Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution

Advances in the understanding and management of leiomyomatosis peritonealis disseminata: A narrative review

Leiomyomatosis peritonealis disseminata (LPD) is a rare gynecologic disorder characterized by the presence of multiple smooth muscle nodules dispersed across the peritoneal surface. While its precise cause remains unknown, studies indicate a role for hormonal, genetic, and molecular influences in disease progression. Advances in imaging, particularly magnetic resonance imaging (MRI) and computed tomography (CT), have enhanced diagnostic precision by differentiating LPD from malignancies, while immunohistochemical markers like smooth muscle actin (SMA), desmin, and estrogen/progesterone receptors (ER/PR) offer valuable pathologic insights. Management strategies include hormonal therapy (e.g., gonadotropin-releasing hormone [GnRH] agonists) and surgical intervention, with treatment plans tailored to disease severity and patient-specific factors. Emerging research suggests the potential role of targeted molecular therapies in managing refractory cases. Despite these advances, LPD remains a complex condition, and further research is needed to clarify its pathogenesis, identify reliable biomarkers, and establish standardized treatment protocols. This review synthesizes current knowledge on LPD to enhance clinical awareness and guide future research on its pathogenesis, biomarkers, and treatment strategies.

A Rare Presentation of Disseminated Peritoneal Leiomyomatosis Following Laparoscopic Hysterectomy and Its Multidisciplinary Management

Disseminated peritoneal leiomyomatosis (DPL) is a rare entity. It is a benign disease but can mimic disseminated malignancy with extensive disease at multiple sites within the abdominopelvic cavity. The primary contributing factor is postulated to be peritoneal spillage of benign leiomyoma, especially after laparoscopic intervention, although hormonal influences might also play a role. It primarily affects females of childbearing age. Cross-sectional imaging studies offer guidance regarding the extensive nature of the disease and surgery is the primary treatment modality. Complete resection, personalized according to the extent of the disease, has to be planned through a multidisciplinary approach. The diagnosis can only be confirmed by histopathology. Hormone suppression might have a role in selected cases.

A Rare Case of Disseminated Peritoneal Leiomyomatosis: A Case Report

Disseminated peritoneal leiomyomatosis is a benign condition characterized by multiple extrauterine leiomyomas in various locations such as the peritoneum, mesentery, abdominal wall, and pelvis. This is typically observed following laparoscopic myomectomy and is an extremely rare disease, with only a limited number of cases reported thus far. It primarily affects women in their reproductive age group and is believed to be associated with ovarian secretions. Leiomyomas are monoclonal smooth muscle tumors with characteristics similar to muscle on computed tomography/magnetic resonance imaging. The presence of multiple nodules dispersed throughout the peritoneal cavity may resemble malignancy. There is no conventional treatment guideline, and the approach depends on the patient's age, symptoms, fertility requirements, and previous treatment. The treatment modalities can be surgical, hormonal, or combined. The presented case involves a 40-year-old woman who developed disseminated peritoneal leiomyomatosis after undergoing laparoscopic myomectomy.

Parasitic Leiomyoma at Laparoscopic Trocar Site: A Report of 2 Cases

BACKGROUND Parasitic leiomyoma refers to leiomyomas outside the uterus, with a prevalence of 0.07%. Patients are initially asymptomatic and may later develop abdominal pain and abdominal distension. Parasitic leiomyomas at a trocar site are extremely rare and lack detailed reporting. Here, we report 2 cases of parasitic leiomyoma at trocar sites. CASE REPORT Case 1. The patient was a 47-year-old woman with parasitic leiomyomas at a left trocar site 4 years after laparoscopic total hysterectomy. After being diagnosed with 3 masses on the surface of the sigmoid colon and 2 in the pelvic cavity, the patient underwent laparoscopic removal of a pelvic lesion and 3 lesions on the surface of the colon, combined with excision of abdominal wall masses. The pathology result indicated that the masses at the left trocar site were multiple leiomyomas, the intestinal mass was multiple leiomyomas with abundant cells, and the pelvic mass was fibrous capsule parietal tissue. This patient received 3 months of gonadotropin-releasing hormone agonist (GnRH-a) treatment, and was followed up for 9 months without recurrence. Case 2. The patient was a 50-year-old woman with parasitic leiomyoma at the right trocar site 15 years after laparoscopic removal of the right ovarian cyst. At admission, she underwent transabdominal total hysterectomy, bilateral fallopian tube resection, and abdominal wall lesion resection. The pathology report showed multiple leiomyomas of the uterus, and the cell-rich parasitic leiomyoma at right trocar site with unclear boundary. She received 3 months of GnRH-a treatment, and was followed up for 6 months without recurrence. CONCLUSIONS For patients with a history of laparoscopy, gynecologists should be alert to the occurrence of parasitic leiomyoma.

Disseminated peritoneal leiomyomatosis after laparoscopic myomectomy - A case report

INTRODUCTION AND IMPORTANCE

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease, characterized by intraperitoneal dissemination of smooth-muscle tumor masses.

CASE PRESENTATION

The patient, a 40-year-old, female - presented with complaints of periodic back pain. During the initial workup, a tumor mass was visualized in the pelvis on ultrasound. Further clinical workup included computer tomography (CT) scan and ultrasound-guided fine-needle biopsy. A tumor mass in the right adrenal gland was identified on CT. Pathological examination revealed no signs of malignancy. The multidisciplinary team decided on surgical treatment. Tumor masses were removed from the pelvic cavity, the anterior abdominal wall, and the projection of the right adrenal gland with preservation of the uterus and ovaries due to the patient's wishes. Pathological examination with immunohistochemistry of surgical specimen confirmed diagnosis of DPL.

CLINICAL DISCUSSION

Due to the rarity of DPL there are no standard guidelines for diagnostics and treatment. In many cases, on initial workup, DPL may look like a malignant tumor with intraperitoneal spread, which may lead to an inappropriate choice of treatment.

CONCLUSION

Differential diagnosis of DPL may be a challenge due to its appearance as a disseminated peritoneal malignancy on CT scans and at laparotomy. A multidisciplinary approach is key to choosing the right clinical course for such patients.

Disseminated Peritoneal Leiomyomatosis-A Challenging Diagnosis-Mimicking Malignancy Scoping Review of the Last 14 Years

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention-with a focus on minimizing iatrogenic risks-conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL.

Case report: Magnetic resonance imaging findings of patients with diffuse uterine leiomyomatosis

Background

Diffuse uterine leiomyomatosis (DUL) is a seldom-seen condition, with only a handful of cases of magnetic resonance imaging (MRI) findings documented. In clinical settings, it is often mistaken for multiple uterine leiomyomas due to a lack of adequate recognition of DUL.

Objective

This study shows two instances of DUL, underscoring their MRI findings to improve preoperative diagnostic precision.

Conclusion

For patients exhibiting multiple uterine leiomyomas with masses present in the parametrial and abdominal cavities, consideration should be given to diagnosing DUL with DPL. The discoveries outlined in this paper furnish insights that can assist in directing treatment choices.

Disseminated peritoneal leiomyomatosis mimicking carcinomatosis: A case report

INTRODUCTION AND IMPORTANCE

Disseminated Peritoneal Leiomyomatosis (DPL) is a rare benign proliferation of solid peritoneal lesions along the abdominopelvic cavity comprised of smooth muscle and connective tissue. Though hormonal and iatrogenic causes have been theorized, the exact etiology remains unknown. Most patients with DPL are frequently premenopausal with a history of myomectomy or prior hysterectomy. These patients can present asymptomatically or with abnormal uterine bleeding and abdominal discomfort. DPL is a rare entity with less than 150 cases reported in the literature, showcasing the need of awareness of this poorly understood neoplasm. Imaging, if performed, is helpful as positron emission tomography (PET) can differentiate DPL from malignant peritoneal disease. Treatment involves medical and surgical options based on patient's clinical presentation, with medical treatment with gonadotropin-releasing hormone agonist being first line.

CASE PRESENTATION

We report a case of a previously healthy female presenting for desired laparoscopic tubal ligation with incidental countless peritoneal nodules suspicious for carcinomatosis found during the operative event but proven leiomyomas after histologic examination.

CLINICAL DISCUSSION

Differentiating DPL from mimickers such as leiomyosarcoma, endometriosis, and carcinomatosis remains a challenge as macroscopic appearances are similar ultimately requiring histology evaluation.

CONCLUSION

Awareness of the entity is crucial to avoid misdiagnosis and unnecessary anxiety associated with a presumptive diagnosis of malignancy for a largely benign entity.

Disseminated peritoneal leiomyoma: a diagnostic dilemma

Disseminated peritoneal leiomyomatosis (DPL) is a rare and benign clinical entity. It is also known as leiomyomatosis peritonealis disseminata (LPD). Here, we report and discuss a case of a primiparous woman in her early 40s who presented with heavy, prolonged, painful menses and heaviness in her lower abdomen. She underwent a laparoscopic myomectomy for a fibroid uterus, 12 months ago for similar complaints. On workup, she was diagnosed with DPL. We performed a total abdominal hysterectomy with bilateral salpingectomy, low anterior resection with stapled colorectal anastomosis and excision of peritoneal tumour deposits in consortium with the gastrosurgery team. Her postoperative period was uneventful, and the patient was discharged on postop day 6. Her histopathology report was consistent with leiomyoma; the follow-up period was uneventful.

Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation

Peritoneal malignancies represent a diagnostic challenge for abdominal radiologists, oncologists, surgeons and pathologists in multidisciplinary teams, who must address their differential diagnosis, staging and treatment. In this article, we explain the pathophysiology of these processes and lay out the role of different imaging techniques in their evaluation. Then, we review the clinical and epidemiological aspects, the main radiological features and the therapeutic approaches for each primary and secondary peritoneal neoplasm, with surgical and pathological correlation. We further describe other rare peritoneal tumors of uncertain origin and a variety of entities that may mimic peritoneal malignancy. Finally, we summarize the key imaging findings of each peritoneal neoplasm to facilitate an accurate differential diagnosis that may impact patient management.Clinical relevance statementImaging plays an essential role in the evaluation of peritoneal malignancies, assessing their extension, detecting unfavorable sites of involvement and facilitating an accurate differential diagnosis, helping to choose the best therapeutic approach.

Leiomyomatosis peritonealis disseminata with low-grade malignant change: A case report

BACKGROUND

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterized by multiple leiomyomas spread all over the peritoneal cavity. It is commonly described as benign in women of reproductive age. Malignant LPD is much rarer.

METHODS

We present a case of LPD with low potential malignant change in a 43-year-old female, who felt a lump in her abdomen after laparoscopic myomectomy 10 years ago and laparoscopic hysterectomy 8 years ago. The patient underwent exploratory laparotomy and salpingectomy, greater omentectomy, and pelvic and abdominal mass resection were performed during the surgery. The pathological findings revealed LPD with low potential malignant change, with strong expression of estrogen receptor and progesterone receptor. The patient refused oophorectomy and chose gonadotropin-releasing hormone agonists injection postoperatively.

RESULTS

No recurrence was found during the follow-up to date.

CONCLUSION

Surgery is the main treatment for LPD, and endocrine therapy is another choice. Although it is reported mostly benign, we need to be alert to the possibility of malignancy.