Disseminated peritoneal leiomyomatosis following laparoscopic myomectomy: a case report

Background. Disseminated peritoneal leiomyomatosis (DPL) is a rare disease of mesenchymal origin that is characterized by the presence of multiple benign myomatous tumors proliferated along the surface of the peritoneum, omentum and other soft tissues of the abdominal cavity and / or pelvis. Despite the benign morphological characteristics, DPL is known for its tendency for recurrence or malignancy. In addition, clinical manifestations of these tumors resemble peritoneal carcinomatosis, therefore, imaging investigations are important to accurately diagnose and treat lesions Currently, due to the rarity of DPL, there are no conventional guidelines for the diagnosis and treatment of this disease. The purpose of this study was to present a case report of a female patient with hormonally sensitive recurrent DPL following laparoscopic myomectomy to improve the algorithms for managing this disease.

Material and Methods. The patient with DPL was treated at N.A. Lopatkin Research Institute of Urology and Interventional Radiology, a branch of the National Medical Research Center of Radiology of the Russian Ministry of Health, DPL. To determine the extent of the tumor and the appropriate treatment tactics for the patient, an extensive differential diagnostic search involving various imaging techniques was performed. The patient underwent diagnostic laparoscopy with urgent morphological examination to finally determine the extent of surgery and achieve the maximum cytoreduction. A subsequent planned morphological examination revealed the presence of estrogen and progesterone receptors within the tumor cells, that was the reason for prescribing hormonal therapy and careful follow-up for the patient.

Conclusion. Study and demonstration of rare clinical cases expands the horizons and understanding of the nature of the disease. Our case report and literature review demonstrated that leiomyoma cells are prone to implantation dissemination.

1. Halama N., Grauling-Halama S.A., Daboul I. Familial clustering of Leiomyomatosis peritonealis disseminata: an unknown genetic syndrome? BMC Gastroenterol. 2005; 5: 33. doi: 10.1186/1471-230X-5-33.

2. Nassif G.B., Galdon M.G., Liberale G. Leiomyomatosis peritonealis disseminata: case report and review of the literature. Acta Chir Belg. 2016; 116(3): 193–96. doi: 10.1080/00015458.2016.1139833.

3. Kim H., Cheong H. Leiomyomatosis Peritonealis Disseminata: An Incidental Finding at Autopsy and Review of Literature. Am J Forensic Med Pathol. 2023; 44(2): 10–12. doi: 10.1097/PAF.0000000000000827.

4. Timchenko M.A., Olovyannikov Yu.S., Nikolaeva M.G. Methods of treatment of symptomatic uterine fibroids through the prism of time (review of scientific literature). Mother and Baby in Kuzbass. 2023; 1(92): 20–29. (in Russian). doi: 10.24412/2686-7338-2023-192-20-29. EDN: KGCYWC.

5. Bucuri C.E., Ciortea R., Malutan A.M., Oprea V., Toma M., Roman M.P., Ormindean C.M., Nati I., Suciu V., Simon-Dudea M., Mihu D. Disseminated Peritoneal Leiomyomatosis-A Challenging Diagnosis-Mimicking Malignancy Scoping Review of the Last 14 Years. Biomedicines. 2024; 12(8): 1749. doi: 10.3390/biomedicines12081749.

6. Vimercati A., Santarsiero C.M., Esposito A., Putino C., Malvasi A., Damiani G.R., Laganà A.S., Vitagliano A., Marinaccio M., Resta L., Cicinelli E., Cazzato G., Cascardi E., Dellino M. An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature. Diagnostics (Basel). 2022; 12(12): 3219. doi: 10.3390/diagnostics12123219.

7. Ma Y., Wang S., Liu Q., Lu B. A clinicopathological and molecular analysis in uterine leiomyomas and concurrent/metachronous peritoneal nodules: New insights into disseminated peritoneal leiomyomatosis. Pathol Res Pract. 2020; 216(5): 152938. doi: 10.1016/j.prp.2020.152938.

8. Smirnova G.F., Kirichenko A.D., Fetisova T.I., Lopatin O.L., Verzhbitskaya N.E., Egorov A.A. Differentiated peritoneal leiomyomatosis. Case report. (in Russian). [Internet]. [cited 2024 Sep 23]. URL: https://oncology.ru/specialist/journal_oncology/archive/0210/006/.

9. Vaishnavi R., Nair S.S., Sudha S., Nitu P.V. Disseminated peritoneal leiomyomatosis: An unusual complication of laparoscopic myomectomy. J. Clin. Diagn. Res. 2024; 18: QD04–QD05. doi: 10.7860/JCDR/2024/63871.19082.

10. Barajas-Puga J.A., Lira-Álvarez E.A., Montañez-Sosa L.G., Berthaúd-González B. Disseminated peritoneal leiomyomatosis. A rare disease with a difficult diagnosis. Revista Médica del Hospital General de México. 2022; 85(3): 131–34. doi: 10.24875/hgmx.22000009.

11. Liu C., Chen B., Tang X., Xiong Y. Disseminated peritoneal leiomyomatosis after uterine artery embolization, laparoscopic surgery, and high intensity focused ultrasound for uterine fibroids: a case report. Int J Hyperthermia. 2020; 37(1): 925–28. doi: 10.1080/02656736.2020.1797909.

12. Seregin A.A., Kosova Ya.A., Seregina P.A., Ponomareva Yu.N., Nadezhdenskaia A.B., Kirilova E.V., Asaturova A.V., Tregubova A.V., Magnaeva A.S., Ishchuk M.P., Ovodenko D.L. Uterine leiomyosarcoma and disseminated peritoneal leiomyomatosis in the surgical treatment of uterine myoma: a retrospective analysis. Gynecology. 2022; 24(5): 386–92. (in Russian). doi: 10.26442/20795696.2022.5.201860. EDN: TPCHVJ.

13. Li B., Wang F., Chen L., Tong H. Global epidemiological characteristics of uterine fibroids. Arch Med Sci. 2023; 19(6): 1802–10. doi: 10.5114/aoms/171786.

14. Kurman R.J., Carcangiu M.L., Herrington C.S., Young R.H., editors. WHO Classification of Tumours of Female Reproductive Organs. IARC: Lyon, 2014. ISBN: 978-92-832-2435-8.

15. Sanada S., Ushijima K., Yanai H., Mikami Y., Ohishi Y., Kobayashi H., Tashiro H., Mikami M., Miyamoto S., Katabuchi H. A critical review of “uterine leiomyoma” with subsequent recurrence or metastasis: A multicenter study of 62 cases. J Obstet Gynaecol Res. 2022; 48(12): 3242–51. doi: 10.1111/jog.15426.

16. Sparic R., Andjić M., D’Oria O., Babović I., Milovanović Z., Panese G., Licchelli M., Tomašević Đ., Morciano A., Tinelli A. Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation. Healthcare (Basel). 2022; 10(10): 2087. doi: 10.3390/healthcare10102087.

17. Uterine fibroids: clinical guidelines of the Ministry of Health of the Russian Federation. 2024. (in Russian). [Internet]. [cited 2024 Sep 23]. URL: https://diseases.medelement.com/disease/ миома-матки-кр-рф-2024/18197.

18. Payanidi U.G., Zhordania K.I. Disseminated peritoneal leiomyomatosis. A clinical observation. Oncogynecology. 2022; 43(3): 25–31. (in Russian). doi: 10.52313/22278710_2022_3_25. EDN: QQCEJP.

19. Qin Z., Wang Y., Zheng A. A case of peritoneal disseminated leiomyomatosis after total hysterectomy. Asian J Surg. 2024; 47(1): 695–96. doi: 10.1016/j.asjsur.2023.09.157.