Disseminated peritoneal leiomyomatosis
© Springer-Verlag 2010
Received: 24 December 2009
Accepted: 15 January 2010
Published: 23 February 2010
We present a case of a 35-year-old lady with disseminated uterine leiomyomatosis diagnosed during laparoscopic uterine myomectomy, 7 years after a laparoscopy performed for the same reason. The disease should be kept in mind in order to avoid aggressive treatment due to the fact that the peritoneal myomas mimic malignant peritoneal tumors.
Disseminated peritoneal leiomyomatosis (DPL) is a rare disease characterized by multifocal proliferation of smooth muscle-like cells that are histologically similar to uterine myomas, occurring predominantly in women of childbearing age. It is usually diagnosed during operations performed for other reasons due to its generally indolent course. We present a case of a patient with DPL and uterine myomas and the suggested treatment.
A 35-year-old lady was referred to our clinic due to uterine myomas. The patient had a previous myomectomy 7 years before and had never been under hormonal treatment. Transvaginal ultrasound detected four uterine myomas and a laparoscopic myomectomy was scheduled.
Histological examination of the excised peritoneal specimen showed it was a myoma, and the diagnosis of disseminated peritoneal leiomyomatosis was made.
Disseminated peritoneal leiomyomatosis occurs primarily in premenopausal women and malignant transformation is extremely rare. The importance of recognizing the disease relies basically on the treatment options. Excision of all myomas has been tried and suggested by some authors , while medical treatment with GnRH analogs, aromatase inhibitors  or chemotherapeutic agents  was suggested by others for unresectable or metastatic disease. In most cases though, conservative treatment and long-term follow-up is recommended because of DPL's generally indolent clinical course . Although it is a rare disease, it must be kept in mind whenever a patient presents with abdominal masses following myomectomy or hysterectomy.
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