Disseminated peritoneal leiomyomatosis after laparoscopic myomectomy - A case report

Introduction and importance: Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease, characterized by intraperitoneal dissemination of smooth-muscle tumor masses. Case presentation: The patient, a 40-year-old, female - presented with complaints of periodic back pain. During the initial workup, a tumor mass was visualized in the pelvis on ultrasound. Further clinical workup included computer tomography (CT) scan and ultrasound-guided fine-needle biopsy. A tumor mass in the right adrenal gland was identified on CT. Pathological examination revealed no signs of malignancy. The multidisciplinary team decided on surgical treatment. Tumor masses were removed from the pelvic cavity, the anterior abdominal wall, and the projection of the right adrenal gland with preservation of the uterus and ovaries due to the patient's wishes. Pathological examination with immunohistochemistry of surgical specimen confirmed diagnosis of DPL. Clinical discussion: Due to the rarity of DPL there are no standard guidelines for diagnostics and treatment. In many cases, on initial workup, DPL may look like a malignant tumor with intraperitoneal spread, which may lead to an inappropriate choice of treatment. Conclusion: Differential diagnosis of DPL may be a challenge due to its appearance as a disseminated peritoneal malignancy on CT scans and at laparotomy. A multidisciplinary approach is key to choosing the right clinical course for such patients.