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Pathophysiology and possible iatrogenic cause of leiomyomatosis peritonealis disseminata

Ayman Al-Talib1, Togas Tulandi

  • 1Department of Obstetrics and Gynecology, McGill University, Montreal, Que., Canada.

Gynecologic and Obstetric Investigation
|January 14, 2010
PubMed

Insights

Leiomyomatosis peritonealis disseminata (LPD) can occur after myoma morcellation. Leaving uterine or myoma fragments in the abdomen may contribute to LPD development, supporting the iatrogenic theory.

Area of Science:

  • Gynecologic Pathology
  • Surgical Pathology

Background:

  • Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by peritoneal dissemination of leiomyoma-like tissue.
  • The etiology of LPD remains debated, with theories including hormonal influence, metaplasia, genetic predisposition, and iatrogenic factors.

Observation:

  • This report details a case of LPD following myoma morcellation during laparoscopic surgery.
  • A literature review identified 132 cases of LPD, with a significant proportion occurring in women of reproductive age.

Findings:

  • The iatrogenic theory, specifically the dissemination of myoma fragments during morcellation, is supported by the current case and previous literature.
  • Metaplasia of subperitoneal mesenchymal stem cells, triggered by residual myoma fragments in susceptible individuals, is a proposed mechanism for LPD development.

Implications:

  • Surgical techniques should aim to prevent the intra-abdominal dissemination of uterine or myoma tissue, particularly during morcellation procedures.
  • Minimizing iatrogenic factors is crucial to reduce the risk of LPD in patients undergoing myomectomy or hysterectomy with morcellation.

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