Sains Malaysiana 49(6)(2020): 1345-1350

http://dx.doi.org/10.17576/jsm-2020-4906-12

 

Disseminated Peritoneal Lieomyomatosis After 10 Years Post TAHBSO: A Case Report

(Leiomiomatosis yang Tersebar di Peritoneum Selepas 10 Tahun Pasca TAHBSO: Suatu Laporan Kes)

 

SEYED JALALEDIN TAHSILDAR TEHRANI1, THEAN YEAN KEW1 & MOHD AMIR KAMARUZZAMAN2*

 

1Department of Radiology, Faculty of Medicine, UKM Medical Centre, Canselor Tuanku Mukhriz Hospital, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

2Department of Anatomy, Faculty of Medicine, UKM Medical Centre Canselor Tuanku Mukhriz Hospital, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

Received: 25 April 2019/Accepted: 31 January 2020

 

ABSTRACT

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the development of multiple smooth muscle-like nodules in extra-uterine region specifically in the peritoneal cavity. We introduce a case of DPL in a 50 year-old-female who presented with symptoms of abdominal pain suspicious for bowel obstruction. With the previous history of total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) since 10 years ago, bowel obstruction due to adhesion was the first provisional diagnosis. The following CT imaging of the abdomen showed a mass within the pelvis with subsequent laparotomy and evacuation of the mass. Biopsy and histopathology result showed leiomyoma. Second episode of bowel symptoms appeared one year later with abdomino-pelvic CT imaging demonstrated the recurrence of the mass at the same location within the pelvis and she was proceeded with removal of mass with similar histopathological result. While the growth of leiomyoma is mainly dependent on oestrogen hormones, absence of the ovaries as the main source of oestrogen in our case, makes it less likely to become a differential diagnosis. So far, few cases of DPL have been reported in post menopause women. This case report may bring clinical implication in term of guideline management of DPL. A careful history taking and thorough investigation with multidisciplinary experts involvement become a crucial aspect for DPL to be suspected so that the appropriate management, surgical intervention, subsequent follow up and surveillance can be achieved to improve patient outcome.

 

Keywords: Disseminated peritoneal leiomyomatosis; lieomyoma; post TAHBSO

 

ABSTRAK

Leiomiomatosis yang tersebar di peritoneum (DPL) adalah keadaan yang agak jarang berlaku yang dicirikan oleh perkembangan nodul-nodul menyerupai otot licin di luar kawasan rahim khususnya dalam ruang peritoneal. Makalah ini membincangkan tentang kes DPL pada wanita berusia 50 tahun dengan keluhan sakit perut yang disyaki mengalami penyumbatan pada saluran usus. Sumbatan usus akibat pelekatan merupakan diagnosis awal memandangkan pesakit pernah menjalanitotal abdominal histerektomi dan bilateral salpingo-ooforektomi (TAHBSO) sejak 10 tahun yang lalu. Kajian pada CT abdomen menunjukkan terdapat ketumbuhan pada pelvis. Pesakit seterusnya menjalani laparotomi dan ketulan tersebut dikeluarkan. Keputusan biopsi dan histopatologi menunjukkan leiomioma. Setahun kemudian, gejala usus berlaku semula dengan pencitraan CT abdomino-pelvik menunjukkan ketumbuhan berulang pada lokasi yang sama di dalam pelvis dan setelah menjalani pembedahan untuk membuang ketumbuhan tersebut, keputusan histopatologi yang sama ditunjukkan. Meskipun proses pertumbuhan leiomioma bergantung kepada hormon estrogen, ketiadaan ovari sebagai sumber utama estrogen dalam kes ini menjadikan ia bukan diagnosis pembanding untuk dipertimbangkan. Setakat ini beberapa kes DPL telah dilaporkan pada wanita pasca menopaus. Laporan kes ini mungkin membawa implikasi klinikal dengan pengambilan sejarah yang teliti dan kajian menyeluruh dengan penglibatan pakar klinikal yang multidisiplin membolehkan DPL dipertimbangkan untuk menjamin kelancaran rawatan dan pengurusan pesakit.

 

Kata kunci: Leiomioma; leiomiomatosis yang tersebar di peritoneum; pasca TAHBSO

 

REFERENCES

Al-Talib, A. & Tulandi, T. 2010. Pathophysiology and possible iatrogenic cause of leiomyomatosis peritonealis disseminata. Gynecologic and Obstetric Investigation 69(4): 239-244.

Barber, E., Eapen, A., Mehta, R., Lin, E., Lane, K., Cheng, Y. & Parajuli, R. 2019. Benign metastasizing leiomyoma to the lung and spine: A case report and literature review. Case Reports in Oncology 12(1): 218-223.

Benton, A., Sood, S., Wagner, S., Newell, J. & Harkins, G. 2018. Disseminated peritoneal leiomyomatosis following hysteroscopic leiomyoma morcellation. Journal of Gynecologic Surgery 34(6): 319-321.

Brandão, R.G., Elias, S., Pinto Nazário, A.C., Alcoforado Assunção, M.D.C.G., Esposito Papa, C.C. & Facina, G. 2018. Leiomyoma of the breast parenchyma: A case report and review of the literature. Sao Paulo Medical Journal 136(2): 177-181.

Chin, H., Ong, X.H., Yam, P.K.L. & Chern, B.S.M. 2014. Extrauterine fibroids: A diagnostic challenge and a long-term battle. BMJ Case Reports 2014: p.bcr2014204928.

Ciebiera, M., Słabuszewska-Jóźwiak, A., Zaręba, K. & Jakiel, G. 2017. A case of disseminated peritoneal leiomyomatosis after two laparoscopic procedures due to uterine fibroids. Videosurgery and Other Miniinvasive Techniques 12(1): 110-114.

Demirkiran, F., Sal, V., Kaya, U., Alhan, C. & Tokgozoglu, N. 2013. Intravenous leiomyoma with extension to the heart: A case report and review of the literature. Case Reports in Obstetrics and Gynecology 2013: Article ID. 602407.

Fasih, N., Prasad Shanbhogue, A.K., Macdonald, D.B., Fraser-Hill, M.A., Papadatos, D., Kielar, A.Z., Doherty, G.P., Walsh, C., McInnes, M. & Atri, M. 2008. Leiomyomas beyond the uterus: Unusual locations, rare manifestations. Radiographics 28(7): 1931-1948.

Fatima, Q., Singh, O., Kothari, D. & Goodara, S. 2015. Cutaneous leiomyoma of scalp: A rare case report with review of literature. International Journal of Research in Medical Sciences 3(4): 993-997.

Gottlieb, J. & Gottlieb, R. 2018. Disseminated peritoneal leiomyomatosis. Applied Radiology 47(1): 46-47.

Hiremath, S.B., Benjamin, G., Gautam, A.A., Panicker, S. & Rajan, A. 2016. Disseminated peritoneal leiomyomatosis: A rare cause of enigmatic peritoneal masses. BJR|Case Reports 2(3): 20150252.

Jeyarajah, S., Chow, A., Lloyd, J., Zacharakis, E., Purkayastha, S. & Tekkis, P. 2009. Follow-up in patients with disseminated peritoneal leiomyomatosis: A report of an unusual, high-risk case. BMJ Case Reports 2009: p.bcr0820080802.

Lin, Y.C., Wei, L.H., Shun, C.T., Cheng, A.L. & Hsu, C.H. 2008. Disseminated peritoneal leiomyomatosis responds to systemic chemotherapy. Oncology 76(1): 55-58.

Marwah, N., Duhan, A., Aggarwal, G. & Sen, R. 2012. An unusual presentation of pelvic leiomyomatosis misdiagnosed as disseminated malignancy. Case Reports in Pathology 2012: 394106.

Momtahan, M., Nemati, M. & Safaei, A. 2011. Disseminated peritoneal leiomyomatosis. Iranian Journal of Medical Sciences 36(1): 57-59.

Mülayim, B. 2015. Unaware of a large leiomyoma: A case report with respect to unusual symptoms of large leiomyomas. Annals of Medicine and Surgery 4(4): 431-433.

Oi, Y., Katayama, K., Hirata, G., Ishidera, Y., Yoshida, H. & Shigeta, H. 2018. Significance of postmenopausal uterine leiomyomas: Focus on variants. Journal of Obstetrics and Gynaecology Research 44(8): 1445-1450.

Ordulu, Z., Dal Cin, P., Chong, W.W.S., Choy, K.W., Lee, C., Muto, M.G., Quade, B.J. & Morton, C.C. 2009. Disseminated peritoneal leiomyomatosis after laparoscopic supracervical hysterectomy with characteristic molecular cytogenetic findings of uterine leiomyoma. Genes, Chromosomes and Cancer 49(12): 1152-1160.

Parmar, J., Mohan, C., Hans, D. & Vora, M. 2017. A diagnostic dilemma of recurrent disseminated peritoneal leiomyomatosis with hypertrophied omental vessels: Imaging and embolization of omental branches with positive outcome. Case Reports in Obstetrics and Gynecology 2017: 8427240.

Rezai, S., Hughes, A., Ligorski, J., Cheung, M.L., Sarina, Lumapas., Leeping A., Henderson, C.E. & Fulle, P.N. 2017. Disseminated peritoneal leiomyomatosis (DPL): A case report and review of literature. Obstetrics & Gynecology International Journal 7(2): 00240.

Saha, P., Dhaliwal, L., Gainder, S., Joshi, R., Saha, S. & Gupta, R. 2015. Disseminated peritoneal leiomyomatosis: A rare entity with diagnostic conundrum. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 4(4): 1194-1196.

Shah, S.D., Gupta, A., Roy, S. & Mukhopadhyay, S. 2013. Intraparenchymal leiomyoma of the breast: A case report. Indian Journal of Surgery 75(1): 88-89.

Sun, P., Ou, H., Huang, S., Wei, L., Zhang, S., Liu, J., Geng, S. & Yang, K. 2017. Perianal atypical leiomyoma: A case report. Medicine 96(48): e8847.

Toriyama, A., Ishida, M., Amano, T., Nakagawa, T., Kaku, S., Iwai, M., Yoshida, K., Kagotani, A., Takahashi, K., Murakami, T. & Okabe, H. 2013. Leiomyomatosis peritonealis disseminata coexisting with endometriosis within the same lesions: A case report with review of the literature. International Journal of Clinical and Experimental Pathology 6(12): 2949-2954.

Wang, X., Ren, J., Chen, G. & Xu, S. 2015. Giant abdominal leiomyoma of male: A case report and literature reviews. International Journal of Clinical and Experimental Pathology 8(7): 8532-8535.

Willson, J.R. & Peale, A.R. 2016. Multiple peritoneal leiomyomas associated with a granulosa-cell tumor of the ovary. American Journal of Obstetrics and Gynecology 64(1): 204-208.

 

*Corresponding author; email: mohdamir@ukm.edu.my

 

 

 

 

previous