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Leiomyomatosis peritonealis disseminata associated with endometriosis: A case report and review of the literature.

Yang R, Xu T, Fu Y, Cui S, Yang S, Cui M - Oncol Lett (2014)

Bottom Line: Considering the patient's medical history, observations during surgery and pathological results, the final diagnosis was LPD.Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months.In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China.

ABSTRACT

Leiomyomatosis peritonealis disseminata (LPD) is a specific type of leiomyomatosis with an unclear pathogenesis that is rarely diagnosed by clinical evaluation. To date, <200 cases have been reported. The majority of the patients have a medical history of laparoscopic myomectomy for uterine fibroids. The use of laparoscopic power morcellation may be a contributor to the development of LPD, therefore, the specific surgical approach used in laparoscopic myomectomy should be carefully considered, and protective measures should be taken to prevent myoma fragments spreading if laparoscopic power morcellation is used. The present study reviewed and analyzed the medical history, diagnostic process and treatment strategy of a case of LPD to improve our understanding of the disease. In this report, the case of a 34 year-old female who underwent laparoscopic myomectomy to remove a uterine fibroid is presented. During the surgery, a myoma was resected using morcellators. Three years after surgery, exploratory laparotomy was performed due to uterine fibroid recurrence. During surgery, myoma was identified at the uterine bladder peritoneal reflection, where several unequally sized leiomyoma tubercles were identified on the uterine surface. Subsequently, myomectomy was performed. Postoperative pathology diagnosed leiomyoma. Two years later, gynecological ultrasound revealed a mass in the abdomen. Exploratory laparotomy was subsequently performed. During surgery, compact myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, and an endometriotic cyst was identified on the left ovary. As the myomas were too compact to remove completely, the majority of leiomyoma on the intestine and mesentery was resected. The endometriotic cyst on the left ovary was also resected. Considering the patient's medical history, observations during surgery and pathological results, the final diagnosis was LPD. Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

No MeSH data available.


Related in: MedlinePlus

Post-operative pathological analysis to determine a diagnosis of leiomyomatosis peritonealis disseminata. Hematoxylin and eosin staining at (A) ×40 magnification and (B) ×100 magnification. Positive immunohistochemical staining for (C) Ki67 (positive rate, 1%), (D) h-caldesmon, (E) α-smooth muscle antibody, (F) desmin, (G) estrogen receptor and (H) progesterone receptor (magnification, ×100).
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f2-ol-09-02-0717: Post-operative pathological analysis to determine a diagnosis of leiomyomatosis peritonealis disseminata. Hematoxylin and eosin staining at (A) ×40 magnification and (B) ×100 magnification. Positive immunohistochemical staining for (C) Ki67 (positive rate, 1%), (D) h-caldesmon, (E) α-smooth muscle antibody, (F) desmin, (G) estrogen receptor and (H) progesterone receptor (magnification, ×100).

Mentions: Based on the clinical manifestation and auxiliary examinations, ovarian neoplasm was considered as a possible diagnosis, therefore, an exploratory laparotomy was performed. During the surgery, concentrated myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, with sizes ranging from 0.4×0.3×0.3 cm to 5.0×4.0×3.0 cm (Fig. 1). Additionally, a 1.5-cm diameter endometriotic cyst was identified on left ovary and a 1-cm endometriosis lesion was identified on the left posterior uterosacral ligaments. The cysts on the surface were partially removed. The frozen section indicated a diagnosis of mesenchymal tumors, however, intestinal leiomyoma could not be excluded. During the surgery, the following diagnoses were made: Intestinal leiomyoma, endometriotic cysts on the left ovary and pelvic endometriosis. The majority of the leiomyoma on the intestine and mesentery was removed, however, the myomas were compact and therefore, not all of them could be removed. The endometriotic cysts on the left ovary and the pelvic endometriosis lesion were removed concurrently. Post-operative pathology determined a diagnosis of leiomyomatosis peritonealis disseminate, with occasional mitosis and no necrosis (Fig. 2A and B). Immunohistochemical staining revealed the resected tissues to be positive for h-caldesmon, α-SMA, desmin, estrogen receptor and progesterone receptor (PR) (Fig. 2C–H), and negative for cluster of differentiation (CD)117, discovered on gastrointestinal stromal tumor-1, CD34, neuron-specific enolase and S-100, with a Ki-67 labeling index of 1%. The post-operative procedure was successful and the patient was monitored by follow-up every six months. Follow-up is scheduled for five years, after which gynecological sonography examination will be performed annually. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.


Leiomyomatosis peritonealis disseminata associated with endometriosis: A case report and review of the literature.

Yang R, Xu T, Fu Y, Cui S, Yang S, Cui M - Oncol Lett (2014)

Post-operative pathological analysis to determine a diagnosis of leiomyomatosis peritonealis disseminata. Hematoxylin and eosin staining at (A) ×40 magnification and (B) ×100 magnification. Positive immunohistochemical staining for (C) Ki67 (positive rate, 1%), (D) h-caldesmon, (E) α-smooth muscle antibody, (F) desmin, (G) estrogen receptor and (H) progesterone receptor (magnification, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301522&req=5

f2-ol-09-02-0717: Post-operative pathological analysis to determine a diagnosis of leiomyomatosis peritonealis disseminata. Hematoxylin and eosin staining at (A) ×40 magnification and (B) ×100 magnification. Positive immunohistochemical staining for (C) Ki67 (positive rate, 1%), (D) h-caldesmon, (E) α-smooth muscle antibody, (F) desmin, (G) estrogen receptor and (H) progesterone receptor (magnification, ×100).
Mentions: Based on the clinical manifestation and auxiliary examinations, ovarian neoplasm was considered as a possible diagnosis, therefore, an exploratory laparotomy was performed. During the surgery, concentrated myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, with sizes ranging from 0.4×0.3×0.3 cm to 5.0×4.0×3.0 cm (Fig. 1). Additionally, a 1.5-cm diameter endometriotic cyst was identified on left ovary and a 1-cm endometriosis lesion was identified on the left posterior uterosacral ligaments. The cysts on the surface were partially removed. The frozen section indicated a diagnosis of mesenchymal tumors, however, intestinal leiomyoma could not be excluded. During the surgery, the following diagnoses were made: Intestinal leiomyoma, endometriotic cysts on the left ovary and pelvic endometriosis. The majority of the leiomyoma on the intestine and mesentery was removed, however, the myomas were compact and therefore, not all of them could be removed. The endometriotic cysts on the left ovary and the pelvic endometriosis lesion were removed concurrently. Post-operative pathology determined a diagnosis of leiomyomatosis peritonealis disseminate, with occasional mitosis and no necrosis (Fig. 2A and B). Immunohistochemical staining revealed the resected tissues to be positive for h-caldesmon, α-SMA, desmin, estrogen receptor and progesterone receptor (PR) (Fig. 2C–H), and negative for cluster of differentiation (CD)117, discovered on gastrointestinal stromal tumor-1, CD34, neuron-specific enolase and S-100, with a Ki-67 labeling index of 1%. The post-operative procedure was successful and the patient was monitored by follow-up every six months. Follow-up is scheduled for five years, after which gynecological sonography examination will be performed annually. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

Bottom Line: Considering the patient's medical history, observations during surgery and pathological results, the final diagnosis was LPD.Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months.In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China.

ABSTRACT

Leiomyomatosis peritonealis disseminata (LPD) is a specific type of leiomyomatosis with an unclear pathogenesis that is rarely diagnosed by clinical evaluation. To date, <200 cases have been reported. The majority of the patients have a medical history of laparoscopic myomectomy for uterine fibroids. The use of laparoscopic power morcellation may be a contributor to the development of LPD, therefore, the specific surgical approach used in laparoscopic myomectomy should be carefully considered, and protective measures should be taken to prevent myoma fragments spreading if laparoscopic power morcellation is used. The present study reviewed and analyzed the medical history, diagnostic process and treatment strategy of a case of LPD to improve our understanding of the disease. In this report, the case of a 34 year-old female who underwent laparoscopic myomectomy to remove a uterine fibroid is presented. During the surgery, a myoma was resected using morcellators. Three years after surgery, exploratory laparotomy was performed due to uterine fibroid recurrence. During surgery, myoma was identified at the uterine bladder peritoneal reflection, where several unequally sized leiomyoma tubercles were identified on the uterine surface. Subsequently, myomectomy was performed. Postoperative pathology diagnosed leiomyoma. Two years later, gynecological ultrasound revealed a mass in the abdomen. Exploratory laparotomy was subsequently performed. During surgery, compact myoma tubercle-like cysts were identified on the surface of the intestine and mesentery, and an endometriotic cyst was identified on the left ovary. As the myomas were too compact to remove completely, the majority of leiomyoma on the intestine and mesentery was resected. The endometriotic cyst on the left ovary was also resected. Considering the patient's medical history, observations during surgery and pathological results, the final diagnosis was LPD. Following surgery, the patient was treated with the gonadotropin-releasing hormone agonist, triptorelin acetate (3.5 mg, once every four weeks), for three months and followed-up every six months. In October 2014, a gynecological sonography examination revealed no abnormalities and at the time of writing, the patient remains alive and well.

No MeSH data available.


Related in: MedlinePlus