Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1639-1644
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1639
Disseminated peritoneal leiomyomatosis with malignant transformation involving right ureter: A case report
Chen-Yueh Wen, Herng-Sheng Lee, Jen-Tai Lin, Chia-Cheng Yu
Chen-Yueh Wen, Jen-Tai Lin, Chia-Cheng Yu, Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
Herng-Sheng Lee, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
Chia-Cheng Yu, School of Medicine, National Yang-Ming University, Taipei 814, Taiwan
Chia-Cheng Yu, Department of Pharmacy, Tajen University, Pingtung 900, Taiwan
Author contributions: Wen CY and Yu CC were involved in case management; Lee HS helped with the pathological interpretation; The images were collected and the main text was written by Wen CY; and all authors helped with data collection and preparation for submission of the final article.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chia-Cheng Yu, Doctor, Professor, Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung 81346, Taiwan. mlee0857@gmail.com
Received: August 7, 2021
Peer-review started: August 7, 2021
First decision: November 6, 2021
Revised: November 14, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: February 16, 2022
Processing time: 187 Days and 20.8 Hours
Abstract
BACKGROUND

Disseminated peritoneal leiomyomatosis (DPL) with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma, and hematuria as a presenting symptom has never been reported. Through this case report, we emphasize the investigation of the etiology, clinical presentation, diagnosis, treatment, and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management.

CASE SUMMARY

We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy. An exploratory laparotomy was performed and all visible nodules were surgically removed. DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results.

CONCLUSION

Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain, hematuria, and imaging of disseminated pelvic tumors in women, especially those with prior history of laparoscopic hysterectomy. Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.

Keywords: Disseminated peritoneal leiomyomatosis; Leiomyosarcoma; Laparoscopic hysterectomy; Hematuria; Ureteroneocystostomy; Case report

Core Tip: Disseminated peritoneal leiomyomatosis (DPL) is a rare disease characterized by the presence of multiple nodules composed of smooth muscle cells located in both peritoneal and extraperitoneal spaces of the abdomen. Malignant changes in DPL correspond to a rare variant of leiomyosarcoma characterized by aggressive behavior. We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy, mimicking urothelial carcinoma with peritoneal carcinomatosis. The aim of our case report is to investigate the etiology, clinical presentation, diagnosis, treatment, and prognosis of DPL and to help develop further clinical management of this disease.