Disseminated peritoneal leiomyomatosis-diagnostic dilemma in an acute presentation-a case report

Diffuse peritoneal leiomyomatosis is a rare benign condition which has a multifactorial origin with genetic or hormonal component leading to metaplasia of peritoneal mesenchymal cells. Thus, a combination of radiology with clinical correlation is an ideal approach for diagnosis. Though benign, radiologically it could give a picture of malignancy. In our case, patient came with an acute presentation resembling torsion ovary which usually needs emergency detorsion. In this scenario, multiple radiology component directed the case towards malignancy while ultimately a history, clinical correlation and biopsy revealed its benign nature. Reviewing the reported cases of disseminated peritoneal leiomyomatosis (DPL) incidence has slightly increased in recent years and is more common in patients with a past history of unconfined laparoscopic myomectomy wherein spillage of the myoma content into the abdominal cavity can trigger DPL as these are hormone sensitive tissues. The indolent course of the disease usually suggests a borderline disease, but only histological and immunohistochemical studies can confirm DPL, showing smooth muscle cells without nuclear atypia, strongly expressing estrogen and progesterone receptors. Mainstay of treatment targets in curbing the hormone influence on DPL and surgical management

A rare cause of dysmenorrhea-accessory cavitated uterine malformation: a case report

Accessory cavitated uterine malformation is a newly recognized mullerian anomaly where the uterine cavity is normal unlike other Mullerian anomalies and hence needs to be described more accurately. These are non-communicating ULMs that occur contiguously along the wall of the uterus. This case report is about a 31 years old female who came with complaints of acute severe dysmenorrhea with a chronic course for the past 2 years and was evaluated for a similar episode in the past where she was diagnosed as fibroid with cystic degeneration and treated with SPRM and OCP which gave no relief from symptoms. With another exacerbation of symptoms two years later, patient was evaluated with an USG suggesting hemorrhagic degeneration in rudimentary horn and gave two differentials- fibroid with cystic degeneration and adenomyoma, wherein the   latter was more likely. As a part of pre-op evaluation, MRI was done. Then came the third differential-ACUM [Accessory cavitated uterine mass]. Patient was counselled about the risk of infertility and uterine rupture in subsequent pregnancy as a post-op complication underwent laparoscopic surgery. Intraoperative and postoperative period was uneventful and HPE of the same confirmed the diagnosis. ACUM is a very treatable cause of severe dysmenorrhea and adequate awareness of this new entity will enable in making the diagnosis early