Obstet Gynecol Sci.  2015 Jul;58(4):314-318. 10.5468/ogs.2015.58.4.314.

Single-port laparoscopic debulking surgery of variant benign metastatic leiomyomatosis with simultaneous lymphatic spreading and intraperitoneal seeding

• Chung YH
• Lee SW
• Shin SY
• Rhim CC
• Im S
• Yoo SH
• Yoon JH

• KMID: 2314053
• DOI: http://doi.org/10.5468/ogs.2015.58.4.314

Abstract

Benign metastatic leiomyomatosis (BML) is a rare disease characterized by smooth muscle cell proliferation in extrauterine sites including the lung, abdomen, pelvis, and retroperitoneum. Depending on location, BML is classified as intravenous leiomyomatosis and diffuse peritoneal leiomyomatosis. Pathogenesis of BML can be iatrogenic after previous myomectomy or hysterectomy, hormonal, or coelomic metaplasia. Treatment options are observation, hormonal suppression, and/or surgical debulking via laparotomy or laparoscopy. Laparoscopic surgery is gaining in popularity in the gynecologic field compared to laparotomic surgery and single-port laparoscopy has the benefits of cosmesis and early tissue extraction by transumbilical morcellation. We report a 39-year-old woman with BML who underwent single-port laparoscopy debulking surgery.

Keyword

Hysterectomy; Laparoscopy; Leiomyomatosis

MeSH Terms

Abdomen
Adult
Female
Humans
Hysterectomy
Laparoscopy
Laparotomy
Leiomyomatosis*
Lung
Metaplasia
Myocytes, Smooth Muscle
Pelvis
Rare Diseases

Figure

• 

  Fig. 1 Multiple metastatic leiomyomatosis in a 39-year-old woman. Contrast enhanced 3-dimensional multi-detector computed tomography images show several well-defined masses (arrows) in abdomino-pelvic cavity (A). Multiple masses are sacttered in the Douglas pouch (B), near the left adnexae (C), peritoneum (D), omentum (E), and near both external iliac vessel (F). A chest computed tomography scan revealed multiple peripheral nodules in both lower lobe and lingula of lung (G,H).

• 

  Fig. 2 Operative findings. Single port system with OCTO Port (A). Multiple leiomyoma of near the left adnexae (B), Douglas pouch (C), near the left external iliac vessel (D), and peritoneum (E). Leiomyoma with red degeneration attached to bowel serosa and mesentery (F). Partial omentectomy (G). Para-aortic lymph node dissection (H). Extracorporeal primary repair of serosal area of small bowel after removal mass attached the small bowel (I).

Reference

1. Awonuga AO, Shavell VI, Imudia AN, Rotas M, Diamond MP, Puscheck EE. Pathogenesis of benign metastasizing leiomyoma: a review. Obstet Gynecol Surv. 2010; 65:189–195.

2. Esteban JM, Allen WM, Schaerf RH. Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions. Arch Pathol Lab Med. 1999; 123:960–962.

3. Taveira-DaSilva AM, Alford CE, Levens ED, Kotz HL, Moss J. Favorable response to antigonadal therapy for a benign metastasizing leiomyoma. Obstet Gynecol. 2012; 119:438–442.

4. Kim YW, Park BJ, Ro DY, Kim TE. Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study. J Minim Invasive Gynecol. 2010; 17:587–592.

5. Steiner PE. Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature. Am J Pathol. 1939; 15:89–110.

6. Yoon G, Kim TJ, Sung CO, Choi CH, Lee JW, Lee JH, et al. Benign metastasizing leiomyoma with multiple lymph node metastasis: a case report. Cancer Res Treat. 2011; 43:131–133.

7. Patton KT, Cheng L, Papavero V, Blum MG, Yeldandi AV, Adley BP, et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis. Mod Pathol. 2006; 19:130–140.

8. Tietze L, Gunther K, Horbe A, Pawlik C, Klosterhalfen B, Handt S, et al. Benign metastasizing leiomyoma: a cytogenetically balanced but clonal disease. Hum Pathol. 2000; 31:126–128.

9. Wang J, Yang J, Huang H, Li Y, Miao Q, Lu X, et al. Management of intravenous leiomyomatosis with intracaval and intracardiac extension. Obstet Gynecol. 2012; 120:1400–1406.

10. Abell MR, Littler ER. Benign metastasizing uterine leiomyoma: multiple lymph nodal metastases. Cancer. 1975; 36:2206–2213.

11. Al-Talib A, Tulandi T. Pathophysiology and possible iatrogenic cause of leiomyomatosis peritonealis disseminata. Gynecol Obstet Invest. 2010; 69:239–244.

12. Toriyama A, Ishida M, Amano T, Nakagawa T, Kaku S, Iwai M, et al. Leiomyomatosis peritonealis disseminata coexisting with endometriosis within the same lesions: a case report with review of the literature. Int J Clin Exp Pathol. 2013; 6:2949–2954.

13. Paley D, Fornasier VL. Leiomyomatosis metastasizing to the spine. J Bone Joint Surg Am. 1984; 66:630.

14. Nuovo GJ, Schmittgen TD. Benign metastasizing leiomyoma of the lung: clinicopathologic, immunohistochemical, and micro-RNA analyses. Diagn Mol Pathol. 2008; 17:145–150.

15. Hahn HS, Kim YW. Single-port laparoscopic pelvic lymph node dissection with modified radical vaginal hysterectomy in cervical cancer. Int J Gynecol Cancer. 2010; 20:1429–1432.