Leiomyomatosis peritonealis disseminata (DPL) is a rare, benign condition characterized by multiple smooth muscle nodules dispersed throughout the abdominopelvic cavity, often mimicking metastatic disease and posing significant diagnostic challenges. Predominantly observed in women of reproductive age, DPL is usually associated with uterine leiomyomas. While its etiology remains unclear, hormonal influences, particularly estrogen, are believed to play a key role.

We report the case of a 44-year-old woman with chronic lower backache and no known comorbidities. Imaging revealed multiple soft tissue deposits in the pelvic and peritoneal cavities, the largest measuring 4.8 × 4.4 cm, along with a uterine leiomyoma. A biopsy of the peritoneal lesion identified a benign spindle cell neoplasm consistent with DPL, confirmed by immunoreactivity in smooth muscle actin (SMA) and a low Ki-67 proliferation index. The multidisciplinary tumor board recommended surgical intervention.

The patient underwent midline laparotomy, complete cytoreduction, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Final histopathology corroborated the initial diagnosis of DPL. Despite the extensive abdominopelvic involvement, early recognition and comprehensive surgical intervention led to a positive outcome. The patient remains asymptomatic on follow-up, highlighting the effectiveness of thorough surgical management in DPL cases. This report underscores the importance of considering DPL in the differential diagnosis of women with multiple peritoneal nodules and a history of uterine leiomyomas, emphasizing the need for timely and appropriate intervention to achieve favorable outcomes.