Disseminated peritoneal leiomyomatosis postmorcellated resection of uterine leiomyomatous tissue

Abstract

In a retrospective review, we identified six cases of disseminated peritoneal leiomyomatosis (DPL) that occurred after resection for uterine leiomyoma(ta) using a morcellation procedure between 2010 and 2016. DPL occurred in less than 1% of all patients who underwent a prior hysterectomy with morcellation, and DPL never occurred without having underwent such a resection. The median age of women at the time of their original resection of uterine tissue was 38.6 years; the median time interval until resection of DPL after the primary morcellation procedure was 73 months and the median age was 48 years. At the time of DPL resection, a median of 6.5 individual lesions was present per patient, with each lesion having a median size of 1.2 cm in the greatest dimension. The most common peritoneal sites of involvement included the sigmoid colon serosa, right pelvis/pelvic side wall, and anterior abdominal parietal peritoneum. The same parameters are described for previously reported cases of DPL in the literature developing after a morcellated resection of uterine leiomyoma(ta). The use of morcellating hysterectomy specimens with leiomyomata may lead to the development of DPL by seeding, may involve numerous peritoneal sites, and often presents 2 years after the original resection.

Disseminated peritoneal leiomyomatosis: an unusual presentation of intra-abdominal lesion mimicking disseminated malignancy

“…Although it's not clear if the stimulus to smooth cell differentiation is hormonal, genetic or both [4,5]. Also, it could be induced after morcellation of myoma during laproscopy [6]. The disease is generally associated with high levels of exogenous or endogenous female gonadal steroids [7].…”

Peritoneal karsinomatozisi taklit eden dissemine peritoneal leiomyomatozis

“…It is considered as the LPD is induced with hormonal or genetic factors during metaplasia of submesothelial mesenchymal cells 2 . Another hypothesis of LPD etiology is the seeding of fibroids which can be by morcellation of fibroids during laparoscopic surgery 8 . Thus, the LPD is a multifactorial disease.…”