Case notes

A 46-year-old woman, gravida 4, para 4, was scheduled to undergo a hysterectomy for management of symptomatic fibroid tumors. Her past medical history was notable only for tobacco abuse. An uncomplicated total abdominal hysterectomy was performed using a vertical skin incision. Significant adhesive disease was noted in the pelvis. At the end of the procedure, multiple masses were palpated on the omentum. When exposed, the masses visually resembled fibroids and varied in size up to approximately 4 cm in diameter ( Figure ). One was resected and sent for frozen section. It was reported as a leiomyoma, which was consistent with the final pathology.

Disseminated peritoneal leiomyomas were found during hysterectomy.

Stefansson. Hide and seek. Am J Obstet Gynecol 2014 .

Conclusions

Disseminated peritoneal leiomyomatosis is a rare but benign condition in which multiple smooth muscle tumors have metastasized to various organs in the abdomen. However, metastasis to more unusual locations, such as the lungs, bones, or heart, has been documented. Leiomyomas have estrogen and progesterone receptors and are primarily seen in women of reproductive age. An association with pregnancy and the use of oral contraceptives has been reported.

Treatment for disseminated peritoneal leiomyomatosis includes surgical management via hysterectomy with bilateral oophorectomy and tumor debulking. This may be supplanted by or combined with medical management consisting of gonadotropin-releasing hormone agonists, selective estrogen receptor modulators, or possibly, chemotherapy for recurrent tumors or those with distant spread.

Our patient underwent an omentectomy and bilateral salpingo-oophorectomy. Further exploration of the upper abdomen did not reveal any other masses. The patient did well postoperatively and was discharged home on postoperative day 4. At her follow-up visit 6 weeks later, she was doing as expected with no further complaints. She will be followed annually with routine clinical examinations.