Leiomyomatosis Peritonealis Disseminata

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is a relatively rare clinical entity which is characterized by the presence of multiple nonneoplastic nodules, mainly due to smooth muscle proliferation over the surface of the abdominopelvic peritoneal cavity. It is usually an incidental finding during procedures such as laparoscopy, cesarean section, laparotomy, and postpartum tubal ligation, and it occurs mainly in women, primarily during the reproductive period. When LPD occurs during pregnancy or during the use of birth control pills, it may regress spontaneously after delivery or discontinuation of the use of the pills. Conservative care is indicated, particularly if fertility is desired. In this study, we report a case of LPD in a pregnant Egyptian woman. To our knowledge, this is the first case reported in an Arab woman. Case ReportA 38-year-old pregnant Egyptian woman of 38 weeks' gestation, gravida 4 para 3, was admitted to the Maternity Hospital, Riyadh Medical Complex, for a cesarean section. The previous history of the patient was unremarkable, except for two previous lower segment cesarean sections for cephalopelvic disproportion, with no intraoperative or postoperative complications. The patient had used oral contraceptive pills for a period of one year three years previously, but there was no other history of use of intrauterine contraceptive device or other hormonal treatment. Physical examination on admission revealed temperature of 37°C, blood pressure of 120/80, and mild lower limb edema. Abdominal examination revealed normal pregnancy at term cephalic 4/5.Within six hours of admission, the patient underwent a cesarean section, and a baby girl was delivered weighing 4.95 kg, with an Apgar score of 9.99. Examination of the abdomen during surgery revealed multiple (about 20-25) small fleshy nodules varying in diameter from 0.1 to 0.5 cm, and scattered over the uterus, fallopian tubes, omentum, and anterior abdominal wall. No nodules were seen over the bowel surface or the liver. A left ovarian multilocular cystic mass measuring 10x6x6 cm was observed. No ascitis was present and the uterus appeared free of any intramural tumor. With a possible diagnosis of disseminated carcinomatosis, examination of a frozen section specimen from one of the nodules was made, which revealed the mass to be a benign leiomyoma. Bilateral salpingooophorectomy and biopsy of another peritoneal nodule was carried out. The postoperative recovery was uneventful and the patient was discharged on the eighth postoperative day. Follow-up ultrasound examination three months later revealed no more nodular masses in the abdominal cavity. Pathologic FindingsThe left ovary was replaced by a well-defined cystic mass measuring 10x6x6 cm. The right ovary was unremarkable. A cross-section view of the left ovarian mass showed a cystic cavity filled with thick granular yellow material with some hair structures. The two biopsies from the peritoneal nodules measured 0.7x0.5x0.5 cm in diameter each. They were smooth and glistening, firm, and pa...