Leiomyomatosis peritonealis disseminata: A case report of recurrent presentation and literature review

Abstract

HighlightsLeiomyomatosis peritonealis disseminata can result from laparoscopic myomectomies.Tumor morcellation should be probably reconsidered.In young women hormonal therapy is probably the best approach.Close follow-up is necessary due to the risk of malignant degeneration.

Untitled

“…Posteriormente fue nombrada leiomimatosis peritoneal diseminada por Taubert y su grupo. 1 En la actualidad existen alrededor de 150 casos registrados en la bibliografía; 2 sin embargo, la verdadera prevalencia del trastorno sigue siendo vaga porque la mayoría de los pacientes cursan asintomáticos, lo que condiciona que la leiomiomatosis peritoneal diseminada sea una variante infradiagnosticada.…”

“…Cuando hay síntomas estos suelen ser inespecíficos e incluyen: dolor abdominal, malestar o incomodidad, sangrado del recto o la vagina, distensión abdominal o masas abdominales que pueden conducir a obstrucción intestinal. 1 En raras ocasiones los síntomas de malignidad, como ascitis e inflamación de los ganglios linfáticos, pueden aparecer al momento del diagnóstico. 9 Se ha asociado con endometriosis; 13 se ha documentado relación de la leiomiomatosis peritoneal diseminada con otros tipos de tumores benignos y malignos, como el caso del leiomioma ovárico 14 o como en nuestra paciente que cursó con carcinoma ductal infiltrante, con metástasis al hueso.…”

Untitled

“…These results suggest that the removal of fibroids benefits especially patients with infertility due to an otherwise unknown cause: Surgery should be strongly recommended for these patients [60]. The most controversial issue is referred to intramural fibroids not distorting the endometrial cavity: in this case there is a clear reduction in benefits rates and an increase in miscarriage rates [61]. Available data are still insufficient to understand if the myomectomy is the most appropriate kind of treatment for these patients.…”

“…treat lesions of 4-6 cm) [70,71]. It has been shown to be a safe and cost-effective approach resulting in high patient satisfaction [61]. The thickness of residual myometrium wall just above the serosa should be measured and shouldn't be less than 5 mm to avoid complications: this way, the risk of rupture of the gravid uterus after the intervention is negligible.…”

“…an endoscopic bag that appears promising [60]; some challenges are that this requires advanced laparoscopic skills to prevent complications and worsens the visualization of structures. In 2015, the European Society of Gastrointestinal Endoscopy proposed an algorithm to help deciding for or against morcellation based on the characteristics of fibroids to avoid treatment of an occult sarcoma [61].…”