LAUSR

CLINICAL CASE OVERVIEW A 33yearold woman with a personal history of uterine leiomyomas, disseminated peritoneal leiomyomatosis, and a borderline peritoneal tumor, presented to the emergency department in November 2022 complaining of acute onset pain located in the left hypochondrium and flank for 48 hours, with no other associated symptoms. Her medical history included three previous surgeries. The first surgery was a laparoscopic myomectomy performed in April 2017, but the surgical description was not available because it was performed by a gynecologist in an external institution (there was no information on whether morcellation was required). The findings and final pathology report were not available, but the patient was informed regarding the benign nature of the disease. Subsequently, surveillance MRI in July 2018 showed free fluid in the pelvis, peritoneal implants, a 5×3 cm mass in the culdesac, and uterine myomatosis. At that time, she underwent laparoscopy where gross findings included a left ovarian tumor with a coralliform appearance of approximately 5 cm, omentum adhesion to the previous myomectomy bed and to the pelvic peritoneum, normal right ovary, uterus with a right intraligamentary myoma extending through the right pillar of the bladder without other lesions, free fluid in the pelvis, tumor implant in the omentum, right diaphragmatic dome and a mirror lesion in the liver. In addition, another retroperitoneal solid tumor at the level of the aortic bifurcation, of approximately 10 cm with a myomatous appearance, was described, with myomatosis implants in both fallopian tubes, right pararectal space, right parietocolic gutter, right diaphragmatic dome, round hepatic ligament and lesser omentum in the lesser curvature of the stomach (7 cm), and multiple lesions with the same characteristics at the level of the greater omentum. A frozen section of the left ovarian mass showed a serous borderline peritoneal tumor and thus resection of the left ovarian tumor, unilateral salpingectomy, myomectomy of multiple peritoneal leiomyomas, resection of a retroperitoneal leiomyoma, total omentectomy, and enterorrhaphy were performed, all by a laparoscopic approach, in July 2018. The final pathology confirmed an International Federation of Gynecology and Obstetrics (FIGO) stage IC borderline tumor in the left ovary, noninvasive implants in the peritoneum and omentum, as well as numerous leiomyomata (Figure 1).