Leiomyomatosis Peritonealis Disseminata (LPD) ten years after laparoscopic myomectomy associated with ascites and lymph nodes enlargement: a case report

Luigi Nappi; Felice Sorrentino; Stefano Angioni; Alessandro Pontis; Ida Barone; Pantaleo Greco

doi:10.1016/j.ijscr.2016.05.017

Leiomyomatosis Peritonealis Disseminata (LPD) ten years after laparoscopic myomectomy associated with ascites and lymph nodes enlargement: a case report

Int J Surg Case Rep. 2016:25:1-3. doi: 10.1016/j.ijscr.2016.05.017. Epub 2016 Jun 2.

Authors

Luigi Nappi¹, Felice Sorrentino², Stefano Angioni³, Alessandro Pontis³, Ida Barone¹, Pantaleo Greco⁴

Affiliations

¹ Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
² Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. Electronic address: felice.sorrentino@alice.it.
³ Institute of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
⁴ Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynaecology, University of Ferrara, Ferrara, Italy.

Abstract

Introduction: We report a case of leiomyomatosis peritonealis disseminata (LPD) arising 10 years after a laparoscopic myomectomy that was associated with ascites and lymph nodes enlargement.

Presentation of case: The patient presented with small uterine fibroids with a dominant posterior intramural fibroid measuring 9cm in diameter and normal Doppler. Laparotomy revealed a uterus enlarged with fibroids, which was densely adhering to the urinary bladder, greater omentum, and sigmoid colon. Multiple tumors of different size were found attached to the peritoneum, omentum and bowel. The histopathologic examination was consistent with leiomyomatosis peritonealis disseminata.

Discussion: Pieces of smooth muscle cell lost in the abdominal cavity during electrical morcellation after laparoscopic myomectomy may progress to leiomyomatosis peritonealis disseminata even after many years (ten in our case) and it can be associated with ascites and lymph nodes enlargement.

Conclusion: This is the first case reported in literature of leiomyomatosis peritonealis disseminata with these particular features (time of clinical presentation, ascites, lymph nodes enlargement).

Keywords: Ascites; Electrical morcellation; Leiomyomatosis peritonealis disseminata; Myomectomy.