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Araujo NM, Cardoso IMDS, Jatobá TKDADS, Mencato Sabey LP, Teixeira AKADAF, Tojal AST, Lima FJN, Filho EF, Neto JB, Fraga TP, Bezerra GS, Silva MC, Araújo GAAD, Soares WGP, Almeida MLD. Rare manifestation of pulmonary benign metastasizing leiomyoma: Respiratory failure. Respir Med Case Rep 2024; 50:102053. [PMID: 38881776 PMCID: PMC11176773 DOI: 10.1016/j.rmcr.2024.102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
We report a case of a 42-year-old woman diagnosed with pulmonary benign metastasizing leiomyomatosis with a random nodular pattern on image and with a rare clinical condition progressing with respiratory failure and severe hypoxemia. This study is relevant due to the rarity of the tomographic pattern and the patient's clinical presentation. There is no treatment guideline for this comorbidity, which further increases the importance of publishing case reports in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | | | - José Barreto Neto
- Department of Respiratory Diseases, Sergipe University Hospital, Brazil
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2
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Hu J, Tian S, Pan Q, Yu Y. Multiple benign metastasizing leiomyoma in the abdominal wall: a case report and literature review. Front Oncol 2024; 14:1391850. [PMID: 38826791 PMCID: PMC11140016 DOI: 10.3389/fonc.2024.1391850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare disease that results from metastasis of uterine leiomyoma to distant sites with benign pathologic features. The lung is the most common metastatic site for BML. This report describes the case of a 49-year-old woman who presented with a mass in the abdominal wall with a surgical history of uterine myomectomy. Ultrasound and Magnetic resonance imaging (MRI) revealed multiple mass lesions. The histopathology of the mass specimen indicated BML. The imaging and clinical features of BML are discussed based on the characteristics of this case and related literature reports.
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Affiliation(s)
- Jiaqi Hu
- Department of Ultrasound Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shuyuan Tian
- Department of Ultrasound Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Qing Pan
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yonghong Yu
- Department of Ultrasound Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
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3
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Siti Kaamilah MZ, Wong YS, Bushra J, Nik Ahmad Fadhil NM, Aisya Natasya M. A hint for abnormal thoracic shadow: look behind the heart. Breathe (Sheff) 2023; 19:230052. [PMID: 37719237 PMCID: PMC10501713 DOI: 10.1183/20734735.0052-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
Can you diagnose this woman with a history of uterine fibroids in the previous year and a recent finding of intrathoracic mass on chest radiography? https://bit.ly/44mQ9Jj.
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Affiliation(s)
| | - Yen Shen Wong
- Faculty of Medicine, University Teknologi MARA (UiTM) Sg Buloh, Selangor, Malaysia
| | - Johari Bushra
- Department of Radiology, Faculty of Medicine, University Teknologi MARA (UiTM) Sg Buloh, Selangor, Malaysia
| | | | - Musa Aisya Natasya
- Faculty of Medicine, University Teknologi MARA (UiTM) Sg Buloh, Selangor, Malaysia
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4
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Hu Z, Liu K, Liu Q, Zhu H. Whole exon capture sequencing for identifying mutations associated with pulmonary benign metastasising leiomyoma. BMJ Case Rep 2023; 16:e251072. [PMID: 36948524 PMCID: PMC10040003 DOI: 10.1136/bcr-2022-251072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
A woman in her early 20s presented with cough and fever. She had undergone an abdominal myomectomy 3 years ago for uterine leiomyoma. Chest CT and positron emission tomography-CT revealed multiple round nodules in both lungs, suggesting metastatic lesions. A CT-guided lung biopsy was performed, and the tumour was diagnosed as pulmonary benign metastasising leiomyoma (PBML) based on pathological analyses. Whole exon capture sequencing of uterine leiomyoma and PBML sections revealed that 13 genes (MCM10, SLC16A9, RAG1, BAZ1A, NLRP2, TRMT61B, CPXM1, NGLY1, SUCLG2, FAM13A, CAGE1, PHTF2 and ZDHHC2) were concurrently present in the two tumours. The patient was prescribed goserelin injections every 4 weeks. The symptoms improved 2 weeks after starting the treatment. The lung nodules considerably decreased in size after three courses of goserelin treatment. The nodular size continues to decrease with the treatment.
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Affiliation(s)
- Zhijun Hu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Kaijiang Liu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Qing Liu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Hong Zhu
- Department of Gynecologic Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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5
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Panagiotou E, Vamvakaris I, Syrigos NK, Kotteas E. Pulmonary benign metastasizing leiomyoma: a case report. Monaldi Arch Chest Dis 2023; 94. [PMID: 36807647 DOI: 10.4081/monaldi.2023.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
Benign metastasizing leiomyoma is a metastasizing form of leiomyoma, which is a benign uterine tumor that typically affects women of reproductive age. A hysterectomy is typically performed 10-15 years before the disease's metastatic progression. We present a case of a postmenopausal woman who presented to the emergency department with worsening dyspnea and a history of hysterectomy due to leiomyoma. A computed tomography scan of the chest revealed diffuse bilateral lesions. An open-lung biopsy was performed, and the lung lesions were found to have leiomyoma cells. The patient began letrozole treatment and showed clinical improvement without any serious adverse events.
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Affiliation(s)
| | - Ioannis Vamvakaris
- Department of Pathology, Athens School of Medicine, Sotiria General Hospital, Athens.
| | - Nikolaos K Syrigos
- Oncology Unit, Athens School of Medicine, Sotiria General Hospital, Athens.
| | - Elias Kotteas
- Oncology Unit, Athens School of Medicine, Sotiria General Hospital, Athens.
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6
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Pulmonary benign metastasizing leiomyoma: a report of two cases. Future Sci OA 2022; 8:FSO814. [DOI: 10.2144/fsoa-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare pathological process associated with pelvic leiomyoma. We present two cases of BML that are associated with giant pulmonary metastasis. BML is a rare benign metastatic phenomenon that could easily be mistaken for malignant neoplasms. Both cases occurred in middle-aged women who presented with cough and dyspnea. They previously underwent hysterectomy for uterine leiomyoma. After history taking, computed tomography, integrated PET/computed tomography and pathological assessment, a multidisciplinary treatment was offered for the diagnosis of BML. Physicians should consider BML among the differential diagnoses in women of reproductive age with a history of uterine leiomyoma presenting with pulmonary nodules, and accurate histopathological analysis should be made.
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7
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Sanada S, Ushijima K, Yanai H, Mikami Y, Ohishi Y, Kobayashi H, Tashiro H, Mikami M, Miyamoto S, Katabuchi H. A critical review of “uterine leiomyoma” with subsequent recurrence or metastasis: A multicenter study of 62 cases. J Obstet Gynaecol Res 2022; 48:3242-3251. [DOI: 10.1111/jog.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sakiko Sanada
- Department of Pathology Kurume University School of Medicine Fukuoka Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology Kurume University Fukuoka Japan
| | - Hiroyuki Yanai
- Department of Pathology Okayama University Hospital Kitaku Okayama Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology Kumamoto University Hospital Kumamoto Japan
| | - Yoshihiro Ohishi
- Department of Diagnostic Pathology Iizuka Hospital Fukuoka Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology Kagoshima University Kagoshima Japan
| | | | - Mikio Mikami
- Department of Obstetrics and Gynecology Tokai University Isehara Kanagawa Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology Fukuoka University Fukuoka Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology Kumamoto University Kumamoto Japan
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Boavida Ferreira J, Cabrera R, Santos F, Relva A, Vasques H, Gomes A, Guimarães A, Moreira A. Benign Metastasizing Leiomyomatosis to the Skin and Lungs, Intravenous Leiomyomatosis, and Leiomyomatosis Peritonealis Disseminata: A Series of Five Cases. Oncologist 2022; 27:e89-e98. [PMID: 35305104 PMCID: PMC8842467 DOI: 10.1093/oncolo/oyab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/09/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Benign metastasizing leiomyomatosis (BML) is a rare disease that typically occurs in women with a history of uterine leiomyomatosis. Benign metastasizing leiomyomatosis occurs more frequently in the lungs but may also develop in other organs and tissues. Other unusual variants of extra-uterine leiomyomatosis include intravenous leiomyomatosis (IVL) and leiomyomatosis peritonealis disseminata (LPD). In this article, three cases of BML are presented. One case, in a premenopausal woman, presented cutaneous metastases. We also present a case of IVL and a case of LPD, which occurred in postmenopausal women. Given the rarity of BML, IVL, and LPD, the authors reviewed the literature and herein discuss the implications for treatment in all five cases. Evidence for treating BML, IVL, and LPD is still scarce, and data available from our series and other small series seem to point to the patient’s hormonal status playing a fundamental part in the treatment plan. Furthermore, a collecting bag when performing excision of uterine leiomyomas may help avoid the potential spreading of leiomyomatosis. Hysterectomized patients with chronic cough, frequent respiratory infections, abdominal discomfort, right heart failure, or non-specific symptoms should be actively screened for BML, IVL, and LPD. Treatment should be individualized according to each patient’s hormonal status and desires.
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Affiliation(s)
- João Boavida Ferreira
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Filipa Santos
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Andreia Relva
- Serviço de Ginecologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Hugo Vasques
- Serviço de Cirurgia Geral, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Gomes
- Serviço de Ginecologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Guimarães
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - António Moreira
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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9
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Whang SG, Gholson M, Rushing RS. Benign metastasizing leiomyoma, a rare imposter of metastatic cervical cancer. Gynecol Oncol Rep 2021; 38:100893. [PMID: 34926773 PMCID: PMC8651751 DOI: 10.1016/j.gore.2021.100893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Differential for necrotic pelvic mass with pulmonary nodules. Benign metastasizing leiomyoma in woman with limited surgical history. Efficacy of estrogen depletion therapy for benign metastasizing leiomyoma.
Benign metastasizing leiomyoma (BML) is a rare variant of common benign smooth muscle neoplasm. We report a case of BML in a 45-year-old premenopausal woman with a significant smoking history and no previous history of cervical cancer screening. The patient presented with vaginal bleeding, abdominal pain, a necrotic mass in the vagina, and an incidental finding of diffuse pulmonary nodules on chest imaging. A total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) was performed for symptomatic management and adequate tissue sampling followed by fine needle biopsy of a pulmonary lesion. The pedunculated uterine mass and the pulmonary nodule were both consistent with smooth muscle neoplasm suggestive of myoma. Six-months following surgery, the patient is asymptomatic with partial regression of her lung nodules and no evidence of new or enlarging lesions while on treatment with Megestrol.
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Affiliation(s)
- S G Whang
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | | | - R S Rushing
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States.,Compass Oncology, United States.,Society of Gynecologic Oncology, United States
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10
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Metastatic uterine fibroid in postmenopausal woman suspected of leiomyosarcoma: A case report and literature review. J Taibah Univ Med Sci 2021; 17:614-618. [PMID: 35983455 PMCID: PMC9356359 DOI: 10.1016/j.jtumed.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Benign metastatic leiomyoma is a unique event presenting most commonly in premenopausal women especially those with a previous history of gynecological surgery as management of uterine fibroids. In this case report, we investigate a rare case of benign metastatic leiomyoma in a 54-year-old postmenopausal female presented with a huge pelvic mass that was rapidly growing along with pulmonary nodules. The patient is suspected to have leiomyosarcoma which is eventually confirmed pathologically as benign metastatic leiomyoma. Although rare, describing the challenging diagnostic and management approach of such entity is essential and to consider it one of the differential diagnoses of patients who present with similar history.
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11
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Mathey MP, Duc C, Huber D. Intravenous leiomyomatosis: Case series and review of the literature. Int J Surg Case Rep 2021; 85:106257. [PMID: 34343794 PMCID: PMC8350006 DOI: 10.1016/j.ijscr.2021.106257] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up. Leiomyomas beyond the uterus (LBU) is defined by benign smooth muscle cell tumor outside of the uterus. Sub classification of this entity are intravenous leiomyomatosis (IVL), benign metastasizing leiomyomas (BML), diffuse peritoneal leiomyomatosis (DPL), retroperitoneal leiomyomas and parasitic leiomyomas. The differential diagnosis of IVL should include benign myoma, thrombus, leiomyosarcoma, soft tissue sarcoma, lymphoma, cardiac myxoma, tumor thrombosis of Wilms tumor or metastasis. Treatment of IVL is usually surgery but there is no consensus about the the optimal approach. Adjuvant therapy sur as bilateral salpingoophorectomy followed by hormonothetherapy have to be balanced with their side effects. Despite being histologically benign, BML shows the metastatic potential of LBU. Because of a high rate of recurrence estimated of 16.6% to 30%, long term follow up is recommended even after radical surgery.
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Affiliation(s)
- M P Mathey
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - C Duc
- Department of Pathology, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland
| | - D Huber
- Department of Gynaecological Surgery, Hospital de Sion, Avenue du Grand-Champsec 80, 1951 Sion, Switzerland; Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
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12
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Fadel S, Villeneuve PJ, Gupta A, Strickland S, Gomes M. Benign Metastasizing Leiomyoma in the Lung Presenting in a Phyllodes-Like Pattern Mimicking a Biphasic Tumor: A Case Report. Int J Surg Pathol 2021; 30:221-226. [PMID: 34287076 PMCID: PMC8899804 DOI: 10.1177/10668969211035059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are
far more commonly primary or metastatic soft tissue tumors with entrapped native
respiratory epithelium, giving the false impression of a biphasic tumor. We report a case
of bilateral benign metastasizing leiomyomas in a 69-year-old female where the tumor cells
diffusely entrapped native respiratory glands in a phyllodes-like pattern. The
radiographic characteristics and histologic appearance were not immediately diagnostic and
covered a wide differential. Reaching the final diagnosis required the use of
immunohistochemical studies as well as correlation with the patient's history and
radiographic findings. To the best of our knowledge, this is the first report of pulmonary
benign metastasizing leiomyoma presenting in a phyllodes-like pattern. This case
illustrates the importance of considering entrapment of native lung epithelium in the
differential diagnosis of biphasic-appearing lung tumors.
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Affiliation(s)
- Saleh Fadel
- The Ottawa Hospital, 12365University of Ottawa, Ottawa, ON, Canada
| | | | - Ashish Gupta
- The Ottawa Hospital, 12365University of Ottawa, Ottawa, ON, Canada
| | - Sarah Strickland
- The Ottawa Hospital, 12365University of Ottawa, Ottawa, ON, Canada
| | - Marcio Gomes
- The Ottawa Hospital, 12365University of Ottawa, Ottawa, ON, Canada
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13
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Le Guen P, Poté N, Morer L, Taillé C. Spontaneous Regression of Miliary Pattern after Delivery. Benign Pulmonary Metastasizing Leiomyoma. Am J Respir Crit Care Med 2021; 203:906-907. [PMID: 33285086 DOI: 10.1164/rccm.202005-1932im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pierre Le Guen
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence Constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France; and
| | - Nicolas Poté
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pathologie, Paris, France
| | - Lise Morer
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence Constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France; and
| | - Camille Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence Constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France; and
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14
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Fan R, Feng F, Yang H, Xu K, Li S, You Y, Wan X, Zhu L. Pulmonary benign metastasizing leiomyomas: a case series of 23 patients at a single facility. BMC Pulm Med 2020; 20:292. [PMID: 33172427 PMCID: PMC7653756 DOI: 10.1186/s12890-020-01330-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary benign metastasizing leiomyoma (PBML) is a rare disease characterized by leiomyoma of benign histopathology existing in the lungs. Because of its rarity, limited literature with a single case or small number of cases has been regarding to the clinical course, pathology or management of PBML. Methods A retrospective study was performed of all PBML cases diagnosed and managed at Peking Union Medical College Hospital (PUMCH) from 2001 to 2019. The clinical characteristics, pathology, treatment and outcomes of each case were studied. Results There were 25 PBML patients identified in the 19-year period in PUMCH, and 23 patients’ data was analyzed. The median age at diagnosis was 46 years. There were 7 patients (30.4%) diagnosed with postmenopausal status. Two patients (8.7%) had no uterine leiomyoma, and 3 patients (13.0%) had no gynecologic surgery history. Immunohistochemistry of most lesions demonstrated positive for desmin, SMA and Estrogen/Progesterone Receptors; and negative for S-100 were shown in 7 cases. After curative or diagnostic surgeries for the PBML, several treatments from observation to medical or surgical castration were performed. Nine premenopausal patients preserved their ovaries at first. At a median follow-up of 8 years, 3 patients finally had oophorectomy. Conclusions PBML is a rare disease and should be treated by individualization according to the patients’ age, symptoms and extent of lesion. Curative surgery for patients with limited lesions can achieve the complete response. For patients that are young and asymptomatic, close observation is recommended as the first choice. All patients should undergo long-term surveillance.
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Affiliation(s)
- Rong Fan
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1, Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Fengzhi Feng
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1, Shuai Fu Yuan, Dong Cheng District, Beijing, China.
| | - Hua Yang
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1, Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Kaifeng Xu
- Department of Pulmonary and Critical Care Medicine, PUMCH, CAMS & PUMC, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, PUMCH, CAMS & PUMC, Beijing, China
| | - Yan You
- Department of Pathology, PUMCH, CAMS & PUMC, Beijing, China
| | - Xirun Wan
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1, Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Lan Zhu
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1, Shuai Fu Yuan, Dong Cheng District, Beijing, China
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15
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Aoki K, Yamamoto T, Terauchi R, Mori T, Shirai T, Kitawaki J. Benign metastasizing leiomyoma in femur and thigh with a history of uterine leiomyoma: A case report and literature review. J Obstet Gynaecol Res 2020; 47:812-817. [PMID: 33164252 DOI: 10.1111/jog.14545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/08/2020] [Accepted: 10/18/2020] [Indexed: 01/29/2023]
Abstract
Benign metastasizing leiomyoma (BML) is a rare disease that is characterized by well-differentiated smooth muscle tumors occurring extrauterine site in women with a history of uterine leiomyoma. The lung is the most common metastatic site for BML. A 48-year-old woman, who had histories of laparoscopic myomectomy and transabdominal total hysterectomy, visited an orthopedics complaining of a mass in her left thigh and difficulty in walking. Magnetic resonance imaging (MRI) and fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography revealed multiple mass lesions in her both thighs and left femur as well as both lungs. She was referred to our hospital for further examination. We diagnosed her tumors as BML according to histopathological analysis of tumor specimen. The left thigh tumor was resected and the treatment with gonadotropin releasing hormone agonist regressed the size of the residual tumors by approximately 30%. BML should be considered when multiple soft tissue tumors are found in women with a history of leiomyomas.
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Affiliation(s)
- Kota Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Takuro Yamamoto
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Ryu Terauchi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Toshiharu Shirai
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
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16
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Libertini M, Hallin M, Thway K, Noujaim J, Benson C, van der Graaf W, Jones RL. Gynecological Sarcomas: Molecular Characteristics, Behavior, and Histology-Driven Therapy. Int J Surg Pathol 2020; 29:4-20. [PMID: 32909482 DOI: 10.1177/1066896920958120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gynecological sarcomas represent 3% to 4% of all gynecological malignancies and 13% of all sarcomas. The uterus is the most frequent primary site (83%); less frequently sarcomas are diagnosed originating from the ovary (8%), vulva and vagina (5%), and other gynecologic organs (2%). As the classification of gynecologic sarcomas continues to diversify, so does the management. Accurate histopathologic diagnosis, utilizing appropriate ancillary immunohistochemical and molecular analysis, could lead to a more personalized approach. However, there are subtypes that require further definition, with regard to putative predictive markers and optimal management. The aim of this review is to highlight the importance of accurate diagnosis and classification of gynecologic sarcoma subtypes by the surgical pathologist in order to provide more tailored systemic treatment, and to highlight the increasing importance of close collaboration between the pathologist and the oncologist.
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Affiliation(s)
| | - Magnus Hallin
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | - Khin Thway
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | | | | | | | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
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17
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Dai HY, Guo SL, Shen J, Yang L. Pulmonary benign metastasizing leiomyoma: A case report and review of the literature. World J Clin Cases 2020; 8:3082-3089. [PMID: 32775390 PMCID: PMC7385613 DOI: 10.12998/wjcc.v8.i14.3082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary benign metastatic leiomyoma (PBML), which is very rare, is a type of benign metastatic leiomyoma (BML). Here, we report a case of PBML, finally diagnosed through multidisciplinary team (MDT) discussions, and provide a literature review of the disease.
CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography (HRCT) scan. Her medical history included total hysterectomy for uterine leiomyoma. The patient was diagnosed with PBML, on the basis of her clinical history, imaging manifestations, and computed tomography (CT)-guided percutaneous lung puncture biopsy, via MDT discussions. As the patient was asymptomatic, she received long-term monitoring without treatment. A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.
CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT, PBML should be considered during diagnosis based on the clinical history, imaging manifestations, CT-guided percutaneous lung puncture biopsy, and MDT discussions.
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Affiliation(s)
- Hai-Yun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Shu-Liang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Li Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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18
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Findakly D, Wang J. Molecular Profiling of Benign Metastasizing Leiomyoma of the Uterus Revealing Unique Novel Therapeutic Targets. Cureus 2020; 12:e7701. [PMID: 32431980 PMCID: PMC7233500 DOI: 10.7759/cureus.7701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Extra-uterine manifestations of benign uterine leiomyoma (fibroids) are rare. Benign metastasizing leiomyoma (BML) comprises an uncommon variant characterized by metastatic lung nodules. The pathologic characteristics for BML are well known in the literature; however, the underlying biology and molecular mechanisms remain poorly understood. We present a case of a 43-year-old woman who presented to the hospital complaining of dyspnea and lower extremity edema. Medical history includes a previous hysterectomy for leiomyomata two years prior. A reduced ejection fraction and right atrium globular filling defect are seen on transthoracic echo (TTE). CT scans of the chest, abdomen, and pelvis reported pelvic mass with an extensive inferior vena cava (IVC) thrombus extending into the right atrium, which was subsequently completely resected. Subsequent histopathology for the thrombus reported intravascular leiomyomatosis (IVL) and pelvic mass reported benign leiomyoma. Two years later, the symptoms recurred, and a chest CT revealed new pulmonary nodules. Subsequent pathology from a biopsy of these nodules was consistent with BML with ER+/PR+ on immunohistochemical staining. Genetic testing showed amplification of JUN, cyclin-dependent kinase 4 (CDK4), and MCL1, and loss of SUFU, AT-rich interaction domain 1A (AR1D1A), RB transcriptional corepressor 1 (RB1), and hepatocyte nuclear factor 1-alpha (HNF1A). The patient deemed to be a poor surgical candidate, and, therefore, she was started on hormonal treatment with leuprolide and letrozole. The disease remained stable upon follow-up at 48 months. Here, we report novel genomic profiling findings for the first time in a patient with a newly diagnosed BML. These findings may suggest molecular evidence that IVL may not be as benign as previously thought. Our study further highlights the value of genetic profiling in the understanding of this tumor's behavior and identification of new patient-specific therapeutic targets.
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Affiliation(s)
- Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Jue Wang
- Genitourinary Oncology, Creighton University School of Medicine/University of Arizona Cancer Center at Dignity Health St. Joseph's, Phoenix, USA
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19
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Benign leiomyoma with multiple metastases to vertebrae and calvarium: An index case with comprehensive review of endocrine targets. Neurosurg Rev 2020; 44:289-300. [PMID: 32078084 DOI: 10.1007/s10143-020-01268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
"Benign" metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as "benign" despite metastasis is their pathological features with low mitotic counts, lack of or minimal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metastases of BMLs were very rarely reported. In treatment of these tumors, hysterectomy and GnRH modifier treatments are widely employed. GnRH agonists act by desensitization and downregulation of the GnRH receptors, while GnRH antagonists act via the canonical competitive blockage. These treatments reduce FSH and LH levels, thereby reducing the systemic levels of sex steroids which stimulate leiomyoma growth. However, leiomyomas inherently harbor aromatase activity and synthesize their own estrogen; hence, treatment with systemic estrogen antagonists may provide better tumor control. Another important factor in BML pathogenesis is progesterone, and both progesterone receptor antagonists and high-dose progesterone receptor agonists may reduce BML growth. Following surgical treatment of the calvarial mass and radiotherapy of the vertebral metastatic foci, our BML case was successfully managed with hysterectomy and anastrozole treatment. Higher awareness of BML cases and their molecular endocrinological features in the neurosurgical community may pave to develop better strategies for treatment of these tumors causing high morbidity.
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20
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Sun R, Guan H, Li H, Bai Y, Wang F, Li C. Computed tomography evaluation of extensive intravenous angioleiomyoma: a case report. BMC Med Imaging 2020; 20:13. [PMID: 32028907 PMCID: PMC7006090 DOI: 10.1186/s12880-020-0417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Uterine angioleiomyoma is a rare variant of leiomyoma, and the main therapy is complete surgery. This study introduces the benefit of three-dimensional computed tomography reconstruction for preoperative preparation. Case presentation A 50-year-old woman presented because of chest distress after activity, with worsening symptoms. After examination, the final diagnosis was uterine angioleiomyoma. The tumour originated in the uterus; grew into the right iliac vein; coursed along the iliac vein, inferior vena cava, and right atrium; and finally invaded the right ventricle. To best complete the surgery, a multidisciplinary surgery was selected. Before the surgery, a three-dimensional computed tomography reconstruction model was created to assess the tumour status, and this model enabled the surgery to be completed successfully. Conclusion Three-dimensional computed tomography reconstruction is of great significance for the preoperative diagnosis of uterine angioleiomyoma and the formulation of surgical treatment plans. Based on its vivid images, surgeons can perform operations more effectively and safely.
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Affiliation(s)
- Rui Sun
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Hongwei Guan
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Hui Li
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Yixuan Bai
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
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21
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Sala ML, von der Thusen JH, Korteweg C, Quarles van Ufford HME. An unusual cause of multiple incidental lung nodules. Clin Case Rep 2020; 8:221-223. [PMID: 31998524 PMCID: PMC6982518 DOI: 10.1002/ccr3.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Cystic or cavitating lung nodules may reflect an additional diagnostic challenge in benign metastasizing leiomyoma. Our case underlines the importance of combining clinical and radiological findings with specific pulmonary pathology consultation.
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Affiliation(s)
- Michiel L. Sala
- Department of RadiologyHaaglanden Medical CenterThe HagueThe Netherlands
| | - Jan H. von der Thusen
- Department of PathologyHaaglanden Medical Center and Erasumus Medical CenterThe Hague and RotterdamThe Netherlands
| | - Christine Korteweg
- Department of PulmonologyHaaglanden Medical CenterThe HagueThe Netherlands
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22
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Abstract
RATIONALE Pulmonary benign metastasizing leiomyoma (PBML) is rare, usually occurs in women who underwent hysterectomy during the reproductive years, and has no obvious clinical symptoms. A full understanding of the characteristics of PBML is important for its sequential treatment and prognosis. PATIENT CONCERNS In this report, a 36-year-old female patient with previous uterine leiomyoma who underwent 3 surgical resections of the uterus, bilateral fallopian tubes, and partial omentum was investigated. The physical examination revealed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. DIAGNOSES Chest computed tomography (CT) confirmed a tumor in the right lower lobe and mediastinum and a solid nodule in the right middle lobe. Further positron-emission tomography computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) of the whole body showed mildly intense accumulation of 18F-FDG in the tumor (maximum standardized uptake value [SUV max], 2.6). A pathological examination then confirmed the presence of fibrous and vascular tissue after CT-guided percutaneous biopsy of the tumor in the right lower lobe. Additionally, surgical resection of the tumor and nodule was performed for histological analysis and immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR). INTERVENTIONS The patient underwent complete tumor surgical resection and nodule wedge resection. OUTCOMES No postoperative complications occurred. No recurrence or other signs of metastasis were found during an 18-month follow-up observation period. CONCLUSION In this case, lung and mediastinal metastasis of uterine fibroids was observed. However, depending on only a postoperative histological analysis is insufficient for the diagnosis of PBML. Histological analysis combined with an evaluation of the expression levels of ER and PR is crucial for the diagnosis and treatment of PBML.
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Affiliation(s)
| | | | | | - Yuwei Guo
- Department of pathology, Hebei Medical University Fourth Hospital
| | - Mengdi Cong
- Department of pathology, Children's hospital of Hebei Province, Shijiazhuang, China
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23
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Yuan X, Sun Y, Jin Y, Xu L, Dai H, Wang J, Zhang Z, Chen X. Multiple organ benign metastasizing leiomyoma: A case report and literature review. J Obstet Gynaecol Res 2019; 45:2132-2136. [PMID: 31381225 DOI: 10.1111/jog.14066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Xiong Yuan
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Ying Sun
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Yichao Jin
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Lei Xu
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Huihua Dai
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Jun Wang
- Department of Radiologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Zhihong Zhang
- Department of Pathologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xing Chen
- Department of Gynecologythe First Affiliated Hospital of Nanjing Medical University Nanjing China
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24
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Abstract
RATIONALE Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign. PATIENT CONCERNS A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy. DIAGNOSES Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made. INTERVENTIONS The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully. OUTCOMES Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence. LESSONS The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
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25
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Nguyen TC, Drew PA, Dang LH, Yuan C. Cancer Genes Mutations in Benign Metastasizing Leiomyoma: A Case Report. Cureus 2019; 11:e5154. [PMID: 31523581 PMCID: PMC6741366 DOI: 10.7759/cureus.5154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Benign metastasizing leiomyoma is a very uncommon clinicopathologic entity with unknown molecular pathogenesis. We present a case of a 40-year-old woman who has a history of surgical resection of a large uterine leiomyoma and then subsequently presented with benign metastasizing leiomyomas to her lungs. Due to her tumor being estrogen receptor (ER) positive and progesterone receptor (PR) positive, she was empirically treated with anastrozole with sustained clinical benefit. Molecular studies with Foundation One testing showed low mutational burden and mutational variants in five known cancer genes. Our findings have important clinical and pathogenetic implication for metastasizing uterine leiomyoma.
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Affiliation(s)
- Thu-Cuc Nguyen
- Internal Medicine, University of Central Florida, Orlando, USA
| | - Peter A Drew
- Pathology, University of Florida, Gainesville, USA
| | - Long H Dang
- Hematology and Oncology, Ochsner Health System, Baton Rouge, USA
| | - Cai Yuan
- Hematology and Oncology, University of Florida, Gainesville, USA
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26
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Declas E, Lucot JP. [Extra uterine leiomyomatosis: Review of the literature]. ACTA ACUST UNITED AC 2019; 47:582-590. [PMID: 31255836 DOI: 10.1016/j.gofs.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 11/24/2022]
Abstract
Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.
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Affiliation(s)
- E Declas
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France.
| | - J P Lucot
- Service de gynécologie-obstétrique, hôpital Saint-Vincent-de-Paul, groupe des hôpitaux de l'institut catholique de Lille (GHICL), boulevard de Belfort, 59000 Lille, France
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27
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Devereaux KA, Schoolmeester JK. Smooth Muscle Tumors of the Female Genital Tract. Surg Pathol Clin 2019; 12:397-455. [DOI: 10.1016/j.path.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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28
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Hernández-Plata E, Velázquez-Wong AC, Jiménez-Ramírez C, Fernández-Ramírez F, Galicia-Sánchez LM, Flores-García CA, Hernández-Hernández JM, Rosas-Vargas H, Huicochea-Montiel JC, Espinosa-Poblano E. Identification of genomic copy number variations in lung benign metastasizing leiomyomatosis. CLINICAL RESPIRATORY JOURNAL 2019; 13:105-113. [PMID: 30597752 DOI: 10.1111/crj.12987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/01/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Lung metastasizing leiomyomatosis (LML) is an infrequently diagnosed pathology developed after sexual maturation, commonly preceded by uterine myomas. Symptoms can include difficulties to breathe, cough, dyspnea and pain, because of mechanical obstruction exerted by expanding local growing leiomyomas. Lung leiomyomas are normally detected by imaging studies, but nowadays the precise diagnosis demands histological characterization of biopsies obtained from the affected tissues. The purpose of the present study was to determine the presence of genomic alterations in circulating cells of LML. METHODS Immunohistochemical characterization of a lung biopsy extracted by thoracoscopy was performed. Pathologic proliferative smooth muscle cells were observed in a major lung metastasizing nodule, with a growing pattern similar to a uterine myoma. The presence of cellular linages different to smooth muscle cells was discarded by testing the presence of a battery of molecular markers. Also, a normal karyotype was determine by GTG-banding cytogenetic study, but a high density microarray analysis revealed six submicroscopic chromosomal regions displaying genomic abnormalities: microduplications were detected on chromosomes 4, 14, 17 and 22; and microdeletions on chromosomes 8 and 10. CONCLUSION This study remarks the relevance of submicroscopic chromosomal analysis of unusual pathologic conditions such as Benign Metastasizing Leiomyomatosis. This propitiate a better understanding of the molecular basis on the development of the pathology, in order to reckon on minimally invasive diagnostic methods, and to design appropriate treatments.
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Affiliation(s)
- Everardo Hernández-Plata
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México.,Departamento de Neuropatología Molecular, Instituto de Fisiología Celular, UNAM, Ciudad de México, México
| | - Ana Claudia Velázquez-Wong
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Carmina Jiménez-Ramírez
- Unidad Médica de Alta Especialidad, Hospital de traumatología, Dr. Victorio de la Fuente Narváez Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | | | - Luz María Galicia-Sánchez
- Servicio de Neumología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - César Antonio Flores-García
- Departamento de Patología, Unidad Médica de Alta Especialidad, Hospital de Cardiología del Centro Médico Nacional, Siglo XXI, IMSS, Ciudad de México, México
| | - José Manuel Hernández-Hernández
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social IMSS, Ciudad de México, México
| | - Juan Carlos Huicochea-Montiel
- Departamento Clínico de Genética Médica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eliseo Espinosa-Poblano
- Servicio de Neumología, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional, Siglo XXI, IMSS, Ciudad de México, México
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29
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Belmarez JA, Latifi HR, Zhang W, Matthews CM. Simultaneously occurring disseminated peritoneal leiomyomatosis and multiple extrauterine adenomyomas following hysterectomy. Proc (Bayl Univ Med Cent) 2019; 32:126-128. [PMID: 30956607 DOI: 10.1080/08998280.2018.1520555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL), also known as leiomyomatosis peritonealis disseminata, is a rare condition characterized by multiple benign smooth muscle tumors proliferating along the peritoneal surfaces. In previous case reports, these tumors have been noted to involve the ovaries, round ligaments, bladder, bowel, peritoneum, and mesentery. To date, approximately 150 cases of DPL have been described in the literature. Extrauterine adenomyoma is an even rarer entity, involving benign tumors composed of smooth muscle tissue, endometrial glands, and endometrial stroma arising outside the uterus. Only 22 cases have previously been reported. We describe a woman presenting with both DPL and multiple extrauterine adenomyomas several years after undergoing laparoscopic morcellated hysterectomy.
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Affiliation(s)
| | - Hamid R Latifi
- Department of Radiology, Baylor University Medical CenterDallasTexas
| | - Wei Zhang
- Department of Pathology, Baylor University Medical CenterDallasTexas
| | - Carolyn M Matthews
- Division of Gynecologic Oncology, Department of Oncology, Baylor University Medical CenterDallasTexas
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30
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Affiliation(s)
- Boris I Medarov
- Division of Pulmonary, Critical Care and Sleep Medicine, Albany Medical College, Albany, New York
| | - Malik M H S Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Albany Medical College, Albany, New York
| | - Aakash Modi
- Division of Pulmonary, Critical Care and Sleep Medicine, Albany Medical College, Albany, New York
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31
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Rosa P, Pidhorecky I. A Case of Intravenous Leiomyomatosis with Involvement of a Renal Vein. Ann Vasc Surg 2018; 53:271.e11-271.e13. [DOI: 10.1016/j.avsg.2018.05.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022]
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32
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Jo HC, Baek JC. Case of pulmonary benign metastasizing leiomyoma from synchronous uterine leiomyoma in a postmenopausal woman. Gynecol Oncol Rep 2018; 26:33-36. [PMID: 30225333 PMCID: PMC6138877 DOI: 10.1016/j.gore.2018.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/19/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022] Open
Abstract
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. Benign metastasizing leiomyoma (BML) can occur in postmenopausal woman without uterine surgery. BMLs in postmenopausal woman can cause respiratory and gynecologic symptoms. Total abdominal hysterectomy and bilateral salpingo-oophorectomy could reduce lung BML in postmenopausal woman.
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Affiliation(s)
- H C Jo
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J C Baek
- Department of Obstetrics and Gynecology, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Quaranta M, Mehra G, Nath R, Culora G, Sayasneh A. A rare case of refractory disseminated leiomyomatosisperitonealis complicated by cauda equina compression. Eur J Obstet Gynecol Reprod Biol 2018; 229:205-207. [PMID: 30181024 DOI: 10.1016/j.ejogrb.2018.08.580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/11/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- M Quaranta
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - G Mehra
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - R Nath
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - G Culora
- Department of Histopathology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - A Sayasneh
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, United Kingdom. c: School of Medical Education, Faculty of Life Sciences and Medicine, King's College, Guy's Campus, St Thomas Street, London, SE1 9RT, United Kingdom; School of Medical Education, Faculty of Life Sciences and Medicine, King's College, Guy's Campus, St Thomas Street, London, SE1 9RT, United Kingdom.
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Aberrant uterine leiomyomas with extrauterine manifestation: intravenous leiomyomatosis and benign metastasizing leiomyomas. Obstet Gynecol Sci 2018; 61:509-519. [PMID: 30018906 PMCID: PMC6046354 DOI: 10.5468/ogs.2018.61.4.509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/17/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Intravenous leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of benign uterine leiomyomas with extrauterine manifestations. Categorizing the extent of disease allows clinicians to delineate the clinical spectrum and the level of sophistication for complete surgical resection. Methods Twelve patients with IVL and BML were reviewed. They were divided into early versus late stage disease groups, and initial manifestation, clinical characteristics, laboratory values, surgical pathology, and follow up data were summarized. Results Patients were mostly pre- or peri-menopausal and parous. Patients with late stage disease were more likely to present with cardiac symptoms or abnormal findings on chest X-ray, whereas those with early stage disease presented with classical leiomyoma symptoms including heavy menstrual bleeding, increased myoma size, or lower abdominal discomfort. Tumor marker levels were within normal ranges. A trend of higher neutrophil to leukocyte ratio was observed in the late versus the early stage group (10.4 vs. 1.51, P=0.07); the platelet leukocyte ratio was statistically higher in patients with late stage IVL (0.23 vs. 0.13, P=0.04). The overall recurrence rate was 25%. No recurrence was observed in stage I or stage III IVL groups, while 50% of the stage II IVL group showed recurrence in the pelvic cavity. Conclusion IVL and BML are benign myoma variants with paradoxically metastatic clinical presentation. Careful inquiry of systemic symptoms, the presence of underlying systemic inflammation, and a high index of suspicion are required for preoperative diagnosis. Furthermore, a multidisciplinary approach is necessary to improve outcomes of surgical resection.
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[Benign pulmonary metastases from a leiomyoma]. Rev Mal Respir 2018; 35:552-555. [PMID: 29793807 DOI: 10.1016/j.rmr.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/07/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Benign metastasizing leiomyoma (BML) is a rare cause of pulmonary nodules. They can occur in women of reproductive age who have undergone hysterectomy for uterine leiomyoma. OBSERVATION We report the case of a 46-year-old women, who was incidentally found to have bilateral pulmonary cavitating nodules. Pathology exam was consistent with BML. CONCLUSION Although BML is a rare cause of pulmonary nodules, it should be considered as one of the possibilities especially in young women with a history of hysterectomy for leiomyoma.
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The Heart as a Site of Metastasis of Benign Metastasizing Leiomyoma: Case Report and Review of the Literature. Case Rep Cardiol 2018; 2018:7231326. [PMID: 29951323 PMCID: PMC5987332 DOI: 10.1155/2018/7231326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/03/2018] [Indexed: 11/17/2022] Open
Abstract
Uterine leiomyomas are the most common gynecological tumors in premenopausal women. While the lung is the most common extrauterine organ afflicted, benign metastasizing leiomyomas (BML) of the heart are rarities. We report an incidental finding of a cardiac mass in a 36-year-old woman who presented to the Emergency Department after a motor vehicle accident. CT scan of the chest revealed 2 well-circumscribed pulmonary nodules and a filling defect in the right ventricle. Echocardiogram showed a 4 cm mass attached to the right ventricular (RV) septum. The cardiac tumor was resected and showed benign histologic features. Immunohistochemical staining was positive for smooth muscle α-actin and desmin, as well as estrogen and progesterone receptors, consistent with the diagnosis of uterine leiomyoma.
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Disseminated peritoneal leiomyomatosis 10 years after a laparoscopic myomectomy: A brief communication. Eur J Obstet Gynecol Reprod Biol 2018; 224:58-59. [PMID: 29547807 DOI: 10.1016/j.ejogrb.2018.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 11/23/2022]
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Alexandre L, Taillieu F, Arlet JB, Passeron A, Michon A, Bats AS, Pouchot J, Ranque B. [Benign metastasizing leiomyoma: An unusual cause of aggressive femoral bone tumor]. Rev Med Interne 2018; 39:431-434. [PMID: 29502928 DOI: 10.1016/j.revmed.2018.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/27/2018] [Accepted: 02/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare condition characterized by histologically benign "metastatic" smooth muscle tumors, which can affect women with history of uterine surgery. We report the case of a patient with bone metastases of BML. CASE REPORT A 78-year-old woman who had undergone uterine surgery six years before hospital admission, was diagnosed with large pulmonary and pleural metastases that necessitated surgical removal. Pathological examination allowed the diagnosis of BML with positive staining for estrogen and progesterone receptors. Three years later, a BML metastasis in the right femoral diaphysis was unexpectedly discovered and treated by osteosynthesis because of a high risk of fracture. Despite an aromatase-inhibitor treatment, new lungs lesions appeared in the next few months. CONCLUSION BML is a potential cause of aggressive, although histologically benign, bone tumor in women with a history of uterine surgery.
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Affiliation(s)
- L Alexandre
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - F Taillieu
- Service de radiologie, hôpital Européen-Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Passeron
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A-S Bats
- Service de gynécologie, hôpital Européen-Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France.
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Jiang J, He M, Hu X, Ni C, Yang L. Deep sequencing reveals the molecular pathology characteristics between primary uterine leiomyoma and pulmonary benign metastasizing leiomyoma. Clin Transl Oncol 2018; 20:1080-1086. [PMID: 29484624 DOI: 10.1007/s12094-018-1847-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Pulmonary benign metastasizing leiomyoma (PBML), a rare condition of smooth muscle tumor, originates from women with a history of uterine leiomyoma (LM). Numerous genetic studies of uterine LM have been reported; however, there are few cytogenetic and molecular descriptions of PBML. Therefore, molecular subtyping is necessary to understand the pathogenesis of metastasizing sites. METHODS Driver gene exon-capture sequencing was performed on one patient's peripheral blood, paraffin samples from primary uterine LM, and lung metastasizing leiomyoma 8 years later. RESULTS The results showed that the same missense mutations of BLMH, LRP2, MED12, SMAD2, and UGT1A8 were concurrently mutated in the primary uterine LM and the PBML. Moreover, a splice mutation of PTEN (c.492+1G>A) was uniquely identified in the lung metastasis of the patient. CONCLUSION This study indicates that the metastatic lung lesions were derived from the same malignant cell clone of uterine LMs and later acquired the novel driver mutations in the evolution of the tumor. In addition, driver gene sequencing can discriminate somatic driver mutations as biological indicators of potential malignant leiomyoma and can identify pathogenic variation driver mutations, which could be used for individualized therapy.
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Affiliation(s)
- J Jiang
- Department of Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, People's Republic of China
| | - M He
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - X Hu
- Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, Shang Tang Road 158, Hangzhou, 310014, Zhejiang, People's Republic of China.
| | - C Ni
- Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, Shang Tang Road 158, Hangzhou, 310014, Zhejiang, People's Republic of China. .,Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang, People's Republic of China.
| | - L Yang
- Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, Shang Tang Road 158, Hangzhou, 310014, Zhejiang, People's Republic of China.
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Sõritsa D, Teder H, Roosipuu R, Tamm H, Laisk-Podar T, Soplepmann P, Altraja A, Salumets A, Peters M. Whole exome sequencing of benign pulmonary metastasizing leiomyoma reveals mutation in the BMP8B gene. BMC MEDICAL GENETICS 2018; 19:20. [PMID: 29386003 PMCID: PMC5793349 DOI: 10.1186/s12881-018-0537-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023]
Abstract
Background Benign metastasizing leiomyoma (BML) is an orphan neoplasm commonly characterized by pulmonary metastases consisting of smooth muscle cells. Patients with BML have usually a current or previous uterine leiomyoma, which is therefore suggested to be the most probable source of this tumour. The purpose of this case report was to determine the possible genetic grounds for pulmonary BML. Case presentation We present a case report in an asymptomatic 44-year-old female patient, who has developed uterine leiomyoma with subsequent pulmonary BML. Whole exome sequencing (WES) was used to detect somatic mutations in BML lesion. Somatic single nucleotide mutations were identified by comparing the WES data between the pulmonary metastasis and blood sample of the same BML patient. One heterozygous somatic mutation was selected for validation by Sanger sequencing. Clonality of the pulmonary metastasis and uterine leiomyoma was assessed by X-chromosome inactivation assay. Conclusions We describe a potentially deleterious somatic heterozygous mutation in bone morphogenetic protein 8B (BMP8B) gene (c.1139A > G, Tyr380Cys) that was identified in the pulmonary metastasis and was absent from blood and uterine leiomyoma, and may play a facilitating role in the metastasizing of BML. The clonality assay confirmed a skewed pattern of X-chromosome inactivation, suggesting monoclonal origin of the pulmonary metastases. Electronic supplementary material The online version of this article (10.1186/s12881-018-0537-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deniss Sõritsa
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia. .,Elite Clinic, Sangla 63, 50407, Tartu, Estonia. .,Competence Centre on Health Technologies, Tartu, Estonia.
| | - Hindrek Teder
- Competence Centre on Health Technologies, Tartu, Estonia.,Institute of Biomedicine and Translational Medicine, Department of Biomedicine, University of Tartu, Tartu, Estonia
| | - Retlav Roosipuu
- Department of Pathology, Tartu University Hospital, Tartu, Estonia
| | - Hannes Tamm
- Department of Pathology, Tartu University Hospital, Tartu, Estonia
| | - Triin Laisk-Podar
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
| | - Pille Soplepmann
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.,Elite Clinic, Sangla 63, 50407, Tartu, Estonia.,Tartu University Hospital's Women's Clinic, Tartu, Estonia
| | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia.,Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andres Salumets
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia.,Institute of Biomedicine and Translational Medicine, Department of Biomedicine, University of Tartu, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maire Peters
- Institute of Clinical Medicine, Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.,Competence Centre on Health Technologies, Tartu, Estonia
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Castagneto Gissey L, Mariano G, Musleh L, Lepiane P, Colasanti M, Meniconi RL, Ranocchi F, Musumeci F, Antonini M, Ettorre GM. Massive pelvic recurrence of uterine leiomyomatosis with intracaval-intracardiac extension: video case report and literature review. BMC Surg 2017; 17:118. [PMID: 29187188 PMCID: PMC5707788 DOI: 10.1186/s12893-017-0306-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine leiomyomas represent the gynecological neoplasm with the highest prevalence worldwide. This apparently benign pathological entity may permeate into the venous system causing the so-called intravenous leiomyomatosis of the uterus (IVL). IVL may seldom extend to large caliber veins and reach the right cardiac chambers or pulmonary arteries and cause signs of right sided congestive heart failure and sudden death. Due to its low incidence, however, IVL with intracardiac extension is often misdiagnosed resulting in deferred treatment. No consensus has been obtained regarding the standard surgical approach to be used for this rare condition. We describe the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and provide a review of the literature, analyzing management and surgical outcomes. CASE PRESENTATION We present the case of a 46-year-old premenopausal woman presenting with lower-extremity edema, recurrent syncopes and a history of subtotal hysterectomy for multiple uterine fibroids. She was diagnosed with pelvic recurrence of uterine leiomyomatosis and IVL with cardiac involvement. A two-stage surgical excision of the intracardiac-intracaval mass and pelvic leiomyomatosis was performed. The patient had an uneventful recovery and no evidence of recurrence was observed on follow-up. CONCLUSIONS By virtue of the rarity of the present pathology, awareness is widely scarce and diagnosis is often delayed. Early recognition is difficult due to initial aspecific and subtle clinical manifestations. Nevertheless, suspicion should be held high in premenopausal women with known history of uterine leiomyomata, presenting with cardiovascular symptoms and evidence of a free-floating mass within the right cardiac chambers. In-depth imaging is crucial for defining its anatomical origin and relations. Prompt surgical treatment with radical excision of pelvic and intravenous leiomyomatosis guarantees favorable outcomes and excellent prognosis with low rates of recurrence, whereas delayed diagnosis and treatment exposes to increased risk of congestive heart failure and sudden death.
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Affiliation(s)
- Lidia Castagneto Gissey
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy. .,Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Germano Mariano
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Layla Musleh
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Pasquale Lepiane
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Roberto L Meniconi
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
| | - Federico Ranocchi
- Department of Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Mario Antonini
- Department of Anesthesia and Critical Care, INMI L. Spallanzani I.R.C.C.S, Rome, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo-Forlanini Hospital POIT - L. Spallanzani INMI, Rome, Italy
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Wu ES, Aguinaldo ET, Hussein YR, Suidan RS, Chi DS. Benign metastasizing leiomyomas thought to be nodal metastases in a case of ovarian cancer. Taiwan J Obstet Gynecol 2017; 56:564-565. [DOI: 10.1016/j.tjog.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 10/19/2022] Open
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A case of disseminated peritoneal leiomyomatosis after two laparoscopic procedures due to uterine fibroids. Wideochir Inne Tech Maloinwazyjne 2017; 12:110-114. [PMID: 28446940 PMCID: PMC5397541 DOI: 10.5114/wiitm.2017.66045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare disorder characterized by the presence of multifocal nodules and tumors composed of proliferating smooth muscle tissue, spread throughout the peritoneum. Estrogens and progesterone are considered to be the main factors initiating the formation of disseminated leiomyomatosis. Disseminated peritoneal leiomyomatosis is often asymptomatic, and acyclic vaginal bleeding or pain in the lower abdomen is associated with leiomyomatous rebuilt uterus corpus. Disseminated peritoneal leiomyomatosis can have other ambiguous presentation. The difficulty in DPL diagnosis is that it is not always accompanied by scattered leiomyomas and can occur after menopause. Some cases of DPL are associated with surgical procedures on uterine fibroids, especially with the use of a morcellator. We present the case of a 39-year-old woman with DPL who underwent laparoscopic myomectomy and laparoscopic supracervical hysterectomy before the final diagnosis of DPL. After the complete surgical treatment performed in our center the patient is free of symptoms.
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Pastré J, Juvin K, Grand B, Gibault L, Valcke J, Israël-Biet D. Pulmonary benign metastasizing leiomyoma presented as acute respiratory distress. Respirol Case Rep 2017; 5:e00216. [PMID: 28116091 PMCID: PMC5244452 DOI: 10.1002/rcr2.216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a very rare condition and is characterized by the presence of benign smooth muscle tumours in organs distant from the uterus, most commonly the lung. It generally affects women of reproductive age and prognostic is usually excellent. However, the course of the disease is unpredictable. We report here the case of a 76‐year‐old woman with a previous medical history of uterine benign leiomyomas in whom BML was acutely revealed by a respiratory distress due to voluminous pulmonary and pleural leiomyomas requiring surgical extraction. Clinical evolution was remarkable by resistance to medical treatment and development of rare bone localization. BML is a contradictory entity characterized by benign histological features but with metastatic potential. Pulmonologists as well as oncologists in charge of patients with multiple pulmonary nodules and a history of uterine leiomyoma should be aware of this potential diagnosis in order to implement appropriate diagnostic procedures for this benign tumour.
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Affiliation(s)
- Jean Pastré
- Université Paris Descartes Sorbonne Paris Cité and AP-HP Paris France; Service de Pneumologie Hôpital Européen Georges Pompidou Paris France
| | - Karine Juvin
- Service de Pneumologie Hôpital Européen Georges Pompidou Paris France
| | - Bertrand Grand
- Service de Chirurgie Thoracique Hôpital Européen Georges Pompidou Paris France
| | - Laure Gibault
- Service d'Anatomo-pathologie Hôpital Européen Georges Pompidou Paris France
| | - Judith Valcke
- Service de Pneumologie Hôpital Européen Georges Pompidou Paris France
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Aka N, Iscan R, Köse G, Kaban I. Benign Pulmonary Metastasizing Leiomyoma of the Uterus. J Clin Diagn Res 2016; 10:QD01-QD03. [PMID: 27790528 DOI: 10.7860/jcdr/2016/17888.8432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/07/2016] [Indexed: 11/24/2022]
Abstract
Benign Metastasizing Leiomyoma (BML) is a rare disease which represents with multiple leiomyomatous lesions in many tissues and organs especially in lungs. These patients have been operated for leiomyoma of the uterus. Here we report a case of a 41-year-old woman who was evaluated in a thoracic surgery hospital for dyspnea and bilateral nodules in chest roentgenogram. She had no history of neoplasm, only myomectomy history of uterine leiomyoma 10 years ago. Biopsy and histopathological examination were consistent with pulmonary leiomyoma. The patient was reffered to our clinic and we performed a total abdominal hysterectomy for her multiple uterine leiomyomas. The final diagnosis was 'benign pulmonary metastasizing leiomyoma'. After this diagnosis, surgical castration was performed but two years later, repeat imaging showed progression in pulmonary lesions and progesterone therapy was administered to the patient. Patient has continued on this hormonal therapy to date and during the 5-years follow-up, the persisting lesions in both lungs regressed.
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Affiliation(s)
- Nurettin Aka
- Associate Professor, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Reyyan Iscan
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Gültekin Köse
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Isik Kaban
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
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Huang BS, Yang MH, Wang PH, Li HY, Chou TY, Chen YJ. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016; 14:64. [PMID: 27716434 PMCID: PMC5053344 DOI: 10.1186/s12958-016-0200-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
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Affiliation(s)
- Ben-Shian Huang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.169, Siaoshe Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Hsin-Yang Li
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
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Mizoguchi C, Matsumoto H, Nasu K, Arakane M, Kai K, Narahara H. Intravenous leiomyomatosis treated with radical hysterectomy and adjuvant aromatase inhibitor therapy. J Obstet Gynaecol Res 2016; 42:1405-1408. [DOI: 10.1111/jog.13063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Chiharu Mizoguchi
- Department of Obstetrics and Gynecology; Oita University Faculty of Medicine; Oita Japan
| | - Harunobu Matsumoto
- Department of Obstetrics and Gynecology; Oita University Faculty of Medicine; Oita Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology; Oita University Faculty of Medicine; Oita Japan
| | - Motoki Arakane
- Diagnostic Pathology; Oita University Faculty of Medicine; Oita Japan
| | - Kentaro Kai
- Department of Obstetrics and Gynecology; Oita University Faculty of Medicine; Oita Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology; Oita University Faculty of Medicine; Oita Japan
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Abstract
Benign metastasizing leiomyoma (BML) is a rare and poorly characterized disease affecting primarily premenopausal women. Asymptomatic patients are often diagnosed incidentally by radiographs or other lung-imaging procedures performed for other indications, and the diagnosis is eventually confirmed by biopsy. Patients with BML are usually treated pharmacologically with antiestrogen therapies or surgically with oophorectomy or hysterectomy. Antiestrogen therapy is typically efficacious and, in general, most patients have a favorable prognosis. Asymptomatic patients with a confirmed diagnosis of BML, may be followed conservatively without treatment.
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Affiliation(s)
- Gustavo Pacheco-Rodriguez
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 5N307, 9000 Rockville Pike, Bethesda, MD 20892-1434, USA
| | - Angelo M Taveira-DaSilva
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 6D05, MSC-1590, 9000 Rockville Pike, Bethesda, MD 20892-1590, USA.
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Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection. Int J Vasc Med 2015; 2015:756141. [PMID: 26783463 PMCID: PMC4689968 DOI: 10.1155/2015/756141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.
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Commentary on the article "Pre-treatment with ulipristal acetate before ICSI procedure: a case report" published in Menopause Review 6/2013 (Przegląd Menopauzalny 2013; 6: 496-500). MENOPAUSE REVIEW 2015; 13:150-1. [PMID: 26327846 PMCID: PMC4520355 DOI: 10.5114/pm.2014.42719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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