Disseminated peritoneal leiomyomatosis after laparoscopic supracervical hysterectomy with characteristic molecular cytogenetic findings of uterine leiomyoma.
Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by scattered smooth muscle nodules over the peritoneal surfaces. The pathogenesis of DPL remains unclear. Herein, we report a case of DPL occurring 7 years after laparoscopic supracervical hysterectomy with morcellation for uterine leiomyomata (UL). We analyzed both the original UL and the subsequent DPL by molecular cytogenetics to assess the role of chromosomal abnormalities in DPL pathobiology. Interestingly, all of the chromosomal aberrations detected in this case of DPL, including r(1)(p34.3q41), del(3)(q23q26.33), and t(12;14)(q14.3;q24.1), are characteristic chromosomal abnormalities detected in UL. Fluorescence in situ hybridization analysis of the initial UL confirmed an interstitial deletion spanning at least 3q24 and 3q25.1, suggesting that functional alteration of a potential gene in this chromosomal region may play a role in DPL development from UL. With the increasing rate of hysterectomy through laparoscopic approach to UL, the unique complications of laparoscopy with morcellation, especially seeding and proliferation of tumor cells over abdominal organs and peritoneum, are becoming more significant and may necessitate review of current surgical protocols to prevent future seeding of the pelvic region with tumor particles.
Ordulu
Zehra
Z
Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA 02115, USA.
Dal Cin
Paola
P
Chong
Wilson W S
WW
Choy
Kwong Wai
KW
Lee
Charles
C
Muto
Michael G
MG
Quade
Bradley J
BJ
Morton
Cynthia C
CC
D002869:Chromosome Aberrations; D002872:Chromosome Deletion; D055028:Comparative Genomic Hybridization; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy; D017404:In Situ Hybridization, Fluorescence; D010535:Laparoscopy; D007889:Leiomyoma / Q000235:genetics / Q000473:pathology / Q000601:surgery; D018231:Leiomyomatosis / Q000235:genetics* / Q000473:pathology; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000235:genetics* / Q000473:pathology; D014594:Uterine Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery