Xiao Xiaoli, Wang Cong, Zhang Yuyuan, Li Fang, Zhang Huan, Ma Ruiqing
Department of Gynecology, Aerospace Center Hospital, Beijing, 100049, China.
Department of Pathology, Aerospace Center Hospital, Beijing, 100049, China.
Heliyon. 2023 Sep 2;9(9):e19794. doi: 10.1016/j.heliyon.2023.e19794. eCollection 2023 Sep.
Leiomyomatosis peritonealis disseminata (LPD) is a non-metastatic, homologous, multicentric benign disorder characterized by small leiomyomas scattered over the peritoneum and omentum. It is a rare and benign disease with invasive potential. LPD mainly attacks women of childbearing age but has also been reported in post-menopausal women, men, and young children. Non-specific clinical and imaging findings of LPD lead to difficult diagnoses and treatment.
This study reports the case of a patient with recurrent LPD with endometriosis after multiple myomectomies and hysterectomy, who presented recurrent abdominal pain with progressive exacerbation. Imaging examinations showed irregular shadows in the pelvic cavity and multiple nodular changes in the peritoneum, which were considered malignant lesions. A solid mass sized 10 cm × 9 cm × 10 cm in the inferior pelvis and nodules scattered over the surface of pelvic and abdominal organs and the peritoneum were detected during the surgery. The patient was treated with cytoreductive surgery (CRS), peritonectomy, ovarian ablation, and hyperthermic intraperitoneal chemotherapy (HIPEC). The surgery was challenging, and the intraoperative bleeding reached 900 ml. However, the patient recovered well and achieved a tumor-free survival of 13 months.
It was concluded that a combination of CRS, ovarectomy, and HIPEC might be one of the therapeutic strategies for recurrent LPD.
播散性腹膜平滑肌瘤病（LPD）是一种非转移性、同源性、多中心性良性疾病，其特征是小的平滑肌瘤散在于腹膜和大网膜。它是一种罕见的具有侵袭潜能的良性疾病。LPD主要侵袭育龄期女性，但也有在绝经后女性、男性和幼儿中报道的病例。LPD的非特异性临床和影像学表现导致诊断和治疗困难。
本研究报告了一例在多次肌瘤切除术和子宫切除术后复发LPD并伴有子宫内膜异位症的患者，该患者出现反复腹痛且进行性加重。影像学检查显示盆腔内有不规则阴影，腹膜有多处结节样改变，考虑为恶性病变。手术中在盆腔下部发现一个大小为10 cm×9 cm×10 cm的实性肿块，盆腔和腹部器官表面及腹膜上散在有结节。该患者接受了细胞减灭术（CRS）、腹膜切除术、卵巢切除术和腹腔内热灌注化疗（HIPEC）。手术具有挑战性，术中出血达900 ml。然而，患者恢复良好，实现了13个月的无瘤生存。
得出结论，CRS、卵巢切除术和HIPEC联合应用可能是复发性LPD的治疗策略之一。
