An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature

Abstract

Minimally invasive treatment of uterine fibroids usually requires a power morcellation, which could be associated with several complications. A rare sequela is disseminated peritoneal leiomyomatosis. Indeed, recurrence or metastasis in these cases could be attributed to iatrogenic or under-evaluation of primary tumors, although a subset of cases is a sporadic sample of biological progression. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously. The diagnosis was predicted preoperatively by an expert sonographer who recognized the ultrasound characteristics of uterine sarcoma and the localization of some of the masses, so the patient was referred to the gynaecological oncologists who could appropriately treat her. We present here a case report and a systematic review that could be a useful tool for further discussion and future clinical practice guidelines.

Disseminated intra-abdominal low-grade smooth muscle neoplasm of uterine origin

“…6 Similar to uterine leiomyomas, they are usually ER/ PR positive with wild type p53 expression and a low Ki-67 index. 7 Radiologic distinction from malignant carcinomatosis may be difficult, as in this case, due to similarity with other diffuse neoplastic abdominal processes. 8 MRI is useful to evaluate the presence of leiomyosarcoma as a differential.…”

“…If a recurrence is suspected, biopsy confirmation is advised to confirm histology, rule out progression to a higher-grade lesion, and obtain tissue for additional studies. 7 For localized/resectable disease, surgical excision is both therapeutic and diagnostic. If a recurrence is confirmed, treatment with an alternate hormonal therapy is usually considered either after surgery or if resection is not feasible, although no consensus guidelines are available to guide the choice of agent.…”

An intrauterine cavity morcellator: A novel approach to high volume uterus morcellation. Ex-vivo study

“…The hysteroscopic tissue removal system seems a feasible surgical option regarding operative time and complications [36]. This hysteroscopic intrauterine morcellation was not affected by the FDA warning about morcellation in relation to the possible dissemination of misdiagnosed uterine sarcomas [37,38]. Unfortunately, the type and size of the myoma remain the biggest challenge in such a technique.…”