Huang Shih-Feng, Wen Chen-Yueh, Liao Cheng-I, Lin Jung-Chia, Tsai Cheng-Chung
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Int J Surg Case Rep. 2021 Apr;81:105745. doi: 10.1016/j.ijscr.2021.105745. Epub 2021 Mar 11.
Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical condition that can be challenging to diagnose because its clinical features mimic other conditions. We present a case of LPD mimicking peritoneal carcinomatosis 13 years after laparoscopic uterine myomectomy using a power morcellator. The aim of this paper is to report a rare case which surgeons can learn from and to provide more clinical information for further studies to investigate LPD.
A 49-year-old woman was referred to us because sonography revealed abnormal abdominal and pelvic nodules. Thirteen years previously, she had undergone laparoscopic uterine myomectomy using a power morcellator. An exploratory laparotomy revealed nodules on the peritoneum, greater omentum, intestinal mesentery, and terminal ileum. We surgically removed all visible nodules and performed bilateral salpingo-oophorectomy. LPD was confirmed based on the morphology and immunohistochemistry results.
Diagnosing LPD preoperatively may be difficult because its clinical manifestations resemble peritoneal carcinomatosis or metastatic lesions. Abdominal pain due to diffuse tumor growth is a common manifestation. LPD degenerating into malignancy is rare, but possible. The probable etiological factors, clinical manifestations, and treatment options which may aid when dealing with LPD have been described in this report.
LPD should be considered in women, particularly those with a history of gynecologic surgery presenting with disseminated intraabdominal or pelvic tumors.
播散性腹膜平滑肌瘤病（LPD）是一种罕见的临床病症，因其临床特征与其他病症相似，诊断具有挑战性。我们报告一例在使用电动粉碎器进行腹腔镜子宫肌瘤切除术后13年出现酷似腹膜癌的LPD病例。本文旨在报告这一罕见病例，供外科医生借鉴，并为进一步研究LPD提供更多临床信息。
一名49岁女性因超声检查发现腹部和盆腔有异常结节而转诊至我院。13年前，她接受了使用电动粉碎器的腹腔镜子宫肌瘤切除术。剖腹探查发现腹膜、大网膜、肠系膜和回肠末端有结节。我们手术切除了所有可见结节，并进行了双侧输卵管卵巢切除术。根据形态学和免疫组化结果确诊为LPD。
术前诊断LPD可能困难，因为其临床表现类似于腹膜癌或转移性病变。弥漫性肿瘤生长引起的腹痛是常见表现。LPD恶变为恶性罕见，但有可能。本报告描述了可能的病因、临床表现以及处理LPD时可能有用的治疗选择。
对于出现腹腔或盆腔播散性肿瘤的女性，尤其是有妇科手术史的女性，应考虑LPD。
