Leiomyomatosis peritonealis disseminata: Three case reports

Abstract

Rationale: Leiomyomatosis peritonealis disseminata (LPD) is a rare benign lesion primarily consisting of smooth muscle cells, which mostly affects premenopausal females. Here, we reported 3 females with LPD (age, 40-48 years) admitted for pelvic masses.

Patient concerns: All 3 LPD cases received laparoscopic uterine fibroid morcellation at 3, 8, and 14 years ago, respectively. Two cases were admitted for pelvic masses. One case was admitted for recurrent fibroids with pollakiuria.

Diagnoses: LPD was considered in 2 cases preoperation according to imaging examination, and one of them received ultrasound-guided biopsy of the lesion in the right lobe of the liver. One case was considered as recurrent fibroids preoperation. After surgery, all cases were pathologically diagnosed as LPD consisting of benign smooth muscle cells.

Interventions: A total abdominal hysterectomy, salpingo-oophorectomy, and debulking was performed for all 3 cases. Intraoperative exploration revealed that the fibroids distributed in the mesentery (3 cases), broad ligament (1 case), omentum (1 case), liver (1 case), and rectus abdominis (1 case).

Outcomes: No recurrence was found during postoperative following-up (5-12 months).

Lesions: Preoperative diagnosis of LPD is presented as a challenge due to unspecific clinical manifestations. Its diagnosis mainly depends on histopathologic evaluation. Surgery still is the primary treatment for LPD. For patients without reproductive desire, total abdominal hysterectomy, salpingo-oophorectomy, and debulking can be performed, and the affected tissue should be removed as much as possible based on the risk assessment.

Figure 1

Ultrasound and CT images of Case 1. A, Transvaginal ultrasound showed multiple hypoechoic nodules in uterus, and the uterus lost its normal shape. B, Transvaginal ultrasound showed hypoechoic nodules in uterine rectal area. C, Transabdominal ultrasound showed hypoechoic nodule in paraumbilical abdominal wall. D, Enhanced CT scan revealed irregular soft tissue mass in the lower abdomen and nodules in abdominal wall below the umbilicus.

Figure 2

Intraoperative images of Case 1. Leiomyomatosis peritonealis disseminata nodules involving (A) the surface of anterior rectus sheath and near the umbilicus, (B) the inferior margin of omentum, and (C) the beginning of the ascending colon laparoscopic visualization.

Figure 3

Ultrasound and intraoperative images of Case 2. A, B, Ultrasound showed multiple masses in the pelvic and abdomen. C, Ultrasound showed a hypoechoic nodule on lower edge of the right hepatic lobe. D, Multiple bead-like hard nodules on the surface of small intestine near to ileocecal junction.

Figure 4

Ultrasound and MRI images of Case 3. A, B, Ultrasound showed multiple hypoechoic nodules in the uterus. C, Ultrasound showed a hypoechoic nodule in uterine rectal fossa, suggesting subserosal fibroids. D, Contrast-enhanced magnetic resonance imaging suggested multiple uterine fibroids and subserosal fibroids.