Leiomyomatosis Peritonealis Disseminata Research Articles

Safety and efficacy of sirolimus in recurrent intravenous leiomyomatosis, pulmonary benign metastatic leiomyomatosis, and leiomyomatosis peritonealis disseminata: a pilot study

BackgroundIntravenous leiomyomatosis (IVL), pulmonary benign metastatic leiomyomatosis (PBML), and leiomyomatosis peritonealis disseminata (LPD) are leiomyomas with special growth patterns and high postoperative recurrence rates. We report the safety and efficacy of a pilot study of sirolimus in the treatment of recurrent IVL, PBML, and recurrent LPD.MethodsThis was a pilot study to evaluate the safety and efficacy of sirolimus in the treatment of leiomyomatosis (ClinicalTrials.gov identifier NCT03500367) conducted in China. Patients received oral sirolimus 2 mg once a day for a maximum of 60 months or until disease progression, intolerable toxicity, withdrawal of consent, or investigator decision to stop. The primary end point of this study was the objective response rate. Secondary end points included safety and tolerability, disease control rate, and progression-free survival.ResultsA total of 15 patients with leiomyomatosis were included in the study, including five with recurrent IVL, eight with PBML and two with recurrent LPD. The median follow-up time was 15 months (range 6–54 months), nine patients (60%) had treatment-related adverse events (including all levels), and two patients had treatment-related grade 3 or 4 adverse events. The objective response rate was 20.0% (95% CI, 7.1–45.2%), and the disease control rate was 86.7% (95% CI, 62.1–96.3%). Partial response was achieved in three patients. The median response time in the three partial response patients was 33 months (range 29–36 months), and the sustained remission time of these three patients reached 0, 18, and 25 months, respectively.ConclusionsSirolimus was safe and effective in the treatment of recurrent IVL, PBML, and recurrent LPD.Trial registrationClinicalTrials.gov identifier NCT03500367. Registered on 18 April 2018.

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

Leiomyomatosis Peritonealis Disseminata: An Incidental Finding at Autopsy and Review of Literature.

From the ∗College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. †Department of Forensic Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Reprints: Harin Cheong, MD, PhD, Department of Forensic Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. E-mail: [email protected]. ORCID Harin Cheong (0000-0003-3797-7010, [email protected]) Hojung Kim (0000-0002-2713-4207, [email protected]) The authors report no conflict of interest. This article does not contain any studies involving human participants or animals performed by the author. Moreover, this case report was based on medicolegal autopsy underwent with court warrant requested by the public prosecutor.

Parasitic leiomyoma – a case report and review of the literature

The aim of this study is to report a case of parasitic leiomyoma in a brief literature report. A 40-year-old woman was repeatedly examined for chronic abdominal pain in 2020. Lesions presented on CT images showed suspicion of carcinomatosis or endometriosis. Her past history is a laparoscopic myomectomy and hysteroscopic transcervical resection of myoma. Parasitic leiomyoma or leiomyomatosis peritonealis disseminata is an extremely rare variant of uterine leiomyoma occurring outside the uterus. According to the International Federation of Gynecology and Obstetric classification, parasitic leiomyoma has been classified as type 8. Previous laparoscopic myomectomy with intraperitoneal morcellation has been implicated in its etiology. The most common symptom - if present, is abdominal pain, pressure, bloating during eating or nausea.

Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution.

Objectives: To investigate the clinical characteristics, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD) following laparoscopic surgery with uncontained morcellation and to summarize clinical features of iatrogenic LPD based on published literature together with our own experience.Methods: A cohort of 13 cases with iatrogenic LPD diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2020 was reported focusing on clinical characteristics, treatment and prognosis.Results: All the patients had a history of laparoscopic myomectomy with uncontained morcellation. The average age was 35.6 (range 25–47) years. The interval between initial laparoscopic surgery and first diagnosis of LPD was 6.08 years on average (range 1–12). Most of the patients had no obvious symptoms. The accuracy of pre-operative diagnosis was low. Two patients had been treated with gonadotropin-releasing hormone agonist (GnRH-a) before surgery without obvious effect. The nodules of LPD are usually located in the lower half of the peritoneal cavity. The most commonly involved site was the pouch of Douglas. The number of nodules ranged from 3 to over 10, and they ranged in size ranged from 0.3 to 22 cm. All patients underwent surgical treatment: six patients underwent laparoscopy and seven underwent laparotomy. Pathology results confirmed LPD. The immunohistochemical profile indicated LPD tends to be positive strongly for desmin, caldesmon, ER, PR and SMA. Only one patient underwent post-operative treatment with GnRH-a. All patients were followed for an average period of 49 months without recurrence.Conclusion: Iatrogenic LPD is a relatively rare condition. Patients usually exhibit no hormonal stimulation factors. Surgery is the main method of treatment, and hormone suppressive therapy is only rarely used. The nodules are usually large and less numerous, and most involve the pelvis. The prognosis of iatrogenic LPD seems good.

Recurrent leiomyomatosis peritonealis disseminate: a case report

Leiomyomatosis peritonealis disseminata (LPD), a rare and unusual condition affecting mainly women of reproductive age, causes peritoneal and subperitoneal nodules formed by smooth muscle. Very few cases have been diagnosed since the disease was first described. We present a 42year old female who was managed for infertility and uterine myomata at a Municipal hospital in Ghana. Following a pelvic ultrasound diagnosis of multiple uterine myomata the patient was booked for myomectomy. At surgery to remove her myomata, the patient was found to have several peritoneal nodules some of which were attached to peritoneum, omentum and the surface of bowel loops in addition to a uterine myoma. The disease has since recurred twice after two laparotomies. The diagnosis was made by histopathology of ultrasound-guided biopsy of the nodules, and she has since been on GnRH analogue treatment. LPD simulates peritoneal carcinomatosis; thus, a good history, clinical evaluation, radiological imaging, and histopathologic analysis must be accurately diagnosed. Surgeons’ and Radiologists’ knowledge of the condition is fundamental to ensuring correct diagnosis and appropriate treatment and to minimising the probability of malignant transformation.

Leiomyomatosis Peritonealis Disseminata: A Clinical Analysis of 13 Cases and Literature Review.

Objective. Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease that is characterized by numerous small muscle nodules disseminated in the abdominal and pelvic cavity. This study analyzed the clinical features, pathologic characteristics, and prognosis of LPD. Methods. We retrospectively analyzed the clinical data of 13 patients with pathologically diagnosed LPD in Shengjing Hospital of China Medical University from January 2001 to January 2018. Results. Overall, 13 cases were collected. The mean age of the 13 patients was 42.23 years (range = 26-51 years). In all 13 female patients, 11 had a surgical history related to uterine leiomyoma, and only 2 had no history of treatment. Most of them were asymptomatic. Thirteen patients underwent resections of the tumors by laparoscopy or laparotomy. Pathological reports of 13 cases indicated LPD. Twelve cases were followed up, and 1 case was lost to follow-up. The median follow-up time was 65.67 months, and 2 patients showed evidence of recurrence. Conclusions. LPD is a rare disease in women of reproductive age. LPD manifests atypical symptoms, which can be easily misdiagnosed and confirmed by the pathological diagnosis. Surgery is the main treatment. Although LPD is a benign disease, a few patients had a tendency for recurrence or malignancy. Therefore, strict follow-up is needed.

La léiomyomatose extra-utérine : revue de la littérature

Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.

Leyomiomatosis peritonealis disseminata associated with ovarian endometriosis in a patient submitted to hysteroscopic myomectomy

To describe laparoscopic management of a case of leyomiomatosis peritonealis disseminata associated with ovarian endometriosis. Surgical video article. Academic hospital. We present a case of a 30-year-old woman referred to our clinic for abdominal and pelvic pain and dyspareunia. A hysteroscopic myomectomy was reported as previous surgical history. At ultrasound examination, a left ovarian cyst of 4cm suspected for typical endometrioma and a mild hydroureteronephrosis of left kidney were revealed. The patient was scheduled for laparoscopic surgery. During laparoscopy, multiple nodules were found simulating widespread metastases involving colon, small bowel, omentum, right diaphragmatic dome, gastric surface, vesico-uterine area and abdominal peritoneum. Several biopsies and a peritoneal washing were performed, suspecting a peritoneal carcinomatosis. The histological frozen section examination revealed a possible benign disease, requiring further immunohistochemical study that diagnosed leiomyomatosis peritonealis. A second laparoscopy was then performed after one month. Enucleation of the left ovarian endometriotic cyst with classic stripping technique was performed. The left ureter was compressed by a fibrotic nodule of 5cm that was isolated and removed. Operating time was 80minutes. The postoperative course was uneventful and the patient was discharged on postoperative day2. Description of a case of leiomyomatosis peritonealis disseminata in a patient with no previous history of intra-abdominal morcellation. The removal of the left ovarian endometriotic cyst and the periureteral nodule was successfully performed. The patient reported good health conditions without hydroureteronephrosis at six months follow up visit. Leiomyomatosis peritonealis disseminata is a rare clinical disorder characterized by proliferation of nodules, consisted by smooth muscle cells. The association of this condition with endometriosis has been described in other studies. Despite several medical therapies have been proposed (chemotherapy, aromatase inhibitor, gonadotropin-releasing hormone agonist), surgical excision remains a good option, frequently performed for symptoms palliation. Laparoscopic approach might be considered the procedure of choice in case of symptomatic women with leiomyomatosis peritonealis disseminata.

Disseminated Peritoneal Leiomyomatosis Masquerading as Peritoneal Carcinomatosis

Abstract Background: Disseminated peritoneal leiomyomatosis (DPL), also known as leiomyomatosis peritonealis disseminata, is a rare benign disease characterized by the presence of multiple leiomyom...

46: Laparoscopic resection of leiomyomatosis peritonealis disseminata

The objective of this video is to demonstrate laparoscopic resection of leiomyomatosis peritonealis disseminata, a rare condition, and reviews preoperative considerations as well as intraoperative advanced dissection techniques that can be utilized. Leiomyomatosis peritonealis disseminata (LPD) is a rare condition that can occur in prior cases of uncontained morcellation. This video shows course of management for the patient diagnosed with LPD, which initially started when she started experiencing pelvic pain years after her prior hysterectomy with uncontained power morcellation. In the images obtained by CT and MRI showed multiple solid pelvic masses on bilateral pelvic side walls close to critical anatomic structures. Intraoperatively, a sound understanding of pelvic anatomy and advanced laparoscopic techniques were needed to assist in removal of these parasitic masses. Leiomyomatosis peritonealis disseminata is a rare condition that can be treated safely laparoscopically with appropriately applied surgical techniques.

Leiomyomatosis peritonealis disseminata (LPD): five case reports and review of the literature

Purpose of investigation: Leiomyomatosis peritonealis disseminata (LPD) is a special type of leiomyomatosis with an unclear pathogenesis. Materials and Methods: The authors investigated five LPD patients who were treated at the Fudan University Shanghai Cancer Center (Shanghai, China) from 2012 to 2016. They reviewed the medical history, preoperative examination, intraoperative manifestation, and postoperative pathologic results. Results: The five LPD patients were all in reproductive age and four of them had a medical history of laparoscopy for uterine fibroids. Two of them had pathologic results of mitotically active leiomyoma. All the conditions may have contributed to the development of LPD. Conclusion: The use of laparoscopic power morcellation, active proliferative status of the uterine fibroids, and hormone in female patients may help cause LPD. The present study may improve our understanding of the disease.

Leiomyomatosis peritonealis disseminata in a nonpregnant woman.

Leiomyomatosis peritonealis disseminata in a nonpregnant woman.

Leiomyomatosis peritonealis disseminata with aromatase cytochrome P450 expression in a postmenopausal woman: a case study with literature review

Leiomyomatosis peritonealis disseminata with aromatase cytochrome P450 expression in a postmenopausal woman: a case study with literature review

A case report of postmenopausal leiomyomatosis peritonealis disseminata

Leiomyomatosis peritonealis disseminata (LPD) is a rare and benign disease, mainly occurred in reproductive age. The authors report a postmenopausal Chinese woman with a large, hard, and unmovable mass in lower abdomen. Computerized tomography revealed a mass of 13.4× 12.0 cm with irregular edges adhering to surrounding organs, with multiple nodules around the abdominal aorta, and in the pelvic peritoneum, mesenteric, and ileocecal regions. She had abnormal higher levels of serum carbohydrate antigen (CA) 125, but normal levels of serum CA 19-9, alpha-fetal protein, and carcinoembryonic antigen. After being treated with epirubicin, carboplatin, and interventional embolization, her abdominal mass was reduced by about 10% and she received a successful radical surgery, including pelvic tumor resection, total hysterectomy, bilateral oophorectomy, omental resection, appendectomy, rectal resection, and anastomosis. Her pelvic mass weighed 1,350 grams and histologically diagnosed as LPD. Immunohistochemistry of the mass showed positive staining of vimentin, caldesmon, smooth muscle actin (SMA), b-catenin, and Bcl-2, but negative for CD10, CD34, CD99, CD117, S-100, progesterone receptor, and DOG1 staining. She had no disease recurrence during a year of follow up.

187 - Abdominopelvic Dissemination of Leiomyomas Following Minimally Invasive Surgery and Tissue Morcellation – a Case Series

Study Objective: This report is a case series that describes differing presentations of abdominopelvic leiomyomatosis following minimally invasive surgery with morcellation. Leiomyomatosis peritonealis disseminata (LPD) is a rare disease in which multiple smooth muscle tumor nodules spontaneously stud the pelvic and peritoneal surfaces, often giving the appearance of metastatic ovarian or peritoneal carcinoma. A disease similar to LPD has been described due to iatrogenic seeding of the peritoneal cavity during morcellation of leiomyomas at the time of minimally invasive surgical procedures. Another variant, benign metastasizing leiomyomas (BML), can imbed in distant organs.

Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases

Objective: To investigate the clinicopathological features, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD). Methods: A total of 10 patients suffered from LPD after laparoscopic uterine myomectomy were collected in the First Affiliated Hospital of Zhengzhou University from September 2012 to September 2016, and all clinical database were retrospectively analyzed. Results: (1)Clinical features: the age of 10 cases was 25-50 years old, and 8 cases of them were in child-bearing age, while 2 cases were in perimenopausal period. Of 10 cases, 2 cases manifested as discontinuous lower abdominal pain, and the other cases were seen the doctor for the examinations found tumors of pelvis or abdomen. All 10 cases had a history of laparoscopic uterine myomectomy under went power morcellation with an average of (4.0±2.2) years (range 1.3 to 8.1 years), 2 cases of them had a history of oral hormone treatment after the first myoma morcellation. (2) Treatment methods and postoperative pathologic diagnosis: during intraoperative exploration, LPD nodules were most distributed in Douglas pouch (10 cases), and next in mesentery (7 cases), abdominal peritoneum (6 cases) and omentum majus (4 cases), etc. Seven of the 8 cases of child-bearing age were performed laparoscopic LPD nodules removal, 1 case gone combined with laparotomy and resecting LPD nodules; 2 cases in perimenopausal period done laparotomy oophorotomy and resected all LPD nodules and omentum. (3) Postoperative relapse and reproductive outcomes: the follow-up time of all cases was 2.8 years, and no recurrence was found during the follow-up period; 2 cases had natural conception and term vaginal birth during the follow-up period. Conclusions: LPD is mainly related to iatrogenic planting and spreading, which is a benign disease and characterized by multiple smooth muscle nodules throughout abdominopelvic cavity, and the nodules of LPD is commonly located in Douglas pouch, mesenteric and omentaum majus, etc. The preferred method of LPD should be individual operative treatment according to different situations, and in which patients may be have better prognosis.

Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases

Abstract Objective: One aim of this article is to present 2 cases of parasitic myomas and 2 cases of leiomyomatosis peritonealis disseminata (LPD) after laparoscopic surgery with electrical morcellation. Other aims include reporting the current authors' incidence and reviewing the literature briefly. Cases: In these 4 cases, an electric tissue morcellator was used for myoma removal without any containment technique. All cases were symptomatic and 1 of them also presented with a 3-cm endometrioma nodule in the port site where the morcellator had been introduced in a previous surgery. All of the patients were young (< 40 years). No case of an unsuspected uterine sarcoma was seen. Results: The final histopathology was benign in all cases. Currently, all patients are asymptomatic. Conclusions: Laparoscopic morcellation of myomas without containment techniques is associated with an increased risk of parasitic myomas or LPD, mainly in reproductive-age women. Techniques for contained morcellation of the uterine ...

Two cases of leiomyomatosis peritonealis disseminata and Review of the Literature

Leiomyomatosis peritonealis disseminata (LPD)is an extremely rare condition. Here we present two cases of LPD in our hospital. We discuss the aetiology and treatment of this disease.

Two cases of leiomyomatosis peritonealis disseminata and Review of the Literature

Two cases of leiomyomatosis peritonealis disseminata and Review of the Literature