Usenko Olexandr, Sydiuk Andrii, Voitiv Yaroslav, Varga Anita, Popov Oleh, Makarov Vladyslav
Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
Chief medical officer Shalimov's National Institute of Surgery and Transplantology, Kyiv, Ukraine.
Int J Surg Case Rep. 2024 Sep;122:110185. doi: 10.1016/j.ijscr.2024.110185. Epub 2024 Aug 16.
Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease, characterized by intraperitoneal dissemination of smooth-muscle tumor masses.
The patient, a 40-year-old, female - presented with complaints of periodic back pain. During the initial workup, a tumor mass was visualized in the pelvis on ultrasound. Further clinical workup included computer tomography (CT) scan and ultrasound-guided fine-needle biopsy. A tumor mass in the right adrenal gland was identified on CT. Pathological examination revealed no signs of malignancy. The multidisciplinary team decided on surgical treatment. Tumor masses were removed from the pelvic cavity, the anterior abdominal wall, and the projection of the right adrenal gland with preservation of the uterus and ovaries due to the patient's wishes. Pathological examination with immunohistochemistry of surgical specimen confirmed diagnosis of DPL.
Due to the rarity of DPL there are no standard guidelines for diagnostics and treatment. In many cases, on initial workup, DPL may look like a malignant tumor with intraperitoneal spread, which may lead to an inappropriate choice of treatment.
Differential diagnosis of DPL may be a challenge due to its appearance as a disseminated peritoneal malignancy on CT scans and at laparotomy. A multidisciplinary approach is key to choosing the right clinical course for such patients.
播散性腹膜平滑肌瘤病（DPL）是一种罕见的良性疾病，其特征为平滑肌肿瘤块在腹膜内播散。
该患者为一名40岁女性，主诉周期性背痛。在初步检查期间，超声检查发现盆腔有一个肿瘤块。进一步的临床检查包括计算机断层扫描（CT）和超声引导下细针活检。CT检查发现右肾上腺有一个肿瘤块。病理检查未发现恶性迹象。多学科团队决定进行手术治疗。根据患者意愿，从盆腔、前腹壁及右肾上腺投影处切除肿瘤块，同时保留子宫和卵巢。手术标本免疫组化病理检查确诊为DPL。
由于DPL罕见，目前尚无诊断和治疗的标准指南。在许多情况下，初步检查时，DPL可能看起来像伴有腹膜内播散的恶性肿瘤，这可能导致治疗选择不当。
由于DPL在CT扫描和剖腹手术中表现为播散性腹膜恶性肿瘤，其鉴别诊断可能具有挑战性。多学科方法是为此类患者选择正确临床治疗方案的关键。
