Disseminated peritoneal leiomyomatosis with malignant transformation involving right ureter: A case report

An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature

Minimally invasive treatment of uterine fibroids usually requires a power morcellation, which could be associated with several complications. A rare sequela is disseminated peritoneal leiomyomatosis. Indeed, recurrence or metastasis in these cases could be attributed to iatrogenic or under-evaluation of primary tumors, although a subset of cases is a sporadic sample of biological progression. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously. The diagnosis was predicted preoperatively by an expert sonographer who recognized the ultrasound characteristics of uterine sarcoma and the localization of some of the masses, so the patient was referred to the gynaecological oncologists who could appropriately treat her. We present here a case report and a systematic review that could be a useful tool for further discussion and future clinical practice guidelines.

Disseminated Peritoneal Leiomyomatosis With Unusual Lung Mesenchymal Malignant Transformation

Disseminated peritoneal leiomyomatosis (DPL) is a benign metastasis of leiomyoma mimicking metastasis of malignancy. It usually affects premenopausal women. Malignant transformation is a rare clinical scenario of DPL. However, its etiology is unknown with unusual growth patterns, either of which makes the diagnosis difficult. It was postulated that the pathophysiology of DPL is metaplasia of mesothelial cells under the effect of hormonal stimulation. Hence, we reported the case of a 62-year-old woman with a history of left breast cancer, who presented with DPL and metastasis to the lung with malignant transformation after two years of starting prophylactic tamoxifen therapy. The influence of tamoxifen use on the development of DPL is not fully understood; this is a rare case that highlights a possible association between tamoxifen and the malignancy transformation of DPL. Hence, it may help raise awareness among clinicians dealing with women using tamoxifen or other hormonal therapy, and the risk of DPL development with potential malignant transformation in such patients.