological features. Accordingly, a diagnosis of LPD with endometriosis within the same lesions was made. A possible origin of LPD is thought to be the submesothelial multipotential stem cells, also referred to as the secondary müllerian system. The presence of endometrial tissues within LPD lesions, as seen in the present case, also support this hypothesis because endometrial tissues are also derived from the müllerian system.
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Affiliation(s)
- Ayano Toriyama
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical ScienceShiga, Japan
| | - Tetsuya Nakagawa
- Department of Obstetrics and Gynecology, Shiga University of Medical ScienceShiga, Japan
| | - Shouji Kaku
- Department of Obstetrics and Gynecology, Shiga University of Medical ScienceShiga, Japan
| | - Muneo Iwai
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Keiko Yoshida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Kagotani
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Kentarou Takahashi
- Department of Community Perinatal Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical ScienceShiga, Japan
| | - Hidetoshi Okabe
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
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Verguts J, Orye G, Marquette S. Symptom relief of leiomyomatosis peritonealis disseminata with ulipristal acetate. ACTA ACUST UNITED AC 2013; 11:57-58. [PMID: 24611038 PMCID: PMC3935105 DOI: 10.1007/s10397-013-0816-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jasper Verguts
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Department of Obstetrics and Gynecology, University Hospital KU Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Guy Orye
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Sophie Marquette
- Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
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