Radical surgical cytoreduction of progressive leiomyomatosis peritonealis disseminata: a case report.
BACKGROUND
Leiomyomatosis peritonealis disseminata (LPD) is an uncommon, benign smooth muscle condition of the peritoneal cavity that appears clinically as a metastatic malignant neoplasm. Generally, radical surgery is not recommended. This unique case involves curative radical surgery after disease progression during depo-medroxyprogesterone acetate therapy. In vitro assays and future implications are discussed.


METHODS
A 31-year-old woman presented with abdominal pain and uterine leiomyomas. During exploratory laparotomy, she had gross evidence of LPD. Despite initial surgery and hormonal therapy, she had progression of disease. She then underwent optimal cytoreductive surgery. Tumor response to megestrol acetate in vitro was evaluated and noted to be heterogeneous; therefore it was not given as adjuvant therapy. Five years after radical surgery, she was without evidence of disease,


CONCLUSIONS
Radical secondary cytoreductive surgery can achieve a durable remission for LPD refractory to primary surgical castration and depomedroxyprogesterone acetate therapy.
Kratz
Katherine Goodrich
KG
Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. katiegoodrich@gmail.com
Santillan
Antonio
A
Gu
Mai
M
Bristow
Robert E
RE
D000328:Adult; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy / Q000601:surgery*; D018231:Leiomyomatosis / Q000601:surgery*; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D010529:Peritoneal Cavity / Q000166:cytology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000601:surgery*
D017258:Medroxyprogesterone Acetate