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Case Reports
. 2017 Aug 7:82:426-430.
doi: 10.12659/PJR.902242. eCollection 2017.

Imaging Findings in a Rare Case of Leiomyomatosis Peritonealis Disseminata with Malignant Transformation

Moinullah Syed  1 , Bikash Parida  1 , Tejas Mankeshwar  1 , Akhil Patil  1
Affiliations
Case Reports

Imaging Findings in a Rare Case of Leiomyomatosis Peritonealis Disseminata with Malignant Transformation

Moinullah Syed et al. Pol J Radiol. .

Abstract

Background: Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by formation of multiple leiomyomas in the abdominal and pelvic peritoneum. Malignant transformation of LPD is an extremely rare occurrence. We hereby report a case of a middle-aged female who was subsequently diagnosed with leiomyomatosis peritonealis disseminata with a few of the lesions showing malignant transformation.

Case report: A forty-year-old female with a history of hysterectomy presenting with vague abdominal pain was completely evaluated with ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) and was subsequently diagnosed with leiomyomatosis peritonealis disseminata. The imaging findings of leiomyomatosis peritonealis disseminata were correlated with and confirmed by a histopathologic examination of the excision biopsy specimen.

Conclusions: The imaging findings were found to be specific for leiomyomatosis peritonealis disseminata with a malignant transformation.

Keywords: Hysterectomy; Leiomyomatosis; Peritoneum.

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Figures

Figure 1
Figure 1
(A, B) Ultrasound images show multiple, well-defined, homogenous hypoechoic lesions in the pelvis and peritoneum.
Figure 2
Figure 2
Color and spectral Doppler of one of the lesions shows a low-resistance arterial waveform.
Figure 3
Figure 3
Axial plain CT image of the pelvis shows multiple, welldefined, isodense lesions as indicated by arrows.
Figure 4
Figure 4
Coronal, reformatted, postcontrast CT image shows heterogeneous enhancement of the above-seen lesions with central non-enhancing areas suggestive of necrosis.
Figure 5
Figure 5
Axial T1W MR image of the pelvis shows multiple, welldefined, iso- to hypointense lesions as indicated by arrows.
Figure 6
Figure 6
A xial T2W MR image at same level as in Figure 5 shows heterogeneous, predominantly hyperintense signal within the mass with cystic areas within. The lesion with the higher signal intensity is indicated by the arrow.
Figure 7
Figure 7
Axial, STIR MR image at same level as in Figure 9 shows hyperintense signal of the same lesions.
Figure 8
Figure 8
Axial, GRE MR image shows central areas of blooming within the masses as indicated by the arrows.
Figure 9
Figure 9
Sagittal, oblique, postcontrast, fat-sat MR image shows intense enhancement of the lesions with central areas of non-enhancement suggestive of necrosis (arrows).
Figure 10
Figure 10
Gross surgical specimen of one of the lesions shows a pale, lobulated, solid mass.
Figure 11
Figure 11
Low power microscopic histopathologic section of a lesion shows abundant spindle-shaped cells in bundles.
Figure 12
Figure 12
High power microscopic histopathologic section of the same slide shows spindle-shaped cells in bundles with few fibroblasts without cellular atypia or pleomorphism.
Figure 13
Figure 13
High power microscopic histopathologic section of another lesion shows cellular atypia with nuclear pleomorphism and increased mitotic figures (arrows).
See this image and copyright information in PMC

References

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