Leiomyomatosis peritonealis disseminata – 4 Fallberichte einer seltenen Erkrankung

Zusammenfassung

Die Leiomyomatosis peritonealis disseminata (LPD) ist charakterisiert durch zahlreiche subperitoneale Leiomyome von wenigen Millimetern bis zu raumfordernden abdominalen Tumorknoten. Vorgestellt werden 4 unterschiedliche Verläufe der seltenen Erkrankung. Patientin 1 wurde initial bei malignem Aspekt ausgedehnt operiert, war anschließend unter endokriner Therapie lange stabil und wurde schließlich bei einem Rezidiv hysterektomiert. In den Leiomyomknoten wurden Endometrioseherde nachgewiesen. Bei Patientin 2 ergab eine laparoskopische PE von kleinsten Herden bei stärkster Dyspareunie und Miktionsbeschwerden überraschend eine LPD. Bei Patientin 3 wurde nach Myomenukleation von 880 g und Hysterektomie wegen Myomen eine mehrknollige LPD operiert, wonach ein Beckenwandrezidiv auftrat und sie mehrere endokrine Therapieversuche erhielt. Patientin 4 hatte zusätzlich zu einem Rezidiv einer LPD ein Leiomyom im linken Labium minus. In der Übersicht werden das Risiko maligner Verläufe, die Frage nach endokrinen Therapieoptionen und die Assoziation zur Endometriose diskutiert. Der Literaturüberblick beschreibt das Risiko einer Schwangerschaft bei Patientinnen mit LPD. Bei der histologischen Sicherung dieser seltenen Entität sollten Hormonrezeptoren mitbestimmt werden.

Abstract

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease. LPD is associated with multiple subperitoneal leiomyomas throughout the entire peritoneal cavity. Patients usually become symptomatic due to the large size of the abdominal mass. We present four different cases of LPD. Patient 1 had a radical debulking operation because of presumed malignancy and recurring LPD, which remained stable for years under endocrine therapy. In Patient 2 with severe dyspareunia and lower abdominal pain, LPD was diagnosed in a small peritoneal lesion by laparoscopic biopsy. In Patient 3 LPD recurred several times after myomectomy and hysterectomy and was treated with GnRH analogues amongst other endocrine agents. Patient 4 had a simultaneous LPD in the peritoneal cavity and a leiomyoma of the labium minus. The risk of malignancy, endocrine therapeutic options and association with endometriosis are discussed, and the risk during pregnancy of LPD patients is reviewed. Part of the diagnosis of this entity should include the analysis of steroid receptors.

Uterus - Leiomyomatosis - peritoneale Tumoren - benigne uterine Erkrankungen - Myome

leiomyoma - leiomyomatosis - peritoneal neoplasm - benign uterine diesease - fibroid

Literatur

• 1 Bruins Slot W, Koopal S A, Keuning J F. [Intussusception in disseminated peritoneal leiomyomatosis].  Ned Tijdschr Geneeskd. 1992;  136 1564-1566
• 2 Fulcher A S, Szucs R A. Leiomyomatosis peritonealis disseminata complicated by sarcomatous transformation and ovarian torsion: presentation of two cases and review of the literature.  Abdom Imaging. 1998;  23 640-644
• 3 Gonzalez-Lavin L, Lee R H, Falk L et al. Tricuspid valve obstruction due to intravenous leiomyomatosis.  AM Heart J. 1984;  108 1544-1546
• 4 Lee P K, David T E, SlogGett C et al. Intravenous leiomyomatosis with intracardiac extension: an unsusual cause of cardiac syncope.  CMAJ. 1990;  142 1257-1259
• 5 Grella L, Arnold T E, Kvilekval K H et al. Intravenous leiomyomatosis.  J Vasc Surg. 1994;  20 987-994
• 6 Kuenen B C, Slee P H, Seldenrijk C A et al. Intravenous leiomyomatosis complicated by Budd-Chiari-Syndrom.  Postgrad Med J. 1996;  72 686-688
• 7 Norris H J, Parmley T. Mesenchymal tumors of the uterus. V. Intravenous leiomyomatosis. A clinical and pathologic study of 14 cases.  Cancer. 1975;  36 2164-2178
• 8 Roman D A, Mirchandani H. Intravenous leiomyoma with intracardiac extension causing sudden death.  Arch Pathol Lab Med. 1987;  111 1176-1178
• 9 Kullo I J, Oh J K, Keeney G L et al. Intracardiac leiomyomatosis: echocardiographic features.  Chest. 1999;  115 587-591
• 10 Mullings A M, Char G, Martin M P et al. Intravenous leiomyomatosis with massive ascites.  Int J Gynaecol Obstet. 1992;  37 285-288
• 11 Fang B R, Ng Y T, Yeh C H. Intravenous leiomyomatosis with extension to the heart: echocardiographic features: a case report.  Angiology. 2007;  58 376-379
• 12 Nam M S, Jeon M J, Kim Y T et al. Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature.  Gynecol Oncol. 2003;  89 175-180
• 13 Saitoh M, Hayasaka T, Nakahara K et al. Intravenous leiomyomatosis with cardiac extension.  Gynecol Obstet Invest. 2004;  58 168-170
• 14 Goldberg M F, Hurt W G, Frable W J. Leiomyomatosis peritonealis disseminata. Report of a case and review of the literature.  Obstet Gynecol. 1977;  49 (1. Suppl.) 46-52
• 15 Haberal A, Kayikcioglu F, Caglar G S et al. Leiomyomatosis peritonealis disseminata presenting with intravascular extension and coexisting with endometriosis: a case report.  J Reprod Med. 2007;  52 422-424
• 16 Lee H J, Choi J, Kim K R. Pulmonary benign metastasizing leiomyoma associated with intravenous leiomyomatosis of the uterus: clinical behavior and genomic changes supporting a transportation theory.  Int J Gynecol Pathol. 2008;  27 340-345
• 17 Patton K T, Cheng L, Papavero V et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.  Mod Pathol. 2006;  19 130-140
• 18 Tori M, Akamatsu H, Mizutani S et al. Multiple benign metastasizing leiomyomas in the pelvic lymph nodes and biceps muscle: report of a case.  Surg Today. 2008;  38 432-435
• 19 Bodner-Adler B, Bartl M, Wagner G. Intravenous leiomyomatosis of the uterus with pulmonary metastases or a case with benign metastasizing leiomyoma?.  Anticancer Res. 2009;  29 495-496
• 20 Thian Y L, Tan K H, Kwek J W et al. Leiomyomatosis peritonealis disseminata and subcutaneous myoma – a rare complication of laparoscopic myomectomy.  Abdom Imaging. 2009;  34 235-238
• 21 Kumar S, Sharma J B, Verma D et al. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy.  Arch Gynecol Obstet. 2008;  278 93-95
• 22 Takeda A, Mori M, Sakai K et al. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: report of a case and review of the literature.  J Minim Invasive Gynecol. 2007;  14 770-775
• 23 Rubin S, Wheeler J E, Mikuta J J. Malignant leiomyomatosis peritonealis disseminata.  Obstet Gynecol. 1986;  68 126-130
• 24 Sharma P, Chaturvedi K U, Gupta R et al. Leiomyomatosis peritonealis disseminata with malignant change in a post-menopausal woman.  Gynecol Oncol. 2004;  95 742-745
• 25 Yamaguchi T, Imamura Y, Yamamoto T et al. Leiomyomatosis peritonealis disseminata with malignant change in a man.  Pathol Int. 2003;  53 179-185
• 26 Lausen I, Jensen O J, Andersen E et al. Disseminated peritoneal leiomyomatosis with malignant change, in a male.  Virchows Arch A Pathol Anat Histopathol. 1990;  417 173-175
• 27 Raspagliesi F, Quattrone P, Grosso G et al. Malignant degeneration in leiomyomatosis peritonealis disseminata.  Gynecol Oncol. 1996;  61 272-274
• 28 Bekkers R L, Willemsen W N, Schijf C P et al. Leiomyomatosis peritonealis disseminata: does malignant transformation occur? A literature review.  Gynecol Oncol. 1999;  75 158-163
• 29 Tanaka Y O, Tsunoda H, Sugano M et al. MR and CT findings of leiomyomatosis peritonealis disseminata with emphasis on assisted reproductive technology as a risk factor.  Br J Radiol. 2009;  82 e44-e47
• 30 Bucher M, Pusztaszeri M, Bouzourene H. Leimyomatosis peritonealis disseminata: immunohistochemical profile and origin.  Ann Pathol. 2006;  26 207-210
• 31 Bristow R E, Montz F J. Leiomyomatosis peritonealis disseminata and ovarian Brenner tumor associated with tamoxifen use.  Int J Gynecol Cancer. 2001;  11 312-315
• 32 Due W, Pickartz H. [Leiomyomatosis peritonealis disseminata. Immunohistochemical case analysis with determination of estrogen and progesterone receptors].  Pathologe. 1987;  8 291-297
• 33 Ghosh K, Dorigo O, Bristow R et al. A radical debulking of leiomyomatosis peritonealis disseminata from a colonic obstruction: a case report and review of the literature.  J Am Coll Surg. 2000;  191 212-215
• 34 Danikas D, Goudas V T, Rao C V, Brief D K. Luteinizing hormone receptor expression in leiomyomatosis peritonealis disseminata.  Obstet Gynecol. 2000;  95 1009-1011
• 35 Herrero J, Kamali P, Kirschbaum M. Leiomyomatosis peritonealis disseminata associated with endometriosis: a case report and literature review.  Eur J Obstet Gynecol Reprod Biol. 1998;  76 189-191
• 36 Kruczynski D, Merz E, Beck T et al. [Minimally invasive therapy of peritoneal leiomyomatosis. A case report of diagnostic and therapeutic problems].  Geburtsh Frauenheilk. 1994;  54 181-183
• 37 Sutherland J A, Wilson E A, Edger D E et al. Ultrastructure and steroid-binding studies in leiomyomatosis peritonealis disseminata.  Am J Obstet Gynecol. 1980;  136 992-996
• 38 Lubczyk V, du Bois A, Fisseler-Eckhoff A. [Leiomyomatosis peritonealis disseminata and borderline lesion].  Pathologe. 2005;  26 291-295
• 39 Dallenbach C, Miklaw H, Dallenbach F D et al. [Disseminated peritoneal leiomyomatosis. A rare disease picture].  Geburtsh Frauenheilk. 1989;  49 201-204
• 40 Takeda T, Masuhara K, Kamiura S. Successful management of a leiomyomatosis peritonealis disseminata with an aromatase inhibitor.  Obstet Gynecol. 2008;  112 491-493
• 41 Deering S, Miller B, Kopelman J N et al. Recurrent leiomyomatosis peritonealis disseminata exacerbated by in vitro fertilization.  Am J Obstet Gynecol. 2000;  182 725-726
• 42 Clavero P A, Nogales F F, Ruiz-Avila I et al. Regression of peritoneal leiomyomatosis after treatment with gonadotropine releasing hormone analogue.  Int J Gynaecol Cancer. 1992;  2 52-54
• 43 Aruh L, Taskin O, Demir N. Recurrent leiomyomatosis peritonealis disseminata.  Int J Gynaecol Obstet. 1993;  43 330-331
• 44 Hales H A, Peterson C M, Jones K P et al. Leiomyomatosis peritonealis disseminata treated with a gonadotropin-releasing hormone agonist. A case report.  Am J Obstet Gynecol. 1992;  167 515-516
• 45 Parente J T, Levy J, Chinea F et al. Adjuvant surgical and hormonal treatment of leiomyomatosis peritonealis disseminata. A case report.  J Reprod Med. 1995;  40 468-470
• 46 Buckshee K, Verma A, Karak A K. Leiomyomatosis peritonealis disseminata.  Int J Gynaecol Obstet. 1998;  61 191-192
• 47 Heinig J, Neff A, Cirkel U et al. Recurrent leiomyomatosis peritonealis disseminata after hysterectomy and bilateral salpingo-oophorectomy during combined hormone replacement therapy.  Eur J Obstet Gynecol Reprod Biol. 2003;  111 216-218
• 48 Lim O W, Segal A, Ziel H K. Leiomyomatosis peritonealis disseminata associated with pregnancy.  Obstet Gynecol. 1980;  55 122-125
• 49 Borsellino G, Zante P, Ciraldo M C. [Diffuse peritoneal leiomyomatosis. A clinical case report].  Minerva Ginecol. 1997;  49 53-57
• 50 DeAngelis S L, Harris R R, Maiman M A et al. Live birth of a normal mature healthy baby by in vitro fertilization-embryo transfer (IVF-ET) after an exploratory laparotomy and multiple myomectomy for leiomyomatosis peritonealis disseminata.  Fertil Steril. 2009;  91 1956.e15-e16
• 51 Summa B, Schem C, Weigel M et al. Leiomyomatosis peritonealis disseminata in a pregnant woman.  Arch Gynecol Obstet. 2009;  , Apr 16 [Epub ahead of print]
  
• 52 Guarch R, Puras A, Ceres R et al. Ovarian endometriosis and clear cell carcinoma, leiomyomatosis peritonealis disseminata, and endometrial adenocarcinoma: an unusual, pathogenetically related association.  Int J Gynecol Pathol. 2001;  20 267-270
• 53 Gana B M, Byrne J, McCullough J et al. Leiomyomatosis peritonealis disseminata (LPD) with associated endometriosis: a case report.  J R Coll Surg Edinb. 1994;  39 258-260
• 54 Dauge M C, Delmas V, Grossin M et al. [Disseminated peritoneal leiomyomatosis associated with endometriosis. Apropos of a case].  Ann Pathol. 1986;  6 221-224
• 55 Karuppaswamy J, Tapp A. Leiomyomatosis peritonealis disseminata – is a different approach needed?.  J Obstet Gynaecol. 2002;  22 446-447
• 56 Zotalis G, Nayar R, Hicks D G. Leiomyomatosis peritonealis disseminata, endometriosis, and multicystic mesothelioma: an unusual association.  Int J Gynecol Pathol. 1998;  17 178-182
• 57 Kaplan C, Benirschke K, Johnson K C. Leiomyomatosis peritonealis disseminata with endometrium.  Obstet Gynecol. 1980;  55 119-122
• 58 Quade B J, McLachlin C M, Soto-Wright V et al. Disseminated peritoneal leiomyomatosis. Clonality analysis by X chromosome inactivation and cytogenetics of a clinically benign smooth muscle proliferation.  Am J Pathol. 1997;  150 2153-2166