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18 January, 2018

CASE STUDY – DISSEMINATED PERITONEAL LEIOMYOMATOSIS

CASE STUDY – DISSEMINATED PERITONEAL LEIOMYOMATOSIS

Case Summary

A 56-year-old female presented with abdominal/pelvic pain and fullness. Her history is significant for a large fibroid uterus treated with a hysterectomy and bilateral salpingo oophorectomy (BSO) approximately 10 years previous.

Imaging Findings

A noncontrast CT scan was ordered and revealed a large lobulated mass filling much of the pelvis and extending into the abdomen. Separate from the large mass were some smaller nodular masses that were initially thought to represent lymphadenopathy. No evidence of omental caking, hepatic metastasis, or ascites was demonstrated.

An MRI of the abdomen and pelvis was then performed with and without gadolinium that demonstrated a large, mildly enhancing, predominantly solid mass that fills the pelvis and extends into the lower abdomen. Other separate nodules were again noted and were initially interpreted incorrectly as lymphadenopathy. On T2-weighted imaging, the mass demonstrates decreased signal with a whorled appearance. No ascites or omental caking is present and there is no metastatic disease demonstrated in the liver or osseous structures.

 

Discussion

A noncontrast CT scan was ordered and revealed a large lobulated mass filling much of the pelvis and extending into the abdomen. Separate from the large mass were some smaller nodular masses that were initially thought to represent lymphadenopathy. No evidence of omental caking, hepatic metastasis, or ascites was demonstrated.

An MRI of the abdomen and pelvis was then performed with and without gadolinium that demonstrated a large, mildly enhancing, predominantly solid mass that fills the pelvis and extends into the lower abdomen. Other separate nodules were again noted and were initially interpreted incorrectly as lymphadenopathy. On T2-weighted imaging, the mass demonstrates decreased signal with a whorled appearance. No ascites or omental caking is present and there is no metastatic disease demonstrated in the liver or osseous structures.

Conclusion

While disseminated leiomyomatosis is a rare entity, it should be considered in a patient with a peritoneal mass or masses, especially if the patient has a coexisting fibroid uterus or has had a hysterectomy for a uterine leiomyoma. The peritoneal masses generally have a darker whorl-like appearance on T2-weighted MRI similar to other smooth muscle tumors and there isusually a lack of ascites and omental caking.

18 January, 2018 | HOME

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