Leiomyomatosis peritonealis disseminata treated with a gonadotropin‐releasing hormone agonist. A case report

Hales, HA; Peterson, Margaret; Jones, K. M.; Quinn, JD

doi:10.1016/0020-7292(93)90215-i

Cited by 14 publications

(20 citation statements)

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“…Animal studies have shown that prolonged elevated levels of estrogen can lead to metaplasia of mesenchymal stem cells and to subsequent development of leiomyomatous peritoneal lesions, similar to LPD [25] . Regression of these nodules can be achieved by decreasing the estrogen level with gonadotropin-releasing hormone agonists [26] or aromatase inhibitors [27] .…”

Section: Hormonal Theorymentioning

confidence: 99%

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Pathophysiology and Possible Iatrogenic Cause of Leiomyomatosis Peritonealis Disseminata

Al-Talib

Tulandi²

2010

Gynecol Obstet Invest

132

123

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We present a case of leiomyomatosis peritonealis disseminata (LPD) after myoma morcellation and review the literature using the keywords leiomyomatosis peritonealis disseminata and disseminated peritoneal leiomyomatosis. The search was conducted in Medline, EMBASE, and Cochrane Database of systematic reviews. We encountered 132 cases of LPD in the English literature; 113 in the reproductive age group, 7 in postmenopausal women, 6 in males, and another in a horse. The possible causes could be divided into hormonal, subperitoneal mesenchymal stem cells, metaplasia, genetic, or iatrogenic after morcellation of myoma during laparoscopic surgery. Our case and 4 others reported in the literature support the contribution of the iatrogenic theory. It appears that LPD could be due to metaplasia of mesenchymal cells of the peritoneum and, in susceptible women, leaving fragments of myoma in the abdominal cavity might contribute to the development of LPD. Accordingly, one should avoid leaving fragments of the uterus or myoma tissue in the abdominal cavity after morcellation.

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Section: Hormonal Theorymentioning

confidence: 99%

“…Ovarian suppression with a GnRH agonist (GnRHa) will shrink the nodules [26,70] . Aromatase inhibitors are effective in other conditions that respond well to GnRHa suggesting that it is a promising medication for LPD.…”

Section: Managementmentioning

confidence: 99%

Pathophysiology and Possible Iatrogenic Cause of Leiomyomatosis Peritonealis Disseminata

Al-Talib

Tulandi²

2010

Gynecol Obstet Invest

132

123

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“…3,4 Most of the cases reported were in their reproductive years and were mostly associated with pregnancy. [4][5][6] Some of the non-pregnant women were under hormonal therapy, [7][8][9] or had granulosa cell tumor of the ovary. 1 A few cases were in the menopausal or perimenopausal age groups.…”

Section: Discussionmentioning

confidence: 99%

Leiomyomatosis Peritonealis Disseminata

Baez-Giangreco¹,

Afzal²,

Sharkawy

et al. 2000

Ann Saudi Med

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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...

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“…If conservative therapy is ineffective, surgical debulking or castration via bilateral oophorectomy are considerations 2,4,5 . Regression of tumors has been shown with the use of gonadotropin-releasing hormone agonists 10 . Regular follow-up is recommended, as recurrence and malignant transformation have been documented 2,3,5 .…”

Section: Multimodality Imaging Findings Of Leiomyomatosis Peritonealimentioning

confidence: 99%

Multimodality imaging findings of leiomyomatosis peritonealis disseminata

Covarrubias

Nardi

Duncan

2009

Ultrasound in Obstet & Gyne

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Leiomyomatosis peritonealis disseminata treated with a gonadotropin‐releasing hormone agonist. A case report

Cited by 14 publications

References 0 publications

Pathophysiology and Possible Iatrogenic Cause of Leiomyomatosis Peritonealis Disseminata

Pathophysiology and Possible Iatrogenic Cause of Leiomyomatosis Peritonealis Disseminata

Leiomyomatosis Peritonealis Disseminata

Multimodality imaging findings of leiomyomatosis peritonealis disseminata

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