Disseminated peritoneal leiomyomatosis with malignant transformation involving right ureter: A case report

Abstract

BACKGROUND Disseminated peritoneal leiomyomatosis (DPL) with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma, and hematuria as a presenting symptom has never been reported. Through this case report, we emphasize the investigation of the etiology, clinical presentation, diagnosis, treatment, and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management. CASE SUMMARY We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy. An exploratory laparotomy was performed and all visible nodules were surgically removed. DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results. CONCLUSION Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain, hematuria, and imaging of disseminated pelvic tumors in women, especially those with prior history of laparoscopic hysterectomy. Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.

An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature

“…Moreover, we reported if the diagnosis of malignancy was made or suspected preoperatively or only after surgery. The patients’ age ranged from 20 [ 20 ] to 72 years [ 16 ], with a mean age of 41.2 years. The disseminated myomas were mainly localized in the pelvis, but retroperitoneal lesions were also detected [ 6 , 7 ].…”

“…The disseminated myomas were mainly localized in the pelvis, but retroperitoneal lesions were also detected [ 6 , 7 ]. Some authors described leiomyomatous nodules of the omentum [ 7 , 8 , 11 , 15 ] and of the intestinal serosa [ 11 , 12 , 13 , 14 , 16 , 17 , 19 ]. Two cases of leiomyomatous nodule of the liver [ 15 , 17 ] were reported, as well as two cases of subdiaphragmatic peritoneum lesion [ 9 , 17 ].…”

“…Two cases of leiomyomatous nodule of the liver [ 15 , 17 ] were reported, as well as two cases of subdiaphragmatic peritoneum lesion [ 9 , 17 ]. Wen et al detected a mass involving the right ureter mimicking metastatic urinary tract cancer [ 16 ]. Almost all malignant transformations were leiomyosarcomas, and two cases of pulmonary and hepatic metastases were reported [ 6 , 15 ].…”

“…A very rare sequela is disseminated peritoneal leiomyomatosis (DPL), a condition characterized by the presence of multiple smooth muscle implants on the abdominal and pelvic peritoneum and on the omentum [ 3 , 5 ]. DPL is considered a benign condition, in fact only a few cases of malignant transformation of DPL have been reported in the literature [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, pelvic endometriosis, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously.…”

Disseminated Peritoneal Leiomyomatosis With Unusual Lung Mesenchymal Malignant Transformation

“…DPL's resemblance to malignancy by radiology, grossly and intraoperatively, makes its diagnosis challenging [ 2 ]. Even microscopically there is some difficulty in the differentiation between DPL and LMS as malignant transformation may occur focally or insidiously, as in our case [ 19 ]. However, there are some differences between the cases of DPL and LMS.…”