A case report of postmenopausal leiomyomatosis peritonealis disseminata

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is a rare and benign disease, mainly occurred in reproductive age. The authors report a postmenopausal Chinese woman with a large, hard, and unmovable mass in lower abdomen. Computerized tomography revealed a mass of 13.4× 12.0 cm with irregular edges adhering to surrounding organs, with multiple nodules around the abdominal aorta, and in the pelvic peritoneum, mesenteric, and ileocecal regions. She had abnormal higher levels of serum carbohydrate antigen (CA) 125, but normal levels of serum CA 19-9, alpha-fetal protein, and carcinoembryonic antigen. After being treated with epirubicin, carboplatin, and interventional embolization, her abdominal mass was reduced by about 10% and she received a successful radical surgery, including pelvic tumor resection, total hysterectomy, bilateral oophorectomy, omental resection, appendectomy, rectal resection, and anastomosis. Her pelvic mass weighed 1,350 grams and histologically diagnosed as LPD. Immunohistochemistry of the mass showed positive staining of vimentin, caldesmon, smooth muscle actin (SMA), b-catenin, and Bcl-2, but negative for CD10, CD34, CD99, CD117, S-100, progesterone receptor, and DOG1 staining. She had no disease recurrence during a year of follow up.

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

“…The hormonal theory suggests that LPD results from the metaplastic change of subcelomic mesenchymal stem cells with exposure to high endogenous or exogenous sex hormone levels [10,11]. This hypothesis is supported by cases found in women with tumors secreting estrogens or in reproductive age, especially those who are pregnant, have prolonged use of contraceptive pills or have received hormone replacement therapy [12,13]. Moreover, tumors in reproductive-aged women can demonstrate spontaneous regression after delivery, oophorectomy or cessation of oral contraceptive use.…”