Korean J Obstet Gynecol.  2010 Jun;53(6):546-550. 10.5468/kjog.2010.53.6.546.

Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy

• Park SY
• Choi JY
• Baek MS
• Koh SB
• Lee TS
• Choi YS

• KMID: 2273897
• DOI: http://doi.org/10.5468/kjog.2010.53.6.546

Abstract

Disseminated peritoneal leiomyomatosis is rare condition characterized by multiple subperitoneal nodules of benign smooth muscle proliferations. It is associated with high level of estrogen such as pregnancy, oral contraceptives or estrogen producing ovarian tumor, and occasionally associated with operation history of myomectomy or hysterectomy. Clinical course of disseminated peritoneal leiomyomatosis is usually benign, but malignant changes also rarely have been reported. We experienced a case of disseminated peritoneal leiomyomatosis who has history of laparoscopic myomectomy 10 years ago. The patient was a 35-year-old woman, and her chief complaint was palpable masses in lower abdomen. She underwent laparoscopic surgery which revealed numerous solid masses on the surface of peritoneum, descending colon, rectosigmoid colon, uterus, round ligament, and broad ligament. We present it with a brief review of literature.

Keyword

Leiomyomatosis; Myomectomy

MeSH Terms

Abdomen
Adult
Broad Ligament
Colon
Colon, Descending
Contraceptives, Oral
Estrogens
Female
Humans
Hysterectomy
Laparoscopy
Leiomyomatosis
Muscle, Smooth
Peritoneum
Pregnancy
Round Ligament of Uterus
Uterus
Contraceptives, Oral
Estrogens

Figure

• 

  Figure 1 Operative findings (arrow: myoma, arrow head: sigmoid colon). (A) Multiple myomas of broad and round ligament. (B) Multiple myomas of anterior peritoneal wall. (C) Large two myomas of sigmoid colon. (D) Myomas of sigmoid colon were attached to bowel serosa and mesentery.

Reference

1. Kumar S, Sharma JB, Verma D, Gupta P, Roy KK, Malhotra N. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Arch Gynecol Obstet. 2008. 278:93–95.

2. Willson JR, Peale AR. Multiple peritoneal leiomyomas associated with a granulosa-cell tumor of the ovary. Am J Obstet Gynecol. 1952. 64:204–208.

3. Kang SS, Jung HW, Chung JE, Chung KS. A case of leiomyomatosis peritonealis disseminata. Korean J Obstet Gynecol. 1999. 42:1595–1598.

4. Park JY, Lee KM, Kong TW, Chang KH, Joo HJ, Chang SJ, et al. A case of leiomyomatosis peritonealis disseminata arising after laparoscopic myomectomy. Korean J Obstet Gynecol. 2009. 52:872–876.

5. Chong GO, Hong DG, Kim BS, Park NY, Lee YS, Park IS. A case of leiomyomatosis peritonealis disseminata. Korean J Obstet Gynecol. 2005. 48:2988–2992.

6. Nucci MR, Quade BJ. Crum CP, Lee KR, editors. Uterine mesenchymal tumors. Diagnostic gynecologic and obstetric pathology. 2006. Philadelphia: Elsevier Saunders;611–673.

7. Sharma P, Chaturvedi KU, Gupta R, Nigam S. Leiomyomatosis peritonealis disseminata with malignant change in a post-menopausal woman. Gynecol Oncol. 2004. 95:742–745.

8. Lausen I, Jensen OJ, Andersen E, Lindahl F. Disseminated peritoneal leiomyomatosis with malignant change, in a male. Virchows Arch A Pathol Anat Histopathol. 1990. 417:173–175.

9. Advincula AP, Hernandez JC, Lieberman R. Images in reproductive medicine. Disseminated leiomyomatosis peritonei. Fertil Steril. 2005. 84:1505–1507.

10. Drake A, Dhundee J, Buckley CH, Woolas R. Disseminated leiomyomatosis peritonealis in association with oestrogen secreting ovarian fibrothecoma. BJOG. 2001. 108:661–664.

11. Miyake T, Enomoto T, Ueda Y, Ikuma K, Morii E, Matsuzaki S, et al. A case of disseminated peritoneal leiomyomatosis developing after laparoscope-assisted myomectomy. Gynecol Obstet Invest. 2009. 67:96–102.

12. Quade BJ, McLachlin CM, Soto-Wright V, Zuckerman J, Mutter GL, Morton CC. Disseminated peritoneal leiomyomatosis. Clonality analysis by X chromosome inactivation and cytogenetics of a clinically benign smooth muscle proliferation. Am J Pathol. 1997. 150:2153–2166.

13. Cohen DT, Oliva E, Hahn PF, Fuller AF Jr, Lee SI. Uterine smooth-muscle tumors with unusual growth patterns: imaging with pathologic correlation. AJR Am J Roentgenol. 2007. 188:246–255.

14. Hardman WJ 3rd, Majmudar B. Leiomyomatosis peritonealis disseminata: clinicopathologic analysis of five cases. South Med J. 1996. 89:291–294.

15. Takeda T, Masuhara K, Kamiura S. Successful management of a leiomyomatosis peritonealis disseminata with an aromatase inhibitor. Obstet Gynecol. 2008. 112:491–493.

16. Lin YC, Wei LH, Shun CT, Cheng AL, Hsu CH. Disseminated peritoneal leiomyomatosis responds to systemic chemotherapy. Oncology. 2009. 76:55–58.