Wen Chen-Yueh, Lee Herng-Sheng, Lin Jen-Tai, Yu Chia-Cheng
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan.
Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan.
World J Clin Cases. 2022 Feb 16;10(5):1639-1644. doi: 10.12998/wjcc.v10.i5.1639.
Disseminated peritoneal leiomyomatosis (DPL) with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma, and hematuria as a presenting symptom has never been reported. Through this case report, we emphasize the investigation of the etiology, clinical presentation, diagnosis, treatment, and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management.
We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy. An exploratory laparotomy was performed and all visible nodules were surgically removed. DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results.
Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain, hematuria, and imaging of disseminated pelvic tumors in women, especially those with prior history of laparoscopic hysterectomy. Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.
播散性腹膜平滑肌瘤病（DPL）合并黏液样平滑肌肉瘤是平滑肌肉瘤的一种罕见变异类型，以血尿为首发症状的情况尚未见报道。通过本病例报告，我们强调对DPL发生恶性变并酷似转移性泌尿系统癌的病因、临床表现、诊断、治疗及预后进行研究，以助于进一步完善临床管理。
我们描述了1例腹腔镜子宫切除术后发生恶性转化累及右侧输尿管的DPL病例。行剖腹探查术并手术切除所有可见结节。根据病理结果确诊为DPL伴局灶性恶性转化为黏液样平滑肌肉瘤。
术前诊断为DPL发生恶性变且累及泌尿生殖道的黏液样平滑肌肉瘤的专业人员，对于女性患者，尤其是有腹腔镜子宫切除术史者，应考虑腹痛、血尿症状及盆腔播散性肿瘤的影像学表现。早期完整切除所有肿瘤是预防DPL发生恶性变的基石。
