Sains Malaysiana 49(6)(2020): 1345-1350

http://dx.doi.org/10.17576/jsm-2020-4906-12

Disseminated Peritoneal Lieomyomatosis After 10 Years Post TAHBSO: A Case Report

(Leiomiomatosis yang Tersebar di Peritoneum Selepas 10 Tahun Pasca TAHBSO: Suatu Laporan Kes)

SEYED JALALEDIN TAHSILDAR TEHRANI¹, THEAN YEAN KEW¹ & MOHD AMIR KAMARUZZAMAN²*

¹Department of Radiology, Faculty of Medicine, UKM Medical Centre, Canselor Tuanku Mukhriz Hospital, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

²Department of Anatomy, Faculty of Medicine, UKM Medical Centre Canselor Tuanku Mukhriz Hospital, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

Received: 25 April 2019/Accepted: 31 January 2020

ABSTRACT

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by the development of multiple smooth muscle-like nodules in extra-uterine region specifically in the peritoneal cavity. We introduce a case of DPL in a 50 year-old-female who presented with symptoms of abdominal pain suspicious for bowel obstruction. With the previous history of total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) since 10 years ago, bowel obstruction due to adhesion was the first provisional diagnosis. The following CT imaging of the abdomen showed a mass within the pelvis with subsequent laparotomy and evacuation of the mass. Biopsy and histopathology result showed leiomyoma. Second episode of bowel symptoms appeared one year later with abdomino-pelvic CT imaging demonstrated the recurrence of the mass at the same location within the pelvis and she was proceeded with removal of mass with similar histopathological result. While the growth of leiomyoma is mainly dependent on oestrogen hormones, absence of the ovaries as the main source of oestrogen in our case, makes it less likely to become a differential diagnosis. So far, few cases of DPL have been reported in post menopause women. This case report may bring clinical implication in term of guideline management of DPL. A careful history taking and thorough investigation with multidisciplinary experts involvement become a crucial aspect for DPL to be suspected so that the appropriate management, surgical intervention, subsequent follow up and surveillance can be achieved to improve patient outcome.

Keywords: Disseminated peritoneal leiomyomatosis; lieomyoma; post TAHBSO

ABSTRAK

Leiomiomatosis yang tersebar di peritoneum (DPL) adalah keadaan yang agak jarang berlaku yang dicirikan oleh perkembangan nodul-nodul menyerupai otot licin di luar kawasan rahim khususnya dalam ruang peritoneal. Makalah ini membincangkan tentang kes DPL pada wanita berusia 50 tahun dengan keluhan sakit perut yang disyaki mengalami penyumbatan pada saluran usus. Sumbatan usus akibat pelekatan merupakan diagnosis awal memandangkan pesakit pernah menjalanitotal abdominal histerektomi dan bilateral salpingo-ooforektomi (TAHBSO) sejak 10 tahun yang lalu. Kajian pada CT abdomen menunjukkan terdapat ketumbuhan pada pelvis. Pesakit seterusnya menjalani laparotomi dan ketulan tersebut dikeluarkan. Keputusan biopsi dan histopatologi menunjukkan leiomioma. Setahun kemudian, gejala usus berlaku semula dengan pencitraan CT abdomino-pelvik menunjukkan ketumbuhan berulang pada lokasi yang sama di dalam pelvis dan setelah menjalani pembedahan untuk membuang ketumbuhan tersebut, keputusan histopatologi yang sama ditunjukkan. Meskipun proses pertumbuhan leiomioma bergantung kepada hormon estrogen, ketiadaan ovari sebagai sumber utama estrogen dalam kes ini menjadikan ia bukan diagnosis pembanding untuk dipertimbangkan. Setakat ini beberapa kes DPL telah dilaporkan pada wanita pasca menopaus. Laporan kes ini mungkin membawa implikasi klinikal dengan pengambilan sejarah yang teliti dan kajian menyeluruh dengan penglibatan pakar klinikal yang multidisiplin membolehkan DPL dipertimbangkan untuk menjamin kelancaran rawatan dan pengurusan pesakit.

Kata kunci: Leiomioma; leiomiomatosis yang tersebar di peritoneum; pasca TAHBSO

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*Corresponding author; email: mohdamir@ukm.edu.my