DISSEMINATED PERITONEAL LEIOMYOMATOSIS - A RARE ENTITY, COMPLICATED BY LATE BLEEDING FROM THE ILEOCOLIC VEIN

Area of Science:

• Gynecology
• Surgical Oncology
• Pathology

Background:

• Disseminated peritoneal leiomyomatosis (DPL) is an exceedingly rare condition characterized by benign smooth muscle nodules on peritoneal surfaces.
• It primarily affects women of childbearing age with estrogen hypersecretion, often mimicking peritoneal carcinomatosis.
• Current management and follow-up guidelines for DPL remain unclear.

Observation:

• A 44-year-old woman with a history of hysterectomy for uterine leiomyoma presented with two large retroperitoneal tumors.
• MRI confirmed well-circumscribed masses consistent with leiomyoma.
• Post-operative bleeding from the ileocolic vein required reoperation and ligation, with successful control.

Findings:

• Surgical removal of the retroperitoneal tumors was performed.
• The patient experienced an uneventful recovery and remained recurrence-free five years post-surgery.
• Preoperative diagnosis of DPL should be considered in women of reproductive age with estrogen hypersecretion and uterine leiomyomas.

Implications:

• Management strategies for DPL should be individualized based on patient age, reproductive status, tumor burden, and symptoms.
• Surgical resection is the primary treatment for single or symptomatic multiple DPL, potentially including hormonal therapy.
• Asymptomatic DPL may not necessitate complete nodule removal due to its typically benign and indolent nature, with an excellent long-term prognosis.