Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution

Abstract

Objectives: To investigate the clinical characteristics, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD) following laparoscopic surgery with uncontained morcellation and to summarize clinical features of iatrogenic LPD based on published literature together with our own experience.Methods: A cohort of 13 cases with iatrogenic LPD diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2020 was reported focusing on clinical characteristics, treatment and prognosis.Results: All the patients had a history of laparoscopic myomectomy with uncontained morcellation. The average age was 35.6 (range 25–47) years. The interval between initial laparoscopic surgery and first diagnosis of LPD was 6.08 years on average (range 1–12). Most of the patients had no obvious symptoms. The accuracy of pre-operative diagnosis was low. Two patients had been treated with gonadotropin-releasing hormone agonist (GnRH-a) before surgery without obvious effect. The nodules of LPD are usually located in the lower half of the peritoneal cavity. The most commonly involved site was the pouch of Douglas. The number of nodules ranged from 3 to over 10, and they ranged in size ranged from 0.3 to 22 cm. All patients underwent surgical treatment: six patients underwent laparoscopy and seven underwent laparotomy. Pathology results confirmed LPD. The immunohistochemical profile indicated LPD tends to be positive strongly for desmin, caldesmon, ER, PR and SMA. Only one patient underwent post-operative treatment with GnRH-a. All patients were followed for an average period of 49 months without recurrence.Conclusion: Iatrogenic LPD is a relatively rare condition. Patients usually exhibit no hormonal stimulation factors. Surgery is the main method of treatment, and hormone suppressive therapy is only rarely used. The nodules are usually large and less numerous, and most involve the pelvis. The prognosis of iatrogenic LPD seems good.

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

“…Recently, iatrogenic tumor implantation following laparoscopic myomectomy or hysterectomy has aroused widespread attention. There has been an increasing number of reports on LPD after laparoscopic myomectomy with power morcellation [16][17][18], during which small fibroid fragments might be missed and left in the abdominal cavity. They may implant into the peritoneum, mesentery, intestines or omental tissues.…”

Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation

“…Leiomyomatosis peritonealis disseminata (LPD) is a very rare benign tumor, characterized by multiple nodules composed of smooth muscle cells that grow along the peritoneal cavity [ 83 – 85 ]. It is usually discovered incidentally in young females during surgery or imaging of uterine leiomyomas, although a few cases have also been reported in perimenopausal and postmenopausal women [ 86 ].…”

“…The classical hormonal theory supports a spontaneous origin related to high estrogen states caused by pregnancy, oral contraceptive use, hormonal replacement therapy or estrogen-producing tumors [ 2 , 5 , 83 ]. Another hypothesis suggests an iatrogenic origin, since several cases have been described after surgical morcellation of uterine leiomyomas [ 84 , 85 ].…”

“…Currently, surgery with complete removal of the peritoneal nodules is considered the treatment of choice in LPD [ 82 , 83 ], and hormone suppressive therapy is usually reserved as an alternative treatment in selected cases [ 85 ]. However, treatment should be individualized according to the patient’s hormonal and reproductive status, age and symptoms.…”

Leiomyomatosis peritonealis disseminata with low-grade malignant change: A case report

“…[10–12] Because of its rarity, there is a lack of consensus on the standard treatment for LDP and the prior treatment is surgery lies on the case reports. [13] Here, we reported a case of LPD with low potential malignant change from Zhejiang Cancer Hospital in September 2020. By sharing this case and reviewing associated literature, we hope to further enhance the understanding of LDP for medical workers, which may benefit for future diagnosis and treatment.…”