1
|
Chen S, Xu G, Ye W, Liu C. Pulmonary benign metastasizing leiomyoma with concurrent granulomatous inflammation: a diagnostic challenge. Quant Imaging Med Surg 2024; 14:2114-2119. [PMID: 38415127 PMCID: PMC10895137 DOI: 10.21037/qims-23-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/06/2023] [Indexed: 02/29/2024]
Affiliation(s)
- Shihao Chen
- Department of Radiology, The First People's Hospital of Pingjiang County, Yueyang, China
| | - Gen Xu
- Department of Radiology, The First People's Hospital of Pingjiang County, Yueyang, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Caolin Liu
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
2
|
Fu XY, Gao X, Zhao CL, Qi XF, Ouyang XJ, Zhu LH, Wang D, Qu LJ, Ye XZ. Pulmonary Epstein-Barr virus-associated smooth muscle tumor after kidney transplantation: two case reports with review of differential diagnosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:107-112. [PMID: 38527990 PMCID: PMC11146452 DOI: 10.47162/rjme.65.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/09/2024] [Indexed: 03/27/2024]
Abstract
Pulmonary nodules are a common complication in solid organ transplant recipients, and may have various underlying causes, with Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) being one of them. Given the rarity of this entity, we describe the diagnosis and therapeutic interventions for post-transplant EBV-SMT in two individuals. Both cases involved female patients who were diagnosed with multiple pulmonary nodules 60 months and 116 months, respectively, after receiving living-related kidney transplantation. Pathological examination revealed a spindle cell tumor, with immunophenotype and EBV in situ hybridization supporting the diagnosis of EBV-SMT. After diagnosis, these two patients underwent intervention by decreasing their intake of immunosuppressants. As of the latest follow-up, the patients' lesion size remained stable, and their overall condition was favorable. We also reviewed literature about the morphological and molecular pathological features of EBV-SMT and highlighted the diagnosis and differential diagnosis of pulmonary spindle cell lesions especially in the setting of immunosuppression.
Collapse
Affiliation(s)
- Xiao-yu Fu
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xia Gao
- Department of Urology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Chun-lei Zhao
- Medical Imaging Center, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Xing-feng Qi
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiao-juan Ouyang
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Ling-hua Zhu
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Dong Wang
- Department of Urology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Li-juan Qu
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xian-zong Ye
- Department of Pathology, The 900th Hospital of the Joint Logistics Support Force, Fuzhou, China
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Minoda N, Tada T, Takatani M, Nakamura S, Wani Y. Pancreatic metastasis of leiomyoma found 27 years after uterine fibroid surgery. Clin J Gastroenterol 2023; 16:931-936. [PMID: 37632657 DOI: 10.1007/s12328-023-01842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
A 59-year-old female was referred to our hospital for pancreatic tumor. She had undergone resection of uterine fibroids 27 years ago, and leiomyoma in the left thigh 8 years ago. Tumor markers were normal. A well-defined hypoechoic tumor measuring 26 mm × 22 mm was detected at the pancreatic tail using ultrasound. Inside the tumor, a small cystic structure was observed. High-sensitivity Doppler imaging revealed faint signals indicating blood flow from the periphery to the interior. Contrast-enhanced ultrasonography in the arterial phase revealed slow, heterogenous enhancement from the periphery to the center of the mass that occurred later than that in the pancreatic parenchyma. The tumor then exhibited homogeneous enhancement except for the periphery, with subsequent washout. Endoscopic ultrasound-fine-needle aspiration was performed. Histopathological examination diagnosed a leiomyoma. The left thigh tumor resected 8 years ago had been diagnosed as benign metastatic leiomyoma (BML). We considered that the current pancreatic tumor was also BML clinically. We report this case because pancreatic metastasis from uterine fibroids is extremely rare. Uterine fibroids are benign tumors, but there are rare cases of metastasis to various organs, which should be considered when performing ultrasound.
Collapse
Affiliation(s)
- Naoki Minoda
- Inspection Technology Department, Japanese Red Cross Society Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
- Clinical Laboratory, Kakogawa Central City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, Hyogo, 675-8611, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan.
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Shinichiro Nakamura
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Yoji Wani
- Clinical Laboratory, Japanese Red Cross Society Himeji Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Kim GW, Baek SK, Han JJ, Kim HJ, Sung JY, Maeng CH. Pulmonary Metastasizing Low-Grade Endometrial Stromal Sarcoma: Case Report and Review of Diagnostic Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12020271. [PMID: 35204363 PMCID: PMC8871004 DOI: 10.3390/diagnostics12020271] [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: 12/13/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023] Open
Abstract
Pulmonary manifestations of benign metastasizing leiomyoma (BML) usually include multiple well-defined, round, bilateral nodules. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor. A 70-year-old woman visited the clinic complaining of acute cough and dyspnea in April 2017. Chest computed tomography (CT) revealed pneumothorax and multiple pulmonary nodules. She had a history of hysterectomy for uterine leiomyoma 23 years ago. Biopsy revealed that the pulmonary masses were consistent with BML. However, the patient had two subsequent episodes of acute, recurrent respiratory distress, accompanied by massive pleural effusions and hydropneumothorax over the next two years. A chest CT performed for acute dyspnea revealed large and multiple hydropneumothoraces. The size and distribution of pulmonary masses were aggravated along with cystic changes and bilateral pleural effusions. Given this aggressive feature, additional immunohistochemical findings and gynecologic pathologist review confirmed the correct diagnosis to be LG-ESS. After initiating anti-estrogen therapy, the patient achieved a partial response, without recurrence of symptoms, for 28 months. Metastatic LG-ESS responds well to anti-hormonal therapy. If the clinical pattern of a disease is different than expected, the possibility of a correction in the diagnosis should be considered.
Collapse
Affiliation(s)
- Geon Woo Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Sun Kyung Baek
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Jae Joon Han
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Hong Jun Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Ji-Youn Sung
- Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea;
| | - Chi Hoon Maeng
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
- Correspondence: ; Tel.: +82-2-958-2965
| |
Collapse
|
6
|
Sathirareuangchai S, Shimizu D, Vierkoetter KR. Pulmonary Lymphangioleiomyomatosis: A Case Report and Literature Review. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:224-229. [PMID: 32666056 PMCID: PMC7350511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pulmonary lymphangioleiomyomatosis (LAM) is a rare lung disease characterized by diffuse cystic changes caused by a destructive proliferation of smooth muscle-like cells or LAM cells. It is a part of the perivascular epithelioid cell family of tumors. LAM may be associated with the genetic disorder tuberous sclerosis complex or may occur sporadically. Individuals affected by LAM are typically females of child-bearing age who present with recurrent spontaneous pneumothorax. The microscopic findings can be subtle and careful examination is needed to identify the neoplastic cells of LAM. Immunohistochemical markers in cases of LAM demonstrate a characteristic co-expression of myogenic and melanocytic markers. We report a case of a 41-year-old woman who presented with multiple episodes of spontaneous pneumothorax and microscopic findings characteristic of LAM.
Collapse
Affiliation(s)
- Sakda Sathirareuangchai
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
| | - David Shimizu
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
- The Queen's Medical Center, Honolulu, HI (DS, KRV)
| | - Koah Robin Vierkoetter
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
- The Queen's Medical Center, Honolulu, HI (DS, KRV)
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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]
|
9
|
Ofori K, Fernandes H, Cummings M, Colby T, Saqi A. Benign metastasizing leiomyoma presenting with miliary pattern and fatal outcome: Case report with molecular analysis & review of the literature. Respir Med Case Rep 2019; 27:100831. [PMID: 30989050 PMCID: PMC6446132 DOI: 10.1016/j.rmcr.2019.100831] [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] [Received: 01/27/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare benign smooth muscle neoplasm that originates in the uterus and metastasizes to distant sites—most commonly the lungs. BMLs are often found incidentally in patients with a history of uterine leiomyoma(s) and tend to be indolent. Occasionally they may be symptomatic and rarely follow an aggressive clinical course. We report an unusual case of BML presenting in a 46-year-old woman as a miliary nodular pattern bilaterally in the lungs and progressive respiratory failure. Her past medical history was significant for uterine “leiomyomas” of at least 9 years' duration. Post mortem histologic evaluation of the uterine and lung lesions revealed benign smooth muscle neoplasms (leiomyomas and BMLs, respectively), and molecular analyses demonstrated identical clonal MED12 mutation, though with greater mutant allelic frequency in the uterus. We document a rare aggressive clinical course in a patient with BML, which presented as a miliary radiologic pattern mimicking an infectious etiology or interstitial lung disease.
Collapse
Affiliation(s)
- Kenneth Ofori
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Helen Fernandes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Matthew Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia, University Medical Center, New York, USA
| | | | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| |
Collapse
|
10
|
Zhang J, Dong A, Cui Y, Wang Y, Chen J. Diffuse cavitary benign metastasising leiomyoma of the lung. Thorax 2018; 74:208-209. [PMID: 30554139 DOI: 10.1136/thoraxjnl-2018-212769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Jun Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong Cui
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yang Wang
- Department of Pathology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia Chen
- Department of Pathology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Zong D, He W, Li J, Peng H, Chen P, Ouyang R. Concurrent benign metastasizing leiomyoma in the lung and lumbar spine with elevated standardized uptake value level in positron-emission tomography computed tomography: A case report and literature review. Medicine (Baltimore) 2018; 97:e11334. [PMID: 29979408 PMCID: PMC6076117 DOI: 10.1097/md.0000000000011334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Benign metastasizing leiomyoma (BML) is rare condition involving distant metastases secondary to benign uterine leiomyoma, and it is most commonly found in the lungs. It rarely metastasizes to the spine to cause osteolytic damage and spinal canal compression. PATIENT CONCERNS A 51-year-old woman with low back and bilateral leg pain and paresthesia was admitted to our ward. She has a previous medical history of uterine leiomyomas. Magnetic resonance imaging of the lumbar spine revealed vertebral body osteolytic destruction and soft tissue mass in the L4/5 with a secondary lumbar spinal stenosis. Positron emission tomography computed tomography showed moderately intense accumulation of 18F-fluorodeoxyglucose in the L4/5 mass, as well as multiple nodules with increased metabolic activity in both lungs. DIAGNOSES Pulmonary and spinal BML. INTERVENTIONS The patient underwent a computed tomography-guided percutaneous needle biopsy of the lung nodule and lumbar corpectomy, tumor excision, and vertebroplasty in the L4/5. OUTCOMES Pathologically, both pulmonary nodule and vertebral mass were diagnosed as leiomyomas without any malignant evidence. Estrogen and progesterone receptors were both positive in the metastatic tumors. The patient's symptoms completely disappeared after the surgery. The patient is currently receiving outpatient anti-estrogen tamoxifen treatment for a BML. LESSONS Through this case, we suggest that BML should be regarded as part of differential diagnosis in female patients with a previous medical history of uterine leiomyomas presenting with multiple nodules in any parts of the body.
Collapse
|