Leiomyomatosis peritonealis disseminata associated with endometriosis: A case report and review of the literature

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is a specific type of leiomyomatosis with an unclear pathogenesis that is rarely diagnosed by clinical evaluation. To date, <200 cases have been reported. The majority of the patients have a medical history of laparoscopic myomectomy for uterine fibroids. The use of laparoscopic power morcellation may be a contributor to the development of LPD, therefore, the specific surgical approach used in laparoscopic myomectomy should be carefully considered, and protective measures should be taken to prevent myoma fragments spreading if laparoscopic power morcellation is used. The present study reviewed and analyzed the medical history, diagnostic process and treatment strategy of a case of LPD to improve our understanding of the disease. In this report, the case of a 34 year-old female who underwent laparoscopic myomectomy to remove a uterine fibroid is presented. During the surgery, a myoma was resected using morcellators. Three years after surgery, exploratory laparotomy was performed due to uterine fibroid recurrence. During surgery, myoma was identified at the uterine bladder peritoneal reflection, where several unequally sized leiomyoma tubercles were identified on the uterine surface. Subsequently, myomectomy was performed. Postoperative pathology diagnosed leiomyoma. Two years later, gynecological ultrasound revealed a mass in the abdomen. Exploratory laparotomy was subsequently performed. During surgery, compact myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, and an endometriotic cyst was identified on the left ovary. As the myomas were too compact to remove completely, the majority of leiomyoma on the intestine and mesentery was resected. The endometriotic cyst on the left ovary was also resected. Considering the patient’s medical history, observations during surgery and pathological results, the final diagnosis was LPD. Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

Disseminated peritoneal leiomyomatosis postmorcellated resection of uterine leiomyomatous tissue

“…The location of DPL lesions at the time of resection varied within the peritoneal cavity, with the most common sites including the uterosacral ligament (n = 10), sigmoid colon serosa (n = 6), and left adnexa (n = 6). Two cases in the literature described recurrence of DPL 50 and 72 months after the first resection of DPL lesions (these are not included in the data analysis) .…”

“…We evaluated previously described cases of DPL in the literature that had occurred after a primary uterine resection of leiomyomatous tissue using morcellation (1,2,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). A search of PubMed, EMBASE, and Ovid for all English language peer reviewed manuscripts published with search forms including myomectomy, morcellation, disseminated peritoneal, leiomyomatosis peritonealis disseminata, diffuse abdominal leiomyomatosis, diffuse peritoneal leiomyomatosis, and disseminated fibrosis deciduosis.…”

“…A search of the literature revealed there to be 30 previously described cases of DPL occurring in the setting of a previous resection of uterine (n = 10), sigmoid colon serosa (n = 6), and left adnexa (n = 6). Two cases in the literature described recurrence of DPL 50 and 72 months after the first resection of DPL lesions (these are not included in the data analysis) (1,20).…”

Surgical removal of multiple mesenteric fibroids (Kg 4,500) by abdominal spread of previous laparoscopic uterine myomectomy

“…Since female gonadal steroids play an important role in the pathogenesis of LPD, it is generally associated with high levels of exogenous and endogenous female gonadal steroids (4). Leiomyomatosis peritonealis disseminata (LPD) is a specific type leiomyomatosis that is rarely identified properly before surgery (5 Surgical removal of multiple mesenteric fibroids (Kg 4,500) by abdominal spread of previous laparoscopic uterine myomectomy V. LEANZA, F.A. GULINO, G. LEANZA, G. ZARBO in a either spherical or nodular shape with a good demarcation from surrounding structure.…”

Oestrogen-Induced Angiogenesis and Implantation Contribute to the Development of Parasitic Myomas after Laparoscopic Morcellation

“…Most women (78.3 %) presented with symptoms, such as abdominal or pelvic pain, dyspareunia, abdominal distension, abdominal pressure, urinary frequency and constipation [13,14,[17][18][19][20][21][22][23]. In 10.1 % patients, debulking procedure, such as omentectomy, appendectomy, or bowel resection, was necessary to eliminate all PMs [18,24,25]. Thus, it is important to elucidate the pathophysiology of laparoscopic morcellator-induced PMs.…”