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Int J Clin Exp Pathol 2013;6(12):2949-2954

Original Article
Leiomyomatosis peritonealis disseminata coexisting with endometriosis within the
same lesions: a case report with review of the literature

Ayano Toriyama, Mitsuaki Ishida, Tsukuru Amano, Tetsuya Nakagawa, Shouji Kaku, Muneo Iwai, Keiko Yoshida, Akiko Kagotani, Kentarou
Takahashi, Takashi Murakami, Hidetoshi Okabe

Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Department of Obstetrics and Gynecology, Department of
Community Perinatal Medicine, Shiga University of Medical Science, Shiga, Japan. Equal contributors.

Received October 1, 2013; Accepted October 29, 2013; Epub November 15, 2013; Published December 1, 2013

Abstract: Leiomyomatosis peritonealis disseminata (LPD) is an extremely rare condition, which is characterized by the presence of multiple
peritoneal and subperitoneal nodules composed of bland smooth muscle cells. Albeit extremely rare, coexistence of endometriosis within LPD
lesions has also reported. Herein, we report the seventh documented case of LPD coexisting with endometriosis within the same lesions and
review the pathogenesis of this lesion. A 42-year-old Japanese female presented with an abdominal tumor. Computed tomography revealed a
tumorous lesion in the right ovary and multiple small nodules in the abdominal cavity. Under a clinical diagnosis of ovarian cancer with
peritoneal dissemination, resection of these lesions was performed. Histopathological study of the disseminated peritoneal nodules revealed
proliferation of interlacing bundles of spindle cells with eosinophilic cytoplasm and bland cigar-shaped nuclei. Mitotic figures were hardly seen.
The peritoneal nodules of the rectum had cystic cavities within the spindle cell bundles, and endometrial glands and stroma were present
around the cystic cavities and spindle cells. The resected tissues of the ovary and cecum showed the same histopathological features.
Accordingly, a diagnosis of LPD with endometriosis within the same lesions was made. A possible origin of LPD is thought to be the
submesothelial multipotential stem cells, also referred to as the secondary müllerian system. The presence of endometrial tissues within LPD
lesions, as seen in the present case, also support this hypothesis because endometrial tissues are also derived from the müllerian system.
(IJCEP1310008).

Keywords: Leiomyomatosis peritonealis disseminata, endometriosis, peritoneum, ovary

Address correspondence to: Dr. Mitsuaki Ishida, Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga
University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan. Tel: +81-77-548-2603; Fax: +81-77-548-2407; E-mail:
mitsuaki@belle.shiga-med.ac.jp