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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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Wojtyś ME, Kacalska-Janssen O, Ptaszyński K, Lisowski P, Kunc M, Wójcik J, Grodzki T. Benign Metastasizing Leiomyoma of the Lung: Diagnostic Process and Treatment Based on Three Case Reports and a Review of the Literature. Biomedicines 2022; 10:biomedicines10102465. [PMID: 36289727 PMCID: PMC9599094 DOI: 10.3390/biomedicines10102465] [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: 08/12/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Uterine leiomyomas may occasionally spread to the lungs forming nodular lesions detectable on chest X-ray. This condition known as benign metastasizing leiomyoma (BML) usually occurs in females with a history of hysterectomy or myomectomy. We present three cases of BML demonstrating the diagnostic process and treatment approaches. Two patients presented with the more common multiple-nodule variant while the other had a single mass, but all were symptom-free. The age of presented patients at diagnosis of BML ranged from 46-53. The first patient was diagnosed with BML at the age of 50, and 12 years prior to the diagnosis, underwent a supracervical hysterectomy. The second patient had a myomectomy at 36, and BML was diagnosed 17 years later at the age of 53. The third patient had a hysterectomy with bilateral salpingo-oophorectomy at the age of 46, with lung lesions present before the hysterectomy. Immunohistochemical studies of postoperative materials showed positive staining of spindle cells with antibodies against desmin and smooth muscle actin, as well as estrogen and progesterone receptors. The final histopathological diagnoses were pulmonary BML. All patients are stable and symptom-free: two at two years follow-up and one at six months follow-up.
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Affiliation(s)
- Małgorzata Edyta Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-891 Szczecin, Poland
- Correspondence: ; Tel.: +48-889944582
| | - Olga Kacalska-Janssen
- Department of Gynecological Endocrinology, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Konrad Ptaszyński
- Department of Pathology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland
| | - Piotr Lisowski
- Students’ Scientific Circle of the Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-891 Szczecin, Poland
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-891 Szczecin, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-891 Szczecin, Poland
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Li Y, Xu T, Wang M, Jiang L, Liu Q, Liu K. Concurrent Benign Metastasizing Leiomyoma in the Abdominal Wall and Pelvic Cavity: A Case Report and Review of the Literature. Front Surg 2022; 9:842707. [PMID: 35510124 PMCID: PMC9058064 DOI: 10.3389/fsurg.2022.842707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Benign metastatic leiomyoma (BML) is a histologically benign disease with invasive biological behavior. Most patients are women of childbearing age with a history of uterine leiomyoma. The progress of the disease is relatively slow, the prognosis is good, and most patients can survive for a long time. The lung is the common metastatic site, and BML with metastatic lesions outside the lung is very rare. A 37-year-old woman with multiple BML in the abdominal wall and pelvic cavity after uterine leiomyoma surgery was admitted to our hospital. Combined with the clinical data of this case and reviewing the relevant literature, this paper discusses the pathological characteristics, diagnosis, differential diagnosis, and treatment of BML.
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Holzmann C, Kuepker W, Rommel B, Helmke B, Bullerdiek J. Reasons to Reconsider Risk Associated With Power Morcellation of Uterine Fibroids. In Vivo 2020; 34:1-9. [PMID: 31882457 DOI: 10.21873/invivo.11739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/28/2022]
Abstract
Our insights into the molecular pathogenesis of uterine smooth muscle tumors have improved significantly. Accordingly, in the present review, we advocate a more refined risk assessment for patients considering surgical removal of fibroids or hysterectomy, respectively, requiring morcellation. For this procedure, the risk estimates given for the iatrogenic spread of a previously unexpected malignancy considerably vary among different studies. Nearly all previous studies conducted retrospectively refer to the risk of a patient having an unexpected malignancy at the time of surgery. We feel that, more appropriately, risk should refer to the number of tumors because, as a rule, every single nodule arises independently and, thus, carries an independent risk of being malignant or not. Furthermore, whether so-called parasitic fibroids carry an underestimated risk of stepwise malignant transformation is discussed.
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Affiliation(s)
- Carsten Holzmann
- Institute of Medical Genetics, University Rostock Medical Center, Rostock, Germany
| | - Wolfgang Kuepker
- Center for Minimal Invasive Gynecology, Endometriosis and Reproductive Medicine, Baden Baden-Buehl, Germany
| | - Birgit Rommel
- Human Genetics, University of Bremen, Bremen, Germany
| | - Burkhard Helmke
- Institute of Pathology, Elbe Clinics, Stade Clinic, Stade, Germany
| | - Joern Bullerdiek
- Institute of Medical Genetics, University Rostock Medical Center, Rostock, Germany .,Human Genetics, University of Bremen, Bremen, Germany
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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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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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