Pathophysiology and Possible Iatrogenic Cause of Leiomyomatosis Peritonealis Disseminata

Abstract

We present a case of leiomyomatosis peritonealis disseminata (LPD) after myoma morcellation and review the literature using the keywords leiomyomatosis peritonealis disseminata and disseminated peritoneal leiomyomatosis. The search was conducted in Medline, EMBASE, and Cochrane Database of systematic reviews. We encountered 132 cases of LPD in the English literature; 113 in the reproductive age group, 7 in postmenopausal women, 6 in males, and another in a horse. The possible causes could be divided into hormonal, subperitoneal mesenchymal stem cells, metaplasia, genetic, or iatrogenic after morcellation of myoma during laparoscopic surgery. Our case and 4 others reported in the literature support the contribution of the iatrogenic theory. It appears that LPD could be due to metaplasia of mesenchymal cells of the peritoneum and, in susceptible women, leaving fragments of myoma in the abdominal cavity might contribute to the development of LPD. Accordingly, one should avoid leaving fragments of the uterus or myoma tissue in the abdominal cavity after morcellation.

Oestrogen-Induced Angiogenesis and Implantation Contribute to the Development of Parasitic Myomas after Laparoscopic Morcellation

“…The duration of sex steroid hormone exposure after laparoscopic morcellation might also be a risk factor for the development of PMs [26]. According to the systematic review, 69 cases PMs after laparoscopic myomectomy by Meulen et al, it is hypothesised that prolonged exposure to sex steroid hormones such as hormonal replacement therapy, could be a risk factor for the development of PMs [8,16,23,31,57]. Our present study highlighted the crucial role of E2 and ERα and PR expressions in the development of laparoscopically-induced PMs.…”

“…Several studies which presented that LPD shrink under sex steroid hormone manipulation, including BSO [53][54][55], menopause [65], megestrol [66], SERM [55], AI [55,67], and GnRHa [55,56,68]. Laparoscopic myomectomy might result in the growth of multiple PM nodules mimicking LPD [31]. Thus it is reasonable to test the prevention and therapeutic effect of sex hormone manipulation on PMs after laparoscopic surgery.…”

Disseminated peritoneal leiomyomatosis: a rare entity with diagnostic conundrum

“…2 Some advocates describe it as a multifactorial disease with hormonal or genetic elements resulting in metaplasia of submesothelial mesenchymal cells or could be induced after morcellation of myoma during laparoscopy. [3][4][5] The frequent association of this condition with pregnancy, prolonged use of oral contraceptives, uterine fibroid and existence of estrogen and progesterone receptor within DPL may justify its hormonal dependence. 1,6,7 Most of the patients of DPL are usually asymptomatic and diagnosed incidentally during caesarean or laparotomy.…”

Leiomiomatosis Peritoneal Diseminada

“…Otros autores refutan esta teoría, ya que de ser exacta todos los nódulos en una LPD deberían ser poblaciones policlonales de células, sin embargo, se ha determinado citogenéticamente que son lesiones monoclonales con inactivación del mismo cromosoma X parental (Quade et al, 1997). En tercer lugar, se ha planteado ampliamente la etiología iatrogénica, en el caso de la fragmentación de un mioma en una cirugía laparoscópica, lo que se corresponde mejor con la naturaleza monoclonal de los tumores (Al Talib & Tulandi, 2010;Ordulu et al, 2010).…”