- Case Report
- Open Access
Complex hyperplastic endometrium in a peritoneal leiomyoma following a CISH hysterectomy
© Springer-Verlag Berlin / Heidelberg 2006
Received: 27 June 2005
Accepted: 23 December 2005
Published: 30 May 2006
We describe a case of a patient presenting with an abdominal tumor 4 years after a classical intrafascial serrated-edged macro-morcellated hysterectomy. The tumor was removed surgically and proved microscopically to be a peritoneal leiomyoma containing complex hyperplastic endometria. To our knowledge, this has never been described before. In addition, the pathogenesis of this rare disease is discussed.
Leiomyomatosis peritonealis disseminata is a rare disease. In the past, more than 100 cases have been described [1, 2]. In the vast majority, these tumors occurred in women who were pregnant or taking oral contraceptives or hormone replacement therapy. The tumor is thought to arise from Mueller's epithelium, which is distributed throughout the subperitoneal mesenchyme. Proliferation of the epithelium may be stimulated by estrogen in predisposed women [1, 3, 4]. The disease mimics peritoneal malignancy but is generally benign. In rare cases (fewer than 10%), malignant leiomyosarcomas do occur [1–4]. Fewer than 10 cases have been described among postmenopausal women [3–6]. Many patients, but not all, have uterine leiomyomas as well. To our knowledge, this is the first case describing a peritoneal myoma containing a complex hyperplastic endometrium.
Supracervical amputation of the uterus
Conization of the cervix
The most likely explanation for the origin of this tumor is a case of peritoneal leiomyomatosis. The pathogenesis of peritoneal leiomyomatosis is thought to be multipotential subcoelomic mesenchymal cells that proliferate in response to estrogens. Proliferation into myoblasts, myofibroblasts, fibroblasts, and decidua-like cells has been described .
Another explanation of the development of this tumor could be spillage of endometrial tissue during the CISH with regrowth of myoblasts, thus simulating regeneration of a uterus with endometrial tissue. This explanation has never been described previously and is only speculative.
We present a case with a peritoneal leiomyoma consisting of myoblasts, fibromyoblasts, and a complex hyperplastic endometrium without atypia. To our knowledge, this has never been reported before.
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