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.