关键词: 寄生性平滑肌瘤, 播散性腹膜平滑肌瘤病, 种植, 病例报告

Abstract:

Objective To discuss the diagnosis and treatment process of the patients with parasitic leiomyoma （PM） of the abdominal wall complicated with disseminated peritoneal leiomyomatosis （DPL） after laparoscopic myomectomy，and to improve the clinical understanding and management of this condition. Methods The clinical data of one patient with PM of the abdominal wall complicated with DPL after laparoscopic myomectomy were collected. The causes， clinical features， diagnosis， differential diagnosis and treatment process were analyzed， and the relevant literatures were reviewed. Results The patient， a 49-year-old woman， was admitted due to a self-discovered abdominal mass lasting for one year. The physical examination results showed a palpable mass， approximately 6 cm×4 cm， in the lower left abdominal wall with poor mobility， with clear borders， and without tenderness. Another palpable mass， approximately 7 cm×5 cm， was found in the lower right abdomen with fair mobility，with clear borders， and without tenderness. The gynecological ultrasonography results showed a hypoechoic area of approximately 6.6 cm×2.7 cm in the subcutaneous tissue below the left umbilicus and another hypoechoic area of approximately 7.6 cm×3.3 cm in the abdominal cavity below the umbilicus. The superficial ultrasonography of the local area showed a hypoechoic area of approximately 5.79 cm×2.55 cm×4.74 cm within the left lower abdominal rectus muscle， with smooth edges， located 1.97 cm from the skin at its shallowest point and 4.73 cm at its deepest point， without penetration of the rectus sheath but adjacent to the peritoneum. The patient was diagnosed as uterine leiomyoma， abdominal mass， and post-myomectomy status. The elective surgeries for uterine leiomyoma enucleation， abdominal wall leiomyoma excision， and peritoneal leiomyoma excision were performed under combined intravenous-inhalation anesthesia. The operation procedure was successful， and the patient recovered well and was discharged smoothly. Conclusion PM and DPL lack typical clinical features and require imaging examinations for diagnosis. Surgical exploration is the main treatment modality， and while PM and DPL are generally benign， there is a potential for malignant transformation， and the patients need further postoperative follow-up.

Key words: Parasitic leiomyoma, Disseminated peritoneal leiomyomatosis, Implantation, Case report