Disseminated Peritoneal Leiomyomatosis: Description of a Case, Radiologic Semiotics and Differential Diagnosis.

IF 0.9 4区 医学 Q3 SURGERY
Riccardo Bisi, Aldo Carnevale, Giacomo Feliciani, Melchiore Giganti, Anna Chiara Palo
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引用次数: 0

Abstract

Aim: Leiomyomatosis peritonealis disseminata or disseminated peritoneal leiomyomatosis (DPL), is a rare nosological entity characterized by multiple leiomyomas growing within the abdominal region. It is one of the uncommon manifestations of extra-uterine leiomyomas and an eventuality that can lead to diagnostic difficulties, especially in neoplastic patients. This pictorial review aims to illustrate the multimodal characteristics of DPL, providing at the same time relevant information regarding pathogenesis, clinical presentation, and treatment. Furthermore, as DPL may enter in differential diagnosis with other atypical smooth muscle tumour localization or abdominal malignancies, such as retroperitoneal leiomyosarcoma or peritoneal carcinomatosis, the review provides a concise description of each condition: the main epidemiological and pathogenetic aspects are summarized, along with essential information on clinical presentation and radiological imaging, closing with some notes on possible treatment options.

Case presentation: A case of incidental detection of DPL in a patient undergoing staging of breast cancer is employed as an example to illustrate the diagnostic difficulties that may be encountered in such scenarios: the finding of multiple vascularized nodules in the abdomen aroused the suspicion of carcinomatous localizations, and the patient underwent in-depth investigations with multiple imaging techniques by ultrasound, computed tomography and magnetic resonance.

Results: Using imaging methods with better contrast resolution in the definition of soft tissues made it possible to orient the diagnostic suspicion over DPL, subsequently confirmed by histological evaluation after laparoscopic excision of bigger nodules. Once the possibility of peritoneal localization of breast cancer was excluded, the patient was treated with neoadjuvant therapy, surgery and adjuvant therapy. Follow-up imaging showed no signs of breast cancer recurrence nor significant changes in the remaining DPL nodules.

Conclusions: Knowledge of the atypical presentation patterns of leiomyomas, the related imaging characteristics and the differential diagnosis allows both the clinician and the radiologist to formulate more accurate diagnostic hypotheses, thus ensuring better patient management from the view of the subsequent possible invasive diagnostic and therapeutic options.

弥散性腹膜平滑肌瘤病:1例描述、放射学符号学和鉴别诊断。
目的:广泛性腹膜平滑肌瘤病或称弥散性腹膜平滑肌瘤病(DPL)是一种罕见的以腹膜内多发平滑肌瘤为特征的疾病。它是子宫外平滑肌瘤的罕见表现之一,是一种可能导致诊断困难的可能性,特别是在肿瘤患者中。这篇图片综述旨在说明DPL的多模态特征,同时提供有关发病机制、临床表现和治疗的相关信息。此外,由于DPL可能与其他非典型平滑肌肿瘤定位或腹部恶性肿瘤(如腹膜后平滑肌肉瘤或腹膜癌)进行鉴别诊断,本文对每种情况进行了简要描述:总结了主要的流行病学和发病方面,以及临床表现和放射成像的基本信息,最后对可能的治疗方案进行了一些说明。病例介绍:以一例乳腺癌分期患者偶然发现DPL为例,说明在这种情况下可能遇到的诊断困难:在腹部发现多个血管化结节,引起癌变定位的怀疑,患者接受了超声、计算机断层扫描和磁共振等多种成像技术的深入调查。结果:采用对比度分辨率较高的软组织成像方法,可明确DPL的诊断嫌疑,并在腹腔镜下切除较大结节后进行组织学评价。一旦排除乳腺癌腹膜定位的可能性,患者将接受新辅助治疗、手术和辅助治疗。随访影像显示未见乳腺癌复发迹象,其余DPL结节也无明显变化。结论:了解平滑肌瘤的非典型表现模式、相关影像学特征和鉴别诊断,使临床医生和放射科医生能够制定更准确的诊断假设,从而从后续可能的侵入性诊断和治疗选择的角度确保更好的患者管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.90
自引率
12.50%
发文量
116
审稿时长
>12 weeks
期刊介绍: Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.
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