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

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is a rare smooth muscle tumor, which is characterized by the dissemination of multiple smooth muscle-like nodules throughout the omental and peritoneal surfaces. The present report describes the case of a 33-year-old woman who had previously undergone laparoscopic myomectomy due to a bizarre leiomyoma. Five years after the initial operation, the patient was referred to our hospital with irregular episodes of right abdominal pain. As the presentation was highly suspicious of malignant uterine tumor metastasis or LPD, the patient subsequently underwent laparoscopic total hysterectomy, bilateral salpingo-oopherectomy, omental resection and excision of some of the disseminated nodules. Histological examination confirmed the diagnosis of LPD. Under laparoscopic examination, LPD must be distinguished from metastatic leiomyosarcoma and other malignant conditions. Frozen section biopsy examination may help with the diagnosis, but the final diagnosis relies on pathological examination. The etiology of LPD includes several theories, such as the hormonal, genetic and iatrogenic theories. A gonadotropin-releasing hormone agonist may be successful in shrinking the nodules. In women who have completed their families, total abdominal hysterectomy, salpingo-oophorectomy, omentectomy and debulking appears to be the optimal treatment.

Keywords: laparoscopic myomectomy; leiomyoma; leiomyomatosis peritonealis disseminata; morcellation; nodules.

Figure 1.

Leiomyomatosis peritonealis disseminata nodules involving (A) the peritoneum, (A-C) omentum and (D) serosal surface of the rectum under laparoscopic visualization.