[Benign, pulmonary metastatic leiomyoma of the uterus]

Benign metastasizing uterine leiomyoma with lymphatic and pulmonary metastases: a case report and literature review

BACKGROUND

Benign metastasizing leiomyoma (BML) is a rare disease usually observed in women of reproductive or premenopausal age with a history of uterine myomectomy or hysterectomy. The most common sites of metastases are the pulmonary, and other sites include heart, bones, liver, lymph nodes, bladder, skeletal muscles, and central nervous system. Here, we report a case of a 50 year-old woman with a history of hysterectomy who was initially suspected of uterine sarcoma but was finally confirmed to have BML with lung and lymph node metastases, and discuss the treatment and prognosis of BML.

CASE PRESENTATION

A 50 year-old woman with a history of total abdominal hysterectomy presented with mild but persistent abdominal pain for more than 3 months. She was suspected of having uterine sarcoma before surgery and laparoscopic extensive debulking surgery including bilateral oophorectomy, pelvic and para-aortic lymph node dissection to the level of the left renal vein, and transcutaneous dissection of the right inguinal lymph nodes. Pathology confirmed a benign leiomyoma, and the patient was diagnosed with BML. No medication was administered after the surgery, and the follow-up was of no significance.

CONCLUSION

Benign metastasizing leiomyoma (BML) is a rare disorder in which histologically benign smooth muscle tumors metastasize to extrauterine sites. Metastases are commonly observed in the lung, liver, lymph nodes, skin, bladder, esophagus, and skeletal muscles. BML is usually misdiagnosed as a malignant tumor before surgery until the pathology confirms its benign nature. However, this treatment remains controversial and undetermined. The prognosis is usually favorable owing to its benign nature.

Case of pulmonary benign metastasizing leiomyoma from synchronous uterine leiomyoma in a postmenopausal woman

Benign metastasizing leiomyoma (BML) is a rare tumor comprising histologically benign smooth muscle cells and exhibits the same histological findings as a uterine myoma although in an extra-uterine location. Most BMLs occur several years after surgery for uterine myoma in women of reproductive age. Here, we report a case of pulmonary BML in a 54-year-old postmenopausal woman with no previous history of myomectomy or hysterectomy. The patient presented with a rapid increase in abdominal girth over the past 3 months and a cough lasting for 2 months. Chest computed tomography (CT) revealed multiple pulmonary nodules, ranging in diameter from a few millimeters to 1.5 cm. Abdominal CT revealed a well-defined heterogeneous hypervascular uterine mass measuring 25 cm at the widest diameter. In addition to the uterine mass, imaging studies identified no other origin of the metastatic lung nodules. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed followed by video-assisted thoracoscopy. The histological findings of the lungs and uterus suggested myoma. The patient remains asymptomatic and disease-free at 7 years after surgery without adjuvant treatment.

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Benign metastasizing leiomyoma (BML) can occur in postmenopausal woman without uterine surgery.

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BMLs in postmenopausal woman can cause respiratory and gynecologic symptoms.

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Total abdominal hysterectomy and bilateral salpingo-oophorectomy could reduce lung BML in postmenopausal woman.

Multiple cavitating pulmonary nodules: rare manifestation of benign metastatic leiomyoma

Benign metastasizing leiomyoma (BML) is a rare disease of pathologically benign, but the tumor metastasizes to other organs. The most common organ involved in BML is lung. Pulmonary involvement usually manifested as multiple nodules on chest X-ray, however we experienced an interesting case of a 52-year-old premenopausal woman who presented with multiple bilateral lung cavitations and nodules on a chest X-ray without any respiratory symptoms. Chest computed-tomography identified multiple cavitary lesions of 5-12 mm in diameter and well-defined nodules of 5-10 mm in diameter in both lung fields. Transthoracic needle biopsy was performed and the resected lesion consisted of benign spindle cells was positive for estrogen receptor (ER) and progesterone receptor (PR) and was diffuse positive for actin and desmin by immunohistochemical (IHC) staining, suggesting leiomyoma. The final diagnosis was benign pulmonary metastasizing leiomyoma (BPML) and the patient underwent subcutaneous injection of a gonadotrophin releasing hormone (GnRH) agonist for 12 months, follow-up low-dose chest computed tomography (CT) scan at 15 months revealed decreased cavitations and nodular lesions. We should take into consideration the possibility of BPML when we encounter multiple cystic or cavitary lesions on chest X-ray, although the common form of BPML is nodulary lesions on imaging studies.

Benign pulmonary metastasizing leiomyoma of the uterus: A case report

Pulmonary benign metastasizing leiomyoma (BML), is characterized by multiple pulmonary nodular lesions and is a rare disease. The present study reports the case of a 45-year-old asymptomatic woman who underwent an excision of uterine leiomyoma 11 years previously. Chest computed tomography (CT) revealed multiple bilateral pulmonary nodules five months prior to admission, during a regular check-up. Intravenous levofloxacin (0.5 g/day) was administered for one week, which demonstrated no effect. Positron emission tomography combined with CT (PET/CT) revealed no evident radioactivity concentration. Due to the suspicion of metastasizing leiomyoma, video-assisted thoracoscopic surgery, with a wedge resection of the right pulmonary lesion, was performed. Post-operative pathological examination revealed the lesion to be a pulmonary leiomyoma accompanied by local necrosis. Immunohistochemical staining revealed that the lesion was positive for the expression of smooth muscle actin, desmin, estrogen receptor, progesterone receptor and B-cell lymphoma-2. Cytokeratin and epithelial membrane antigen were not expressed in the tumor cells. Staining for Ki-67 revealed expression of Ki-67 in ~1% of the spindle cells. The overall morphological and immunohistochemical features, accompanied by the remote patient history of primary uterine leiomyoma, supported the diagnosis of pulmonary BML.

Leiomyomas beyond the uterus; benign metastasizing leiomyomatosis with paraaortic metastasizing endometriosis and intravenous leiomyomatosis: a case series and review of the literature

Uterine leiomyomas affect 20-30 % of women 35 years and older. Extrauterine leiomyomas are rare and present a greater diagnostic challenge. Those unusual growth patterns occur more often in women of reproductive age with a history of hysterectomy or surgery for uterine leiomyomas. They have been reported in the literature in case reports and small case series and include benign metastasizing leiomyoma (BML), disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis (IVL), parasitic leiomyomas, and retroperitoneal growth. In this case series we present a case of BML with a first report of concomitant endometriosis metastasis to paraaortic lymphnodes, and a case of IVL. The findings and surgical management of those cases, as well as a review of the literature pertinent to those entities, are also presented.

Benign metastatic leiomyoma presenting as a hemothorax

Uterine leiomyomas have been reported to metastasize to various organs including the lungs, skeletal muscles, bone marrow, peritoneum, and heart. They may present with symptoms related to the metastases several years after hysterectomy. These tumors regress after menopause, and it is rare to detect active tumors in postmenopausal women. Despite their ability to metastasize, they are considered to be benign due to the lack of anaplasia. Pulmonary benign metastasizing leiomyoma is usually detected in the form of pulmonary nodules incidentally on imaging. Tissue biopsy of these nodules is required to identify them as benign metastasizing leiomyomas. Immunohistochemical analysis and molecular profiling may further help detect any malignant transformation in it. Untreated pulmonary benign metastasizing leiomyoma may result in the formation of cystic structures, destruction of lung parenchyma, and hemothorax and may cause respiratory failure. Surgical resection and hormonal therapy help prevent progression of this disease and provide an avenue for a cure.

Benign pulmonary metastasizing leiomvomatosis: case report and a review of the literature

The authors report here on a case of a nearly asymptomatic 51-year-old Korean woman who was found to have diffuse, multiple nodules of the lungs on a routine chest radiograph. She had undergone hysterectomy 16 years previously for uterine myoma. An open lung biopsy revealed tumor that was composed of interlacing bundles of spindle cells with cigar shaped nucleus and eosinophilic myofibrils in the cytoplasm; consistent with multiple leiomyomas. The stains for SMA, desmin, MSA and Ki-67 were positive and the stain for c-kit was negative. The other stains for estrogen and progesterone receptor were positive. During the open lung biopsy procedure, all the nodules were excised. We report here on an interesting case of benign metastasizing leiomyoma (BML) in 51-year-old patient. To the best of our knowledge, this case showed the longest period of clinical progression in Korea. This is also one of a few cases in which curative excision was successfully performed.

Benign abdominal and pulmonary metastasizing leiomyoma of the uterus

BACKGROUND

Benign metastasizing leiomyoma (BML) is a rare disease in which the lung is described to be the most afflicted extrauterine organ.

METHODS

We report of a 42-year-old African woman with a BML in the abdomen and lung who had undergone a hysterectomy for uterine leiomyoma 10 years ago. She was admitted to our hospital for investigation of a huge tumor mass in the pelvis consisting of multiple nodules in the abdomen and left lung. Assuming an advanced intraperitoneal malignancy was present, a 'palliative' limited tumor debulking and due to a tumor compressing the sigmoid a Hartmann's procedure was performed.

RESULTS

The histopathologic examination showed a leiomyoma positive for estrogen receptor. Treatment was started with GnRH analoga. In the presence of a stable disease after 12 months, the patient underwent a re-laparotomy with a reanastomosis of the colon. Treatment was continued with GnRH analoga and the residual nodules have not increased in size during 36 months of follow-up.

CONCLUSIONS

The review of the literature supports the concept that the primary tumor of BML is located in the uterus and that leiomyomas in the uterus can metastasize leading via hematogenous spread to BML. However, the origin of the tumor remains controversial.