Leiomyomatosis peritonealis disseminata in a Nigerian woman
The patient was a 48-year-old woman who was referred to the gynecology clinic of a teaching hospital in Nigeria because of an ultrasound report suggestive of LPD. She was para 3 + 0 with 3 living children. She had noticed a slowly progressive abdominal swelling of about one year duration which made her to carry out the abdominal ultrasound. She was first seen at the hospital in June, 2008, and had no other symptoms. Her menarche was at the age of seventeen years and she had a regular 28-day menstrual cycle with a 5-day normal menstrual flow. She had not noticed any weight loss. She had used combined oral contraceptives (COC) for about 6 years for child spacing. Her last confinement was in 1993. There was no family history of fibroid, genital or breast cancers.\nThere was no abnormality on general examination. Her abdomen was full, nontender, and moved with respiration. The liver, spleen and kidneys were not palpable. There was a firm, nodular and nontender suprapubic mass of about 20 weeks’ gestation size. There was no shifting dullness. On vaginal examination, there was no vaginal bleeding. The cervix appeared healthy and moved with the abdominal mass. The lateral and posterior vaginal fornices were occupied by firm, nontender, and mobile masses. There were no significant findings on examination of the respiratory and cardiovascular systems. A working diagnosis of uterine fibroid coexisting with LPD was made to rule out ovarian malignancy. Results of her full blood count, chest radiogram, renal, and liver function tests were normal.\nThe ultrasound report showed “Bulky uterus measuring 18×7.5 cm in anteroposterior dimension. It harbours multiple heteroechoic well circumscribed masses—leiomyomata. A subserosal mass bulges into the posterior wall of the bladder and measures 2.8×3.9 cm. Multiple similar masses are also seen scattered in the abdominal cavity. A right hypochondrial/subhepatic mass measures 10.5×8.0 cm. An epigastric mass: 3.6 cm×3.8 cm. Left hypochondrial mass: 9.9×7.2 cm. Three left flank masses subjacent to the spleen are seen measuring 5.0×3.4 cm, 4.8×3.1 cm, 2.5×3.0 cm. The spleen was not well visualized. The liver, gall bladder, and both kidneys appear sonographically normal.” She consented to exploratory laparotomy.\nAt laparotomy, there was no ascitis. The uterus was enlarged with fibroids and there were innumerable grey-white, firm nodular seedlings of varying sizes attached to the adnexa and the greater omentum [Figures and ]. She had a total abdominal hysterectomy, bilateral salpingo-ophorectomy, and infracolic omentectomy. Histology of surgical specimen showed “benign smooth muscle lesions composed of bundles of mature smooth muscle cells devoid of mitosis or atypia separated by thin fibromuscular connective tissue septae”; and confirmed the diagnosis of LPD.\nShe was being followed up routinely and there had not been any physical or radiologic feature of the disease progression.