Leiomyomatosis peritonealisis disseminata: Two unusual cases with literature review.

BACKGROUND: Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease characterized by numerous smooth muscle-like cell nodules disseminated among the abdominal cavity. The pathogenesis of LPD is not well-known; one hypothesis, widely reported, is parasitic LPD (after uterine myoma surgery). The role of hormonal status has been raised without any evidence yet confirmed. Lesions of LPD can mimic carcinomatosis and lead to an inappropriate treatment. Total and spontaneous regression of the nodules is sometimes reported. This benign disease is also associated with leiomyosarcoma or invasive lesions, leading to mechanical complication or death.

CASES AND REVIEW: We report two additional cases. The first case occurred in a 78-year-old woman with a history of total hysterectomy for uterine myoma, and was revealed by a small bowel obstruction. Second case occurred in a 50-year-old non-menopausal woman suffering from obesity (BMI 61,7), with an incidental diagnostic of LPD during a surgical procedure and spontaneous full regression of the disease. We analyzed 165 articles. We fond 16 menopausal women with LPD, 5 patients with intestinal obstruction or peritonitis due to LPD and 5 cases with spontaneous regression of LPD lesions. Six cases of recurrence as leiomyosarcoma were found.

CONCLUSION: Cases of LPD have been reported without uterine myoma history and could be from extrauterine origin. Hysterectomy and oophorectomy should not be performed in first line. Peritoneal cytology should be done in case of ascites. Recurrences as leiomyosarcoma are reported and occurs early and justify a close follow up the first years.