Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5217-5225
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5217
Treatment of leiomyomatosis peritonealis disseminata with goserelin acetate: A case report and review of the literature
Jia-Wen Yang, Yu Hua, Hua Xu, Liu He, Hai-Zhong Huo, Chen-Fang Zhu
Jia-Wen Yang, Yu Hua, Hua Xu, Liu He, Hai-Zhong Huo, Chen-Fang Zhu, Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
Author contributions: Yang JW and Hua Y wrote the manuscript; Xu H and He L analyzed the data; Huo HZ and Zhu CF revised the paper; all authors conceived the manuscript, supervised the findings of this work, discussed the results, and contributed to the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen-Fang Zhu, MD, PhD, Doctor, Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China. sammizz1977@126.com
Received: January 4, 2021
Peer-review started: January 4, 2021
First decision: April 29, 2021
Revised: May 1, 2021
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: July 6, 2021
Processing time: 170 Days and 15.2 Hours
Abstract
BACKGROUND

Leiomyomatosis peritonealis disseminata (LPD) is a rare condition characterized by multiple pelvic and abdominal nodules, which are composed of smooth-muscle cells. To date, no more than 200 cases have been reported. The diagnosis of LPD is difficult and there are no guidelines on the treatment of LPD. Currently, surgical excision is the mainstay. However, hormone blockade therapy can be an alternative choice.

CASE SUMMARY

A 33-year-old female patient with abdominal discomfort and palpable abdominal masses was admitted to our hospital. She had undergone four surgeries related to uterine leiomyoma in the past 8 years. Computed tomography revealed multiple nodules scattered within the abdominal wall and peritoneal cavity. Her symptoms and the result of the core-needle biopsy were consistent with LPD. The patient refused surgery and was then treated with tamoxifen, ulipristal acetate (a selective progesterone receptor modulator), and goserelin acetate (a gonadotropin-releasing hormone agonist). Both tamoxifen and ulipristal acetate were not effective in controlling the disease progression. However, the patient achieved an excellent response when goserelin acetate was attempted with relieved syndromes and obvious shrinkage of nodules. The largest nodule showed a 25% decrease in the sum of the longest diameters from pretreatment to posttreatment. Up to now, 2 years have elapsed and the patient remains asymptomatic and there is no development of further nodules.

CONCLUSION

Goserelin acetate is effective for the management of LPD. The long-term use of goserelin acetate is thought to be safe and effective. Hormone blockade therapy can replace repeated surgical excision in recurrent patients.

Keywords: Goserelin acetate, Leiomyomatosis peritonealis disseminata, Hormone blockade therapy, Conservative treatment, Disseminated peritoneal leiomyomatosis, Case report

Core Tip: Goserelin acetate is effective for the long-term management of leiomyomatosis peritonealis disseminate (LPD) and can be an alternative when leuprolide acetate is not available. Repeated surgical excision in LPD cases should be carefully considered. Tamoxifen and ulipristal acetate may not be effective in treating LPD.