Leiomyomatosis peritonealis disseminata (lpd) after laparoscopic myomectomy using morcelator
Main Article Content
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is an uncommon disease featured by the presence of multiple nodules of smooth muscle cells scattered in the abdominal cavity. We report a case of recurrent LPD after laparoscopic myomectomy. 42-year-old woman who had 2 children, were indicated for laparoscopic myomectomy surgery in 2015. In 2020, she went to her gynecologist complaining of abdominal pain. A MRI and ultrasound were performed and reported multiple pelvic masses, subsequently excised during laparotomy. The histological exam confirms LPD diagnosis. An exploratory laparotomy revealed nodules on the peritoneum, greater omentum and terminal ileum. We surgically removed all visible nodules. This is a rare condition which is uncommon in our routine practice. The reason is small pieces of nodules were scattered to the peritoneum during morcellation, then developed silently in size and diagnosed after 65 months. A large LPD is not always symptomatic. After a laparoscopic myomectomy, especially with power morcellation, long-term follow-up is necessary to detect LPD.
Article Details
Keywords
Leiomyoma, Leiomyomatosis peritonealis disseminata (LPD), Laparoscopic myomectomy, morcellator
References
2. Lete I, González J, Ugarte L, Barbadillo N, Lapuente O, Álvarez-Sala J. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2016;203:250-259. doi:https://doi.org/10.1016/j.ejogrb.2016.05.025.
3. Lu B, Xu J, Pan Z. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation. J Obstet Gynaecol Res. 2016;42(8):990-999. doi:https://doi.org/10.1111/jog.13011.
4.Yoshino Y, Yoshiki N, Nakamura R, Iwahara Y, Ishikawa T, Miyasaka N. Large leiomyomatosis peritonealis disseminata after laparoscopic myomectomy: A case report with literature review. Int J Surg Case Rep. 2020;77:866-869. doi:https://doi.org/10.1016/j.ijscr.2020.12.005.
5. Darii N, Anton E, Doroftei B, et al. Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review. J Adv Res. 2019;20:1-8. doi:https://doi.org/10.1016/j.jare.2019.04.004.
6. Kumar S, Sharma JB, Verma D, Gupta P, Roy KK, Malhotra N. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Arch Gynecol Obstet. 2008;278(1):93-95. doi:10.1007/s00404-007-0536-9.
7. Dashraath P, Lim LM, Huang Z, Ilancheran A. Parasitic leiomyoma. Am J Obstet Gynecol. 2016;215(5):665.e1-665.e2. doi:https://doi.org/10.1016/j.ajog.2016.07.017
8. Wang K, Guo R, Yuan Z, et al. [Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases]. Zhonghua Fu Chan Ke Za Zhi. 2017;52(8):533—538. doi:10.3760/cma.j.issn.0529-567x.2017.08.006.
9. Yang L, Liu N, Liu Y. Leiomyomatosis peritonealis disseminata: Three case reports. Medicine (Baltimore). 2020;99(41). https://journals.lww.com/md-journal/Fulltext/2020/10090/Leiomyomatosis_peritonealis_disseminata__Three.70.aspx.
10. Zapardiel I, Boria F, Halaska MJ, Santiago JD. Laparoscopic Power Morcellation: Techniques to Avoid Tumoral Spread. J Minim Invasive Gynecol. Published online 2020. doi:https://doi.org/10.1016/j.jmig.2020.09.012.
11. Leal MA, Piñera A, Santiago J de, Zapardiel I. Novel Technique for Contained Power Morcellation through Umbilicus with Insufflated Bag. Gynecol Obstet Invest. 2016;82:205-207.