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Kim H, Cheong H. Leiomyomatosis Peritonealis Disseminata: An Incidental Finding at Autopsy and Review of Literature. Am J Forensic Med Pathol 2023; 44:e10-e12. [PMID: 36989105 DOI: 10.1097/paf.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Hojung Kim
- From the College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Harin Cheong
- Department of Forensic Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Yang JW, Hua Y, Xu H, He L, Huo HZ, Zhu CF. Treatment of leiomyomatosis peritonealis disseminata with goserelin acetate: A case report and review of the literature. World J Clin Cases 2021; 9:5217-5225. [PMID: 34307570 PMCID: PMC8283592 DOI: 10.12998/wjcc.v9.i19.5217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple pelvic and abdominal nodules, which are composed of smooth-muscle cells. To date, no more than 200 cases have been reported. The diagnosis of LPD is difficult and there are no guidelines on the treatment of LPD. Currently, surgical excision is the mainstay. However, hormone blockade therapy can be an alternative choice.
CASE SUMMARY A 33-year-old female patient with abdominal discomfort and palpable abdominal masses was admitted to our hospital. She had undergone four surgeries related to uterine leiomyoma in the past 8 years. Computed tomography revealed multiple nodules scattered within the abdominal wall and peritoneal cavity. Her symptoms and the result of the core-needle biopsy were consistent with LPD. The patient refused surgery and was then treated with tamoxifen, ulipristal acetate (a selective progesterone receptor modulator), and goserelin acetate (a gonadotropin-releasing hormone agonist). Both tamoxifen and ulipristal acetate were not effective in controlling the disease progression. However, the patient achieved an excellent response when goserelin acetate was attempted with relieved syndromes and obvious shrinkage of nodules. The largest nodule showed a 25% decrease in the sum of the longest diameters from pretreatment to posttreatment. Up to now, 2 years have elapsed and the patient remains asymptomatic and there is no development of further nodules.
CONCLUSION Goserelin acetate is effective for the management of LPD. The long-term use of goserelin acetate is thought to be safe and effective. Hormone blockade therapy can replace repeated surgical excision in recurrent patients.
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Affiliation(s)
- Jia-Wen Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yu Hua
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Liu He
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hai-Zhong Huo
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
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Lee WY, Noh JH. Leiomyomatosis peritonealis disseminata associated with appendiceal endometriosis: a case report. J Med Case Rep 2015; 9:167. [PMID: 26215629 PMCID: PMC4532259 DOI: 10.1186/s13256-015-0637-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Leiomyomatosis peritonealis disseminata is a very rare benign condition of the peritoneal cavity that may mimic peritoneal carcinomatosis or metastatic leiomyosarcomas. It mainly develops in association with pregnancy, but is also rarely associated with endometriosis. CASE PRESENTATION A 31-year-old Asian woman presented to our hospital with abdominal pain in the right lower quadrant. Her abdominopelvic computed tomography scan showed a 1.2cm-sized nodule at the appendiceal tip, but no other abnormal findings. We suspected acute appendicitis and performed an exploratory laparoscopy. Her appendix was enlarged at the tip portion. Also noted were blood-colored fluid collections in her pelvic cavity and bilateral ovarian cysts. Additionally, several small whitish firm solid nodules, ranging from 0.5 to 1.0cm in size, were present on her pelvic peritoneum. Her histological examination confirmed that the endometriosis of her appendix coexisted with leiomyomatosis peritonealis disseminata. CONCLUSIONS We report a case involving a 31-year-old woman with acute symptoms of endometriosis of the appendix associated with leiomyomatosis peritonealis disseminata. Appendiceal endometriosis with leiomyomatosis peritonealis disseminata presenting as acute appendicitis is extremely rare. To the best of our knowledge, this is the first such case reported in the literature.
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Affiliation(s)
- Woo Yong Lee
- Department of Surgery, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul, 100-032, Korea.
| | - Ji Hyun Noh
- Department of Obstetrics and Gynecology, Ilsan Paik Hospital, Inje University College of Medicine, 170, Juhwaro, Ilsanseogu, Gyeonggido, 411-706, Korea.
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Yuri T, Kinoshita Y, Yuki M, Yoshizawa K, Emoto Y, Tsubura A. Leiomyomatosis peritonealis disseminata positive for progesterone receptor. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:300-4. [PMID: 25992687 PMCID: PMC4444146 DOI: 10.12659/ajcr.893570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Female, 30 Final Diagnosis: Leiomyomatosis Symptoms: Abnormal finding in abdominal-pelvic CT scan Medication: — Clinical Procedure: Surgical tumorectomy Specialty: Oncology
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Affiliation(s)
- Takashi Yuri
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuichi Kinoshita
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Michiko Yuki
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Katsuhiko Yoshizawa
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuko Emoto
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Airo Tsubura
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
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Isaac ML, Spaulding KA, Goodrich ZJ. Imaging diagnosis--disseminated peritoneal leiomyomatosis in a dog. Vet Radiol Ultrasound 2014; 56:E25-30. [PMID: 24870205 DOI: 10.1111/vru.12175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/13/2014] [Indexed: 11/27/2022] Open
Abstract
A 17-month-old male Labrador retriever presented for evaluation of an abdominal mass felt during abdominal palpation. Multiple variably sized cystic masses were identified on sonographic and radiographic images. Exploratory laparotomy revealed multiple peritoneal masses that exhibited atypical contractions and lacked an identifiable organ of origin. Histology and immunohistochemistry of multiple surgically excised masses was consistent with benign tumors of smooth muscle origin (leiomyomas). The presence of multiple peritoneal leiomyomas in this dog is consistent with disseminated peritoneal leiomyomatosis. Two years after diagnosis and multiple surgical interventions, continual insidious enlargement of leiomyomas was identified on ultrasound and CT.
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Affiliation(s)
- Markay L Isaac
- College of Veterinary Medicine and Biomedical Sciences, College of Veterinary Medicine, Texas A&M University, 422 Raymond Stotzer Pkwy, College Station, TX, 77845
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Selected case from the Arkadi M. Rywlin International Pathology Slide Series: Leiomyomatosis peritonealis disseminata: report of 3 cases with extensive review of the literature. Adv Anat Pathol 2014; 21:201-15. [PMID: 24713991 DOI: 10.1097/pap.0000000000000024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the clinicopathologic features of 3 cases of leiomyomatosis peritonealis disseminata (LPD). The patients were 33, 34, and 41 years old at the time of diagnoses. The 3 women had undergone laparoscopic removal of multiple uterine leiomyomas between 1 and 6 years before the diagnoses of LPD. Laparoscopic uterine leiomyomectomies were performed on 3 occasions in patient 1, and once in patients 2 and 3 by the time a diagnosis of LPD was made. In patients 2 and 3, one of the multiple uterine leiomyomas had been qualified as mitotically active. Patients 1 and 2 received hormonal treatment before LPD was diagnosed. Malignancy was clinically and/or pathologically suspected in all the 3 cases. Patients 1 and 2 were managed conservatively. Patient 3 underwent radical hysterectomy with bilateral adnexectomy and omentectomy. Patients 1 and 2 belong to a rare subset of LPD that have fewer tumor nodules larger (5 to 10 cm) than typically seen. Patient 3 was classic in that she exhibited innumerable nodules measuring between a few millimeters and 1.5 cm, intraoperatively mimicking peritoneal carcinomatosis. Histopathologically, patients 1 and 2 were diagnosed as pure LPD, whereas patient 3 was diagnosed as LPD associated with endometriosis (adenomyosis type). Patients 1 and 3 had incipient foci of leiomyomatous changes in the blood vessel walls, at the site of the LPD tumors, supporting the hypothesis that these are de novo lesions arising locally and not migrated or disseminated from the previously excised or concurrent uterine smooth muscle tumors, usually seen in this context. Conceivably, laparoscopic leiomyomectomy with morcellation may play a role in the pathogenesis of this rare condition, at least in hormonally susceptible patients. Alternatively, LPD may derive from metaplastic submesothelial cells, a condition analogous to gliomatosis peritonei.
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Leiomyomatosis peritonealis disseminata as a possible result of laparoscopic myomectomy—report of four cases. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s10397-013-0806-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wong NACS, Melegh Z. Gastrointestinal stromal tumours can express CD10 and epithelial membrane antigen but not oestrogen receptor or HMB45. Histopathology 2012; 59:781-5. [PMID: 22014058 DOI: 10.1111/j.1365-2559.2011.03979.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Gastrointestinal stromal tumour (GIST) may share morphological and/or immunohistochemical features with various intra-abdominal neoplasms, including endometrial stromal sarcoma, perivascular epithelioid cell tumour (PEComa), melanoma and synovial sarcoma. Each of these various neoplasms has characteristic immunohistochemical markers, including epithelial membrane antigen (EMA), CD10, oestrogen receptor alpha (ERa) and/or HMB45, and therefore the primary aim of this study was to determine whether these markers are also expressed by GISTs. METHODS AND RESULTS Standard size sections of 52 GISTs were immunostained for EMA, CD10, ERa and a melanoma marker cocktail (targeting HMB45 and melan-A). Ten GISTs (19%) showed CD10 immunopositivity. This positivity was confined almost completely to small intestinal GISTs, and was seen among spindle cell GISTs but not epithelioid or mixed cell-type GISTs. Five of the 52 GISTs (9.6%) showed EMA immunopositivity. This positivity was always focal and usually seen in a perivascular location. None of the GISTs showed immunopositivity for ERa or the melanoma marker cocktail. CONCLUSIONS GISTs occasionally show CD10 immunopositivity (especially small intestinal spindle cell GISTs), and infrequently show focal EMA positivity. GISTs do not show immunopositivity for ERa or HMB45.
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Affiliation(s)
- Newton A C S Wong
- Department of Histopathology, Bristol Royal Infirmary Department of Cellular Pathology, Southmead Hospital, UK.
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Abstract
This review aims to summarize recent knowledge gained about gastrointestinal stromal tumour (GIST) of particular relevance to histopathologists. KIT and PDGFRA mutation analyses can be useful for confirming a diagnosis of GIST, but there are some diagnostic limitations to these analyses, and so immunohistochemical markers currently remain crucial to the diagnostic process. Of these markers, CD117 and Discovered on GIST 1 (DOG1) are currently the most sensitive and specific markers of GIST, and recent data appear to disprove the fear that antigen retrieval causes false-positive CD117 immunostaining. The accurate prognostication of GIST has been greatly helped by the National Institutes of Health (NIH) and Armed Forces Institute of Pathology (AFIP) classification systems, although both systems still have limitations, and the behaviours of certain GIST subgroups are less well predicted by both systems. KIT and PDGFRA mutation analyses can help to predict the response of GISTs to receptor tyrosine kinase inhibitors, and both GISTs that respond and those that show resistance to these inhibitors may show characteristic pathological changes. Some GIST subgroups (e.g. Carney syndrome and paediatric GISTs) have had recently described clinicopathological and/or molecular characteristics which may help with the diagnosis and/or treatment of these specific neoplasms.
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Leiomyomatosis peritonealis disseminata in a pregnant woman. Arch Gynecol Obstet 2009; 281:123-7. [DOI: 10.1007/s00404-009-1074-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/24/2009] [Indexed: 12/26/2022]
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The presence and role of progesterone receptor in the ovaries of postmenopausal women who have not applied hormone replacement therapy. Folia Histochem Cytobiol 2009; 46:277-82. [PMID: 19056530 DOI: 10.2478/v10042-008-0038-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
At present, not much is known about progesterone receptor (PR) expression and localization in postmenopausal women ovaries. In the ovaries of reproductive age women, PR is localized in internal theca and granulosa cells, corpus luteum, ovary surface epithelium (OSE) and in stroma. PR expression depends on the serum concentration of progesterone, estrogen, gonadotropin and androgen. The goal of the conducted studies was to examine PR localization and expression in the ovaries of postmenopausal women who have not applied hormone replacement therapy so far. Also, the correlation was examined between PR expression and localization in the ovaries, steroid and gonadotropin hormone serum concentrations, and influence of the time from the last menstruation. The material came from 50 postmenopausal women who had their ovaries removed due to non-neoplastic diseases. The women were divided into 3 groups (A, B, C) depending on the time from the last menstruation. The follitropin (FSH), luteotropin (LH), estradiol (E2), testosterone (T), androstendione (A) and dehydroepiandrosterone sulphate (DHEAS) concentrations in blood plasma were measured. Monoclonal mouse anti-human PR antibody was used for immunohistochemical detection (examination involved 50 postmenopausal ovaries). Between particular groups, E2 serum concentrations did not differ, but FSH, LH, T, A, DHEAS serum concentrations were significantly different. Immunohistochemical nuclear localization of PR in postmenopausal women ovaries was observed. PR expression was similar in all three groups (A, B, C). PR expression was observed in OSE nuclei and invaginations cysts deriving from the isolation of invaginated epithelium and metaplastic columnar epithelium and in stroma. In the ovaries of postmenopausal women who have not applied hormone replacement therapy so far, PR was detected in all three groups. Its expression did not depend on the time from menopause and was similar in all examined groups. FSH, LH, T, A, DHEAS serum concentrations did not influence PR expression.
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Nappi C, Sardo ADS, Mandato VD, Bifulco G, Merello E, Savanelli A, Mignogna C, Capra V, Guida M. Leiomyomatosis peritonealis disseminata in association with Currarino syndrome? BMC Cancer 2006; 6:127. [PMID: 16686944 PMCID: PMC1481579 DOI: 10.1186/1471-2407-6-127] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 05/10/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leiomyomatosis peritonealis disseminata (LPD) is a rare disease in which multiple smooth muscle or smooth muscle-like nodules develop subperitoneally in any part of the abdominal cavity. No reports of multiple congenital malformations associated with LPD have been found in the English literature. CASE PRESENTATION A 27 year-old patient referred to our gynaecology unit for pelvic pain, amenorrhoea, stress incontinence, chronic constipation and recurrent intestinal and urinary infections. Multiple congenital malformations had previously been diagnosed. Most of these had required surgical treatment in her early life: anorectal malformation with rectovestibular fistula, ectopic right ureteral orifice, megadolichoureter and hemisacrum. An ultrasound scan and computed tomography performed in our department showed an irregular, polylobate, complex 20 cm mass originating from the right pelvis that reached the right hypochondrium and the epigastrium. The patient underwent laparotomy. The three largest abdominal-pelvic masses and multiple independent nodules within the peritoneum were progressively removed. The histological diagnosis was of LPD. CONCLUSION The case we report is distinctive in that a rare acquired disease, LPD, coexists with multiple congenital malformations recalling a particular subgroup of caudal regression syndrome: the Currarino syndrome.
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Affiliation(s)
- Carmine Nappi
- Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Attilio Di Spiezio Sardo
- Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Vincenzo Dario Mandato
- Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Giuseppe Bifulco
- Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Elisa Merello
- Department of Neurosurgery, Gaslini Children's Hospital, Genoa, Italy
| | - Antonio Savanelli
- Department of Pediatric Surgery, University of Naples "Federico II", Italy
| | - Chiara Mignogna
- Department of Biomorphologic and Functional Sciences, Pathological Anatomy Section, University of Naples "Federico II", Italy
| | - Valeria Capra
- Department of Neurosurgery, Gaslini Children's Hospital, Genoa, Italy
| | - Maurizio Guida
- Department of Gynecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
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Heinig J, Neff A, Cirkel U, Klockenbusch W. Recurrent leiomyomatosis peritonealis disseminata after hysterectomy and bilateral salpingo-oophorectomy during combined hormone replacement therapy. Eur J Obstet Gynecol Reprod Biol 2004; 111:216-8. [PMID: 14597256 DOI: 10.1016/s0301-2115(03)00237-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Leiomyomatosis peritonealis disseminata is a rare disease characterised by the occurrence of multiple smooth muscle cells building up tumour nodules within the peritoneal cavity. Approximately 50 cases of this disease have been reported in the world literature. To our knowledge, this is the first case reporting the recurrence of leiomyomatosis peritonealis disseminata during combined hormone replacement therapy after hysterectomy and bilateral salpingo-oophorectomy and six laparotomies because of recurrence of the disease.
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Affiliation(s)
- Joerg Heinig
- Department of Obstetrics and Gynaecology, University of Münster, Albert-Schweitzer-Street 33, 48149 Münster, Germany.
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