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INTERESTING CASES
Year : 2021  |  Volume : 20  |  Issue : 3  |  Page : 322-323

18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata


1 Department of Nuclear Medicine, Penang Adventist Hospital, Penang, Malaysia
2 Department of Surgery, Penang Adventist Hospital, Penang, Malaysia

Date of Submission20-Jan-2021
Date of Decision24-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication20-Aug-2021

Correspondence Address:
Dr. Alex Cheen Hoe Khoo
Department of Nuclear Medicine, Penang Adventist Hospital, 465, Jalan Burma, 10350 George Town, Penang
Malaysia
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DOI: 10.4103/wjnm.wjnm_8_21

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   Abstract 

Leiomyomatosis peritonealis disseminata (LPD) is a rare benign condition characterized by multiple smooth muscle implants in the peritoneal cavity. The clinical presentation is usually nonspecific abdominal discomfort and nontender abdominal mass. Preoperative imaging usually points to suggests malignancy due to its unusual location, but the diagnosis can only be confirmed by histopathological examination. We share 18F-Fluorodeoxyglucose positron emission tomography-computed tomography images of a 43-year-old woman diagnosed with LPD and briefly discuss the clinical aspects of this disease.

Keywords: 18F-fluorodeoxyglucose positron emission tomography-computed tomography, fibroid, leiomyomatosis peritonealis disseminate, morcellation, peritoneum, smooth muscle


How to cite this article:
Khoo AC, Lim SY. 18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata. World J Nucl Med 2021;20:322-3

How to cite this URL:
Khoo AC, Lim SY. 18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata. World J Nucl Med [serial online] 2021 [cited 2021 Sep 22];20:322-3. Available from: http://www.wjnm.org/text.asp?2021/20/3/322/324174

A 43-year-old multiparous woman with insignificant medical history other than laparoscopic myomectomy for uterine fibroid 4 years ago presented with vague abdominal discomfort and nontender subcutaneous mass in the left iliac fossa. Abdominal computed tomography (CT) imaging showed a subcutaneous nodule in the left iliac fossa and multiple peritoneal nodules at the right hypochondrium and left pelvic region. The largest peritoneal lesion (4.5 cm × 7.4 cm × 7.9 cm) showed central hypodensities with septation. Her tumor markers including CA125 were normal. 18F-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)-CT was performed for further assessment of the disease and preoperative staging. [Figure 1]a shows the maximal intensity projection of the subcutaneous lesion in the left iliac fossa (green arrow) and the peritoneal soft-tissue lesions in the abdomen and pelvis (red arrows). [Figure 1]b and [Figure 1]c shows the fused 18F-FDG PET-CT axial images of the subcutaneous lesion in the left iliac fossa (green arrow) and the soft-tissue lesions in abdomen and pelvis (red arrows). The lesions show low 18F-FDG avidity with the highest measured at SUVmax 2.9. She proceeded to have surgical resection of all the visualized tumors which were subsequently confirmed to be leiomyomatosis peritonealis disseminata (LPD). This benign smooth muscle disease originating from the metaplasia of submesothelial multipotent mesenchymal cells affects premenopausal women and is associated with lower threshold of smooth muscles to estrogen as well as the increased levels of circulating estrogen. Laparoscopic myomectomy and morcellation have been linked to the dispersion of the myoma debris within the peritoneum. The subcutaneous lesion found at the previous laparoscopy site in the left iliac fossa in this case supports the notion that LPD is due to dissemination of morcellated myoma debris.[1],[2] Metastatic gastrointestinal stromal tumor may present similarly with multiple peritoneal nodules with no significant nodal involvement on imaging.[3] Thus obtaining good clinical history is vital to formulating the diagnosis of LPD. Uterine leiomyomas have variable 18F-FDG avidity but majority show mild uptake. There is a cyclical pattern to the uptake of 18F-FDG within leiomyoma with higher uptake seen during the luteal phase compared to other menstrual phases.[4],[5] Limited data on 18F-FDG PET-CT imaging in LPD can be found in the literature. The tumors as seen in this case and in other reported cases of LPD where 18F-FDG PET-CT is performed have low 18F-FDG avidity.[6] Malignant transformation of LPD into leiomyosarcoma are rare and have been shown to occur in postmenopausal women with incompletely resected LPD.[7] Uterine leiomyoma usually have lower 18F-FDG avidity and rarely high 18F-FDG avidity, whereas it is the contrary for leiomyosarcoma. Nonetheless, the avidity of the lesions cannot be used to distinguish leiomyoma from leiomyosarcoma.[8],[9] There are no clear treatment guidelines due to the rarity of the disease and treatment has to be personalized.
Figure 1: (a) Shows the maximal intensity projection of the subcutaneous lesion in the left iliac fossa (green arrow), and the peritoneal soft-tissue lesions in the abdomen and pelvis (red arrows). (b and c) Shows the fused 18F-fluorodeoxyglucose positron emission tomography-computed tomography axial images of the subcutaneous lesion in the left iliac fossa (green arrow), and the soft-tissue lesions in the abdomen and pelvis (red arrows)

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Acknowledgment

The authors would like to acknowledge the patient who gave his consent for the publication of this article.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Thian YL, Tan KH, Kwek JW, Wang J, Chern B, Yam KL. Leiomyomatosis peritonealis disseminata and subcutaneous myoma – A rare complication of laparoscopic myomectomy. Abdom Imaging 2009;34:235-REF.  Back to cited text no. 1
    
2.
Xu S, Qian J. Leiomyomatosis Peritonealis Disseminata with Sarcomatous Transformation: A Rare Case Report and Literature Review. Case Rep Obstet Gynecol. 2019 Dec 5;2019  Back to cited text no. 2
    
3.
El-Agwany AS, Meleis MH. Disseminated peritoneal leiomyomatosis and metastatic GIST: Differential diagnosis dilemma regarding multiple nodular serosal lesions and management. Indian J Gynecol Oncol 2018;16:17.  Back to cited text no. 3
    
4.
Kitajima K, Murakami K, Yamasaki E, Kaji Y, Sugimura K. Standardized uptake values of uterine leiomyoma with 18F-FDG PET/CT: Variation with age, size, degeneration, and contrast enhancement on MRI. Ann Nucl Med 2008;22:505-12.  Back to cited text no. 4
    
5.
Nishizawa S, Inubushi M, Kido A, Miyagawa M, Inoue T, Shinohara K, et al. Incidence and characteristics of uterine leiomyomas with FDG uptake. Ann Nucl Med 2008;22:803-10.  Back to cited text no. 5
    
6.
Soni S, Pareek P, Narayan S. Disseminated peritoneal leiomyomatosis: An unusual presentation of intra-abdominal lesion mimicking disseminated malignancy. Med Pharm Rep 2020;93:113-6.  Back to cited text no. 6
    
7.
Bekkers RL, Willemsen WN, Schijf CP, Massuger LF, Bulten J, Merkus JM. Leiomyomatosis peritonealis disseminata: Does malignant transformation occur? A literature review. Gynecol Oncol 1999;75:158-63.  Back to cited text no. 7
    
8.
Punt SE, Eary JF, O'Sullivan J, Conrad EU. Fluorodeoxyglucose positron emission tomography in leiomyosarcoma: imaging characteristics. Nucl Med Commun 2009;30:546-9.  Back to cited text no. 8
    
9.
Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol 2010;195:737-43.  Back to cited text no. 9
    


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