Case reportsPatient no. I The patient, a 26-year-old black woman, gravida 1, para 1, had a normal full term vaginal delivery. Postpartum she developed a large vulval haematoma and a laparotomy was performed to exclude broad ligament haematoma. At laparotomy there were numerous small nodules on the uterine serosa. the serosa of the bowel, the omentum and parietal peritoneum. A biopsy was taken of the omentum. No uterine leiomyomata were visible.IIistological examination revealed numerous nodules in the omentum. These nodules were composed of decidua, which showed a gradual transition to interlacing smooth muscle cells in the centre of each nodule (Figs 1 and 2). The nodules were well circumscribed and partly covered by a single layer of flattened mesothelial cells. The smooth muscle cells had plump nuclei but lacked mitotic activity. A diagnosis of leiomyomatosis peritoriealis disseminata (LPD) wab made.Ultra5tructural examination of the formalinfixed tissue showed cells which had the features of smooth muscle cells (Fig. 3). The cells were elongated with oval nuclei, with a single nucleolus. Longitudinally orientated myofilanients and dense bodies as well as short profiles of rough endoplasmic reticulum were present in the cytoplasm. The cell membranes showed numerous pinocytotic vesicles. The cells were surrounded by collagen.The immediate postoperative course was uneventful: but the patient was lost to follow-up.
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