Recurrent Leiomyomatosis Peritonealis Disseminata: Sonographic and Laparoscopic Correlation

Abstract

We present a 39-year-old G0P0 with history of infertility treatment-caused ovarian hyperstimulation and uterine fibroids, who was found to have a rare pathological presentation. Peritoneal lesions were identified during laparoscopic treatment for this patient's fibroids. Histological evaluation of these lesions revealed leiomyomatosis peritonealis disseminata (LPD), also known as disseminated peritoneal leiomyomatosis. While LPD can often be confused for metastatic leiomyosarcoma due to the histological presence of fibroblasts, myofibroblasts, smooth muscle, collagen, and spindle cell appearance, cases of LPD are generally benign, and present no need for therapy in asymptomatic cases. We present a discussion based on the clinical and sonographic presentation of LPD, its pathophysiology, treatment options and prognosis. A question set has been designed to reinforce comprehension of this presentation and associated topics for health care professionals.

Recurrent leiomyomatosis peritonealis disseminate: a case report

“…In men and postmenopausal women, the condition is attributed partly to the increased responsiveness of tumour cells to normal hormone levels. 1,3,5,6,8,10,11 Myomectomy and hysterectomy, which fall in the iatrogenic category, are believed to produce leiomyoma fragments that disseminate and implant on the peritoneum and later grow into LPD nodules. 1,5 The history of the index patient make her condition lean more towards this aetiological model than the others aforementioned.…”

“…One such aggressive treatment is bilateral salpingo-oophorectomy which is believed to provide a cure in patients with symptomatic LPD with worrisome gross or histopathological features. 1,3,8…”

“…This is due to its asymptomatic nature hence the possibility of being underdiagnosed. 1,2,3,4,5 LPD is commonly noted in women of reproductive age and rarely in men or postmenopausal women. Patients usually have a history of pregnancy, oral contraceptive use, myomectomy, hysterectomy, uterine leiomyoma, or ovarian tumours.…”