Disseminated Peritoneal Leiomyomatosis: Two Rare Cases With Diagnostic Mimics and a Novel Central Nervous System Disease Association

Our plain-English summary of Disseminated Peritoneal Leiomyomatosis: Two Rare Cases With Diagnostic Mimics and a Novel Central Nervous System Disease Association, by P.S. Renavikar, T.J. Auen, S.M. Lele, et al (Curēus, 2025).

The study

• Authors: P.S. Renavikar, T.J. Auen, S.M. Lele, D.G. Wagner
• Journal: Curēus
• Published: 2025;17(2):e79158
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign smooth muscle tumor that proliferates along the peritoneal surface and is mostly reported in young women. Our cases highlight the wide clinical and radiologic mimics of DPL, including primary peritoneal (mesothelial) entities and malignant processes like metastasis or pseudomyxoma peritonei. Both cases shared common findings of premenopausal age (hormonal influence) and a history of prior abdominal surgery. One case was clinically thought to be benign multicystic mesothelioma, while the other had a history of medulloblastoma as a child, followed by recurrent meningiomas. The presentation of multiple previous tumors in the latter case is an unusual association with DPL that has not been previously described. Here, we discuss the existing literature on the etiology and differential diagnosis of DPL, report our histopathologic findings, and highlight novel central nervous system (CNS) disease associations with DPL.

Copyright © 2025, Renavikar et al.

In plain English

This case report described two women from one hospital setting who were diagnosed with disseminated peritoneal leiomyomatosis (DPL), a rare benign smooth muscle tumor that grows along the lining of the abdomen. The article does not discuss asbestos. In the first case, benign multicystic peritoneal mesothelioma was suspected but not confirmed. That patient, in her late 20s, had earlier surgery to remove a uterine fibroid, and her scans showed many cystic masses. Tissue examination instead showed bland smooth muscle cells, and most of the cystic appearance came from associated endosalpingiosis. She made a full recovery after surgery. The second patient, in her late 30s, had a childhood medulloblastoma and later radiation-induced recurrent meningiomas. Her solid abdominal masses were also diagnosed as DPL, and after surgery and hormonal therapy the remaining masses were stable. The authors concluded that DPL can mimic other peritoneal conditions. They described the brain-tumor history as a novel association but called it an incidental observation needing more cases with molecular testing, which was not done here.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (two cases), with discussion of the literature
• Who was studied: Two premenopausal women from one hospital setting, one in her late 20s and one in her late 30s. The hospital is not named; the authors are at the University of Nebraska Medical Center, Omaha, USA.
• Exposure: No asbestos exposure is reported. The factors the authors discuss for these patients are prior abdominal or pelvic surgery and hormonal influence (for example, pregnancies in case 1).
• Main results:
  • Case 1: imaging showed multiple multilocular cystic abdominopelvic and perihepatic masses, and the clinical suspicion was benign multicystic peritoneal mesothelioma.
  • Case 1: tissue showed bland spindle cells with no atypia, necrosis or mitoses. The cystic appearance was mostly due to endosalpingiosis.
  • Case 1: the lesional cells were positive for estrogen receptor (100%) and progesterone receptor (100%) and negative for the mesothelial markers WT1, calretinin and D2-40. The diagnosis was DPL.
  • Case 2: the patient had a history of childhood medulloblastoma and radiation-induced recurrent meningiomas. She presented with multiple abdominopelvic and mesenteric solid lesions measuring 4.5 to 7.0 cm.
  • Case 2: estrogen receptor (35%) and progesterone receptor (15%) were expressed on the uterine and adnexal masses but were negative on the mesenteric masses.
  • Follow-up: case 1 made a full recovery after surgery. In case 2, stable residual masses of 2.1 to 4.0 cm remained and were treated with letrozole.
• The authors' conclusion: The authors concluded that DPL causes diagnostic confusion with benign multicystic peritoneal mesothelioma, gastrointestinal stromal tumor and pseudomyxoma peritonei. They reported what they called a novel association between peritoneal leiomyomatosis and CNS tumors in one patient.
• Limitations the authors state:
  • The authors called the link with CNS tumors an incidental observation that will need more cases with molecular assessment to establish any genetic link.
  • No molecular assessment of the tumors was performed.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Multicystic Mesothelioma (MCM), Etiology, Differential Diagnosis.

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