Disseminated peritoneal leiomyomatosis-diagnostic dilemma in an acute presentation-a case report

Abstract

Diffuse peritoneal leiomyomatosis is a rare benign condition which has a multifactorial origin with genetic or hormonal component leading to metaplasia of peritoneal mesenchymal cells. Thus, a combination of radiology with clinical correlation is an ideal approach for diagnosis. Though benign, radiologically it could give a picture of malignancy. In our case, patient came with an acute presentation resembling torsion ovary which usually needs emergency detorsion. In this scenario, multiple radiology component directed the case towards malignancy while ultimately a history, clinical correlation and biopsy revealed its benign nature. Reviewing the reported cases of disseminated peritoneal leiomyomatosis (DPL) incidence has slightly increased in recent years and is more common in patients with a past history of unconfined laparoscopic myomectomy wherein spillage of the myoma content into the abdominal cavity can trigger DPL as these are hormone sensitive tissues. The indolent course of the disease usually suggests a borderline disease, but only histological and immunohistochemical studies can confirm DPL, showing smooth muscle cells without nuclear atypia, strongly expressing estrogen and progesterone receptors. Mainstay of treatment targets in curbing the hormone influence on DPL and surgical management.