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Wei XW, Zhou DM, Han L, Lin Y, Xi XW, Xiang JD. Pulmonary benign metastasizing leiomyoma: a case description and analysis of the literature. Quant Imaging Med Surg 2024; 14:5224-5233. [PMID: 39022261 PMCID: PMC11250290 DOI: 10.21037/qims-23-1863] [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: 12/29/2023] [Accepted: 04/16/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Xiao-Wei Wei
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Mei Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital of Nanjing Medical University, Nanjing Medical University School of Medicine, Shanghai, China
| | - Lei Han
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Lin
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Wei Xi
- Department of Gynecology and Obstetrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang-Dong Xiang
- Department of Gynecology and Obstetrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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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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3
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Yin X, Wei X, Al Shamsi R, Ali FS, Al Kindi F, Zhang X, Liang J, Pan X, Al Masqari M, Zheng L, Zhou Q, Agaimy A, Chen N. Benign metastasizing fumarate hydratase (FH)-deficient uterine leiomyomas: clinicopathological and molecular study with first documentation of multi-organ metastases. Virchows Arch 2024:10.1007/s00428-024-03806-8. [PMID: 38642139 DOI: 10.1007/s00428-024-03806-8] [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: 02/04/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
Leiomyoma is the most prevalent benign tumor of the female reproductive system. Benign metastasizing leiomyoma (BML) is a rare phenomenon that presents at distant sites, typically the lungs, exhibiting histopathological features similar to the primary uterine tumor in the absence of malignancy features in both. Fumarate hydratase-deficient uterine leiomyoma (FH-d UL) is an uncommon subtype among uterine smooth muscle tumors (0.5-2%), showing distinctive histomorphology and FH inactivation. The majority of FH-d ULs are sporadic, caused by somatic FH inactivation, while a minority of cases occur in the context of the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome caused by germline FH inactivation. Metastasizing FH-d UL has not been well documented and might be under-reported. Here, we present two cases (21- and 34-year-old females) who presented with metastasizing FH-d UL after myomectomy/hysterectomy with histologically proven multiple lung metastases in both, in addition to multi-organ involvement in one case (cervical-thoracic lymph nodes, left kidney, perihepatic region, left zygomatic bone, and soft tissues). Pathological examination confirmed FH-d leiomyomas in the primary/recurrent uterine tumors, multiple lung lesions, and a renal mass. The minimal criteria for diagnosis of leiomyosarcoma were not fulfilled. Genetic testing revealed germline pathogenic FH variants in both cases (c.1256C > T; p.Ser419Leu in Case 1 and c.425A > G; p.Gln142Arg in Case 2). These novel cases highlight a rare but possibly under-recognized presentation of FH-d BML. Our study suggests that FH-d BML cases might be enriched for the HLRCC syndrome.
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Affiliation(s)
- Xiaoxue Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxia Wei
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ruqaiya Al Shamsi
- Department of Pathology, The Royal Hospital, Muscat, Sultanate of Oman
| | - Fatima S Ali
- Department of Pathology, The Royal Hospital, Muscat, Sultanate of Oman
| | - Faiza Al Kindi
- Department of Radiology, The Royal Hospital, Muscat, Sultanate of Oman
| | - Xingming Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiuyi Pan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Linmao Zheng
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Abbas Agaimy
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China.
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4
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Chouchane A, Boughizane S, Nouira M, Remadi S. Benign Metastasizing Leiomyoma: New insights into a rare disease with an obscure etiopathogenesis. Diagn Pathol 2024; 19:2. [PMID: 38172926 PMCID: PMC10765933 DOI: 10.1186/s13000-023-01427-4] [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] [Received: 09/06/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare disease with an unknown etiopathogenesis that mostly affects middle-aged women with uterine leiomyoma. Many metastatic nodules outside the uterus characterize the condition. The metastases are smooth muscle lesions without malignancy. Morphologically and immunohistochemically, they resemble uterine leiomyomas, indicating a shared clonal origin. The lungs are the most prevalent site for incidental metastasis detection. BML has a relatively slow progression and good prognosis, and historically, there has been a lack of established guidelines for its treatment. CASE PRESENTATION Herein, we report a case of BML in a patient with multiple metastases. Through extensive histological and immunohistochemical analyses, this complex case enabled not only the definitive diagnosis of BML, but also shed light on its complex etiopathogenesis. CONCLUSION This study presents novel histology evidence suggesting a potential causal relationship between metaplasia and the development of BML.
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Affiliation(s)
- Aziz Chouchane
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | | | | | - Sami Remadi
- Laboratoire d'Anatomie Et Cytologie Pathologiques, Rue Leopold Senghor, 4000, Sousse, Tunisia.
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Liu Y, Li D, Li X, Wang J, Wang J. Benign Metastasizing Leiomyoma: Is "Wait and Watch" Strategy Feasible? Reprod Sci 2023; 30:3568-3577. [PMID: 37531066 DOI: 10.1007/s43032-023-01314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
Benign metastasizing leiomyoma (BML) is a rare disease that affects women with a history of uterine leiomyoma. The aim of this study is to investigate the clinical characteristics and outcome patterns. We collected 385 cases from previous reports indexed in PubMed and Google Scholar and made a thorough review. All relevant clinical parameters were carefully reviewed, including age at diagnosis, clinical presentations, course of disease, medical history, imaging, molecular tests, treatment, and outcomes. Univariate survival analysis was performed to investigate the effects of treatment strategies on outcomes. The mean age at diagnosis was 46.2 years. The most common site for the metastasis was lung, and followed by abdomen/pelvis/retroperitoneum, bone, lymph nodes, and heart. The medical histories and molecular alterations were non-specific, and the pathogenesis was still unclear. Due to its unresectable nature, hormone deprivation treatment, including oophorectomy and hormone drugs, is the most effective strategy to reduce or delay tumor progression. The present study may provide a useful consultation for diagnosing and managing BMLs.
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Affiliation(s)
- Yixuan Liu
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Dong Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Xueqing Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China
| | - Jingnan Wang
- Department of Pathology, School of Basic Medicine, Qingdao University, No. 308 Ningxia Road, Shandong, 266071, Qingdao, China
| | - Jigang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Shandong, 266555, Qingdao, China.
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Sarode G, Gondivkar SM, Gore A, Anand R, Sengupta N, Mehta V, Sarode SC. Clinico-pathological and prognostic overview of metastasizing ameloblastoma: An overview of the systematic reviews. J Oral Biol Craniofac Res 2023; 13:751-757. [PMID: 38028232 PMCID: PMC10661192 DOI: 10.1016/j.jobcr.2023.10.006] [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: 08/25/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Metastasizing Ameloblastoma (MA) is an aggressive variant of ameloblastoma (AM) with the ability to metastasize without cytological malignant changes. Thus it aims to comprehensively review the clinico-pathological and prognostic aspects of MA through integration of current literature. Methods Electronic searches were conducted in PubMed-MEDLINE, Scopus, Web of Science and Google Scholar. Two independent reviewers screened abstracts and evaluated paper eligibility. AMSTAR2 checklist was used to assessed methodological quality of included systematic reviews (SRs). Results From 390 initial papers, 279 underwent eligibility screening, with five systematic reviews (SRs) meeting inclusion criteria. Six hundred sixty-one MA cases were found in five SRs that were included. MA predominantly affects men, exhibits mandible preference, and occurs in individuals in their fourth or fifth decade. Benign metastatic deposits commonly manifest in lungs and lymph nodes. Distant metastasis probability rises with multiple recurrences and incomplete surgical removal. Tumor recurrence and metastasis unfavorably impact clinical outcomes. Quality of evidence assessment was absent across SRs; four SRs were critically low in methodological quality. Conclusions AM's metastatic potential lacks predictability. Early/multiple recurrences post-treatment may signal poor prognosis, warranting vigilant follow-up. Methodical analysis of each AM case is imperative to comprehend the metastatic-benign histology relationship.
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Affiliation(s)
- Gargi Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Shailesh M. Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Akanksha Gore
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Rahul Anand
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Namrata Sengupta
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra State, India
| | - Sachin C. Sarode
- Department of Oral Pathology & Microbiology, Dr. D.Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra State, India
- Dr. D. Y. Patil Unitech Society's Dr D Y Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, 411018, Maharashtra, India
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Kachhwaha A, Bharti JN, Solanki A, Soni S, Pareek P. A rare case of benign metastasizing leiomyoma at vertebrae. J Cancer Res Ther 2023; 19:2072-2075. [PMID: 38376323 DOI: 10.4103/jcrt.jcrt_1386_21] [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: 08/15/2021] [Accepted: 01/28/2022] [Indexed: 02/21/2024]
Abstract
ABSTRACT Benign metastasizing leiomyoma (BML) is a rare disease that usually occurs in women of reproductive age, with a history of uterine leiomyoma treated with hysterectomy. This may present as lesions in lungs, lymph nodes, bones, brain, mediastinum, and soft tissues. However, the most commonly affected site is the lung. Here is a case report of a patient who presented with BML at vertebral body with distant metastasis to lungs, brain, and bones. A 37-year-old female, with no known comorbidities, presented with pain in the upper back, urinary and bowel incontinence, and weakness in the bilateral lower limbs. Radiological, multiple metastases were present at D2 and D9 vertebral bodies, multiple nodular lesions were present in the lungs, and solitary lesion was found in the right frontal lobe of the brain. Histology proved it to be of myoepithelial origin with low Ki-67 index. The treatment in this case was based on hormone production suppression and radiotherapy, with no signs of progression at follow-up.
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Affiliation(s)
- Avni Kachhwaha
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Akanksha Solanki
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | - Sweta Soni
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | - Puneet Pareek
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
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8
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Wu S, Cai J, Chen Q, Wu J, Chen H. Increased 68Ga-FAPI Uptake in Benign Metastasizing Leiomyoma. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00609. [PMID: 37335290 DOI: 10.1097/rlu.0000000000004748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
ABSTRACT Benign metastasizing leiomyomas (BMLs) are benign disseminated extrauterine tumors in patients with prior history of uterine leiomyomas and may occur years after hysterectomy. In this case, we presented 18F-FDG and 68Ga-FAPI PET/CT findings in a 37-year-old woman with benign leiomyoma metastasizing to lung and pelvis. The metastatic lesions demonstrated faint 18F-FDG but elevated 68Ga-FAPI activity, indicating the low level of glucose metabolism but excessive accumulation of activated fibroblasts in the BMLs. This case demonstrated that 68Ga-FAPI PET/CT may be potentially useful in the evaluation of BMLs.
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Affiliation(s)
- Simin Wu
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center
| | - Jiayu Cai
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center
| | - Qi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jing Wu
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center
| | - Haojun Chen
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center
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9
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Zazulak HE, Single M, O’Herron T, Thompson JP. Incidental detection of benign metastasizing leiomyoma in asymptomatic female. J Clin Imaging Sci 2023; 13:16. [PMID: 37405365 PMCID: PMC10316221 DOI: 10.25259/jcis_37_2023] [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: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare finding of histologically benign smooth muscle tumors in extrauterine locations, most commonly the lungs. We report a case of BML found incidentally on pre-operative imaging in a 42-year-old patient. BML is found in premenopausal women with a history of leiomyoma and, often, hysterectomy. As in our case, the metastatic pulmonary nodules are not hypermetabolic on 18F-fluorodeoxyglucose Positron emission tomography/computed tomography. BML may be clinically malignant or asymptomatic. Since the imaging appearance of BML simulates metastatic disease of more malignant etiology, awareness of its multimodality imaging appearance and presentation can aid in diagnosis.
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Affiliation(s)
- Hannah E. Zazulak
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, United States
| | - Meghan Single
- Department of Diagnostic Imaging, Rochester General Hospital, Rochester, New York, United States
| | - Timothy O’Herron
- Department of Diagnostic Imaging, Rochester General Hospital, Rochester, New York, United States
| | - Joel P. Thompson
- Department of Diagnostic Imaging, Rochester General Hospital, Rochester, New York, United States
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10
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Tirotta F, Napolitano A, Noh S, Schmitz E, Nessim C, Patel D, Sicklick JK, Smith M, Thway K, van der Hage J, Ford SJ, Tseng WW. Current management of benign retroperitoneal tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1081-1090. [PMID: 35879135 DOI: 10.1016/j.ejso.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
Benign retroperitoneal tumors (BRT) represent a rare group of heterogeneous diseases. The literature lacks high-quality evidence about the optimal management of BRT, and most of the information available takes the form of case reports or case series. The aim of this review is to provide an overview of current management strategies for adult patients with BRT. A literature search using PubMed indexed articles was conducted and BRT were classified into five different biological subgroups: 1) lipomatous tumors, 2) smooth muscle tumors, 3) peripheral nerve sheath tumors, 4) myofibroblastic tumors, and 5) others. Tumors that are primarily pelvic in origin were excluded. Despite the significant heterogeneity of the disease, several generic considerations have emerged and can be applied to the management of BRT. Specifically, the risk of misdiagnosing a BRT with another pathology such as retroperitoneal sarcoma is notable. When encountered, suspected BRT should therefore be referred to a specialized sarcoma center. Multidisciplinary tumor boards, present at these centers, have a pivotal role in managing BRT. The decision of whether to offer surgery, nonsurgical treatment or a "watch-and-wait" approach should be made after multidisciplinary discussion, depending on tumor histology. Moving forward, collaborative research efforts dedicated to BRT remain crucial in gathering evidence and knowledge to further optimize patient care.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Sangkyu Noh
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, 91766-1854, USA
| | - Erika Schmitz
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dakshesh Patel
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA
| | - Myles Smith
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Department of Pathology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Su H, Fan R, Yang H, You Y, Zhu L, Feng F. Pulmonary benign metastasizing leiomyoma in patients aged 45 years and younger: clinical features and novelty in treatment. BMC Pulm Med 2023; 23:168. [PMID: 37189093 DOI: 10.1186/s12890-023-02406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Pulmonary benign metastasizing leiomyoma (PBML) is the most common extrauterine spread of uterine leiomyoma, and its biological behavior is traditionally thought to be hormone dependent. Studies on older PBML patients have been previously reported, but limited literature has been published regarding the clinical features and treatment of PBML in young women. METHODS A total of 65 cases of PBML in women aged 45 years and younger were reviewed, including 56 cases selected from PubMed and 9 cases from our hospital. The clinical characteristics and management of these patients were analyzed. RESULTS The median age of all the patients at diagnosis was 39.0 years. PBML most commonly presented as bilateral solid lesions (60.9%), with other rare imaging manifestations. The median interval time from a pertinent gynecologic procedure to diagnosis was 6.0 years. A total of 16.7% of patients received careful observation, and all achieved stable status in a median follow-up time of 18.0 months. A total of 71.4% of patients were administered anti-estrogen therapies, including surgical castration (33.3%), gonadotropin-releasing hormone analog (23.8%) and anti-estrogen drugs (14.3%). Eight of 42 patients underwent surgical resection of metastatic lesions. Patients who underwent curative surgery for the removal of pulmonary lesions combined with adjuvant anti-estrogen therapies had favorable outcomes compared with those who only underwent surgical resection. The disease control rates of surgical castration, gonadotropin-releasing hormone analog, and anti-estrogen drugs were 85.7%, 90.0%, and 50.0%, respectively. For two patients, sirolimus (rapamycin) achieved successful relief of symptoms and control of pulmonary lesions without lowering hormone levels and causing estrogen deficiency symptoms. CONCLUSIONS In the absence of standard treatment guidelines for PBML, maintaining a low-estrogen environment using different kinds of antiestrogen therapies has been the mainstream strategy and has satisfying curative effects. A wait-and-see strategy might be an option, but therapeutic approaches must be contemplated when complications or symptoms progress. For PBML in young women, the negative effect on ovarian function of anti-estrogen treatment, especially surgical castration, should be considered. Sirolimus might be a new treatment option for young PBML patients, especially for those who want to preserve ovarian function.
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Affiliation(s)
- Hao Su
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Rong Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China.
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, China.
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Martínez-Cachero García M, Menéndez de Llano Ortega R, Martínez Camblor L, Carrasco Aguilera B, Rodríguez Castro J, Gómez Illán R. Extrauterine leiomyomatosis, the great mimicker. RADIOLOGIA 2023; 65:251-257. [PMID: 37268367 DOI: 10.1016/j.rxeng.2023.01.004] [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: 11/18/2022] [Accepted: 01/08/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Describe the radiographic features of the different forms of extrauterine leiomyomatosis. CONCLUSIONS Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.
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Affiliation(s)
| | | | - L Martínez Camblor
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Carrasco Aguilera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Rodríguez Castro
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
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Tong T, Fan Q, Wang Y, Li Y. Benign metastasizing uterine leiomyoma with lymphatic and pulmonary metastases: a case report and literature review. BMC Womens Health 2023; 23:154. [PMID: 37005604 PMCID: PMC10068149 DOI: 10.1186/s12905-023-02237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare disease usually observed in women of reproductive or premenopausal age with a history of uterine myomectomy or hysterectomy. The most common sites of metastases are the pulmonary, and other sites include heart, bones, liver, lymph nodes, bladder, skeletal muscles, and central nervous system. Here, we report a case of a 50 year-old woman with a history of hysterectomy who was initially suspected of uterine sarcoma but was finally confirmed to have BML with lung and lymph node metastases, and discuss the treatment and prognosis of BML. CASE PRESENTATION A 50 year-old woman with a history of total abdominal hysterectomy presented with mild but persistent abdominal pain for more than 3 months. She was suspected of having uterine sarcoma before surgery and laparoscopic extensive debulking surgery including bilateral oophorectomy, pelvic and para-aortic lymph node dissection to the level of the left renal vein, and transcutaneous dissection of the right inguinal lymph nodes. Pathology confirmed a benign leiomyoma, and the patient was diagnosed with BML. No medication was administered after the surgery, and the follow-up was of no significance. CONCLUSION Benign metastasizing leiomyoma (BML) is a rare disorder in which histologically benign smooth muscle tumors metastasize to extrauterine sites. Metastases are commonly observed in the lung, liver, lymph nodes, skin, bladder, esophagus, and skeletal muscles. BML is usually misdiagnosed as a malignant tumor before surgery until the pathology confirms its benign nature. However, this treatment remains controversial and undetermined. The prognosis is usually favorable owing to its benign nature.
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Affiliation(s)
- Tong Tong
- Department of Gynecological Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Hengshan Road No. 910, Shanghai, 200030, China
| | - Qiong Fan
- Department of Gynecological Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Hengshan Road No. 910, Shanghai, 200030, China
| | - Yudong Wang
- Department of Gynecological Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Hengshan Road No. 910, Shanghai, 200030, China.
| | - Yuhong Li
- Department of Gynecological Oncology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Hengshan Road No. 910, Shanghai, 200030, China
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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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15
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Conde M, Costa AS, Gomes T. Benign metastasizing leiomyoma presenting as multiple pulmonary nodules: A radiological-pathological correlation. Pulmonology 2023; 29:160-162. [PMID: 36371395 DOI: 10.1016/j.pulmoe.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- M Conde
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - A S Costa
- Radiology Department, Hospital Prof. Doutor Fernando Fonseca, E.P.E, Portugal
| | - T Gomes
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real Portugal
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16
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Vieira Naia J, Pimenta D, Paiva A, Costa R, Souto de Moura C, Pereira R, Cruz JF. When benign leiomyomas metastasize to the lungs - a case report. Monaldi Arch Chest Dis 2023; 93. [PMID: 36786165 DOI: 10.4081/monaldi.2023.2488] [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: 11/19/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Benign metastasizing leiomyoma is a rare disease that primarily affects premenopausal women who have a history of uterine leiomyoma, which is characterized by pulmonary metastases. The pathogenesis of this condition is unknown. Patients are usually asymptomatic or have vague symptoms. Pathological examination in conjunction with immunohistochemistry is required for diagno-sis. Treatment is determined by the patient's age, hormonal status, symptoms, and the extent of the lesions (number, size, and location of nodules), with surgical resection being the most effective. We present the case of a 72-year-old woman who had a total hysterec-tomy 30 years earlier due to myomas and developed a persistent dry cough. Her computed tomography of the chest revealed several small nodules in the pulmonary parenchyma. Because of the nod-ules' small size and difficult accessibility, a surgical biopsy was per-formed for histopathological examination and immunohistochemi-cal staining, which revealed metastasizing leiomyoma. Letrozole treatment was started and was well tolerated.
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Affiliation(s)
| | | | | | - Rita Costa
- Thoracic Surgery Department, University Hospital Center of São João, Porto.
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Martínez-Cachero García M, Menéndez de Llano Ortega R, Martínez Camblor L, Carrasco Aguilera B, Rodríguez Castro J, Gómez Illán R. Leiomiomatosis extrauterina, la gran simuladora. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Nair A, Leong P. The panorama of pulmonary leiomyoma: A tale of two tumours. Respirol Case Rep 2023; 11:e01088. [PMID: 36741207 PMCID: PMC9887405 DOI: 10.1002/rcr2.1088] [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: 09/06/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023] Open
Abstract
Pulmonary leiomyoma has a diverse clinical spectrum of disease. Here we describe two patients with vastly different presentations. The first case is a 23-year-old female with a chronic cough and no visible tracheal lesion on computer tomography (CT) chest imaging. Flexible bronchoscopy revealed a small tracheal nodule, with histopathology confirming pulmonary leiomyoma. The second case is a 57-year-old female with a painless abdominal mass. CT imaging revealed widespread lung 'cannonball' nodules. Percutaneous biopsy confirmed metastatic leiomyoma. After progression on surveillance and endocrine therapy, she was commenced on doxorubicin with interval radiological improvement. These cases highlight the clinical heterogeneity in this disease, and thus, complexity in devising standardized diagnostic and therapeutic protocols.
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Affiliation(s)
- Ajit Nair
- Monash Lung Sleep Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia,School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Paul Leong
- Monash Lung Sleep Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia,School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
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19
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Jaber M, Winner PJ, Krishnan R, Shu R, Khandelwal KM, Shah S. Benign Metastasizing Leiomyoma Causing Severe Tricuspid Regurgitation and Heart Failure. J Investig Med High Impact Case Rep 2023; 11:23247096231173397. [PMID: 37154166 PMCID: PMC10170589 DOI: 10.1177/23247096231173397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
We present the case of a 51-year-old woman with severe tricuspid valve regurgitation due to aseptic tricuspid valve vegetation. She presented with bilateral lower extremity edema and a tricuspid valve vegetation was found on echocardiography. Initially, infectious and autoimmune causes of valve vegetation were considered; however, on biopsy, the mass was ultimately found to be a benign metastasizing leiomyoma (BML). Additional history revealed clinical features consistent with uterine leiomyomas, which metastasized to all leaflets the tricuspid valve, causing symptoms of heart failure. Benign metastasizing leiomyoma is rare itself, but when found, typically presents as asymptomatic pulmonary nodules. Mechanism of spread is unknown. Diagnosis is typically made long after a hysterectomy or fibroidectomy, but in our case, the BML was found prior to an actual fibroid diagnosis. By comparison, metastasis to the heart is extremely rare and has a higher potential for morbidity. Our patient required open heart surgery and tricuspid valve replacement for management of her symptoms, but her risk of further or recurrent metastasis going forward is unknown. Management strategy to prevent metastases in such cases of aggressive disease is not an established protocol and needs to be further studied.
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Affiliation(s)
- Mohammad Jaber
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | | | - Rajagopal Krishnan
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Loma Linda University Medical Center, CA, USA
| | - Richard Shu
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Loma Linda University Medical Center, CA, USA
| | - Keerti M Khandelwal
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Loma Linda University Medical Center, CA, USA
| | - Shivang Shah
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Loma Linda University Medical Center, CA, USA
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20
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A giant benign leiomyoma of the lung: A case report. Asian J Surg 2023; 46:571-572. [PMID: 35850896 DOI: 10.1016/j.asjsur.2022.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
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21
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Otsuka S, Yanazume S, Mizuno M, Togami S, Kobayashi H. Metastatic Leiomyoma Following Menopause: A Case Report and Review of Literature. Cureus 2022; 14:e31549. [DOI: 10.7759/cureus.31549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
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22
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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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23
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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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24
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Dyspnea in a 49-Year-Old Woman with Innumerable Cavitating Pulmonary Nodules. Ann Am Thorac Soc 2022; 19:1414-1418. [PMID: 35913461 DOI: 10.1513/annalsats.202112-1384cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Leiomiomatosis metastatizante benigna: presentación de un caso. Med Clin (Barc) 2022; 159:e45-e46. [DOI: 10.1016/j.medcli.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022]
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26
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Huynh KN, Nguyen BD. PET/CT of delayed uterine leiomyoma metastasizing to lung and femur. J Nucl Med Technol 2022; 50:jnmt.122.263901. [PMID: 35882587 DOI: 10.2967/jnmt.122.263901] [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: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Benign metastasizing leiomyomas are benign disseminated extra-uterine tumors in patients with prior history of uterine leiomyomas and may occur years after hysterectomy. The lung is mostly affected, with less common occurrence in the brain, heart, spine, retroperitoneum, and bone. The authors present the role of 18F-FDG PET/CT in the metabolic staging and post-surgical monitoring of a patient with lung and femoral involvement.
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27
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Li M, Lee AX, Wong WL, Tan KT. Benign metastasising leiomyoma: a rare disease and a diagnostic challenge. BMJ Case Rep 2022; 15:e248575. [PMID: 35835485 PMCID: PMC9289031 DOI: 10.1136/bcr-2021-248575] [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: 12/24/2022] Open
Abstract
Benign metastasising leiomyoma (BML) is a rare tumour characterised by extrauterine metastasis of histologically benign leiomyomas. We present a case of BML with pulmonary involvement. A 49-year-old woman presented with large pelviabdominal masses complicated by gross abdominal and lower limb swelling 6 years following open myomectomy. Preoperative CT imaging showed pelviabdominal masses and multiple bilateral pulmonary nodules. Initial impression was that of a stage 4 gynaecological malignancy. Palliative total hysterectomy bilateral salpingo-oophorectomy was performed. Histopathology confirmed benign uterine leiomyomas. Biopsy of pulmonary nodules showed benign leiomyomas, strongly positive for oestrogen and progesterone receptors. Definitive diagnosis of BML was made on histopathology and immunohistochemistry. The patient declined letrozole treatment as she had just undergone bilateral oophorectomy. She opted for conservative monitoring of her lung nodules. CT imaging 7 months postsurgery showed disease regression. She will require long-term surveillance scans to detect disease progression.
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Affiliation(s)
- Mingyue Li
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Ai Xin Lee
- Ministry of Health Holdings Pte Ltd, Singapore
| | - Wai Loong Wong
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kim Teng Tan
- O&G, KK Women's and Children's Hospital, Singapore
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28
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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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Glassman D, Patel JM, Hathout L, Thomas S, Girda E. Benign metastasizing leiomyoma in retroperitoneal lymph nodes with concurrent early stage cervical cancer. Gynecol Oncol Rep 2022; 40:100975. [PMID: 35434238 PMCID: PMC9011033 DOI: 10.1016/j.gore.2022.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022] Open
Abstract
BML of the retroperitoneal lymph nodes is a rare, benign disease. BML can mimic metastatic lymphadenopathy in the setting of concurrent malignancy. BML in the retroperitoneal lymph nodes is a diagnosis of exclusion. Consider biopsy if suspect metastatic disease in patients with BML risk factors.
Extrauterine leiomyomas can present as benign metastasizing leiomyoma involving lymph nodes, which can be mistaken for metastatic malignancy. We report a case of a 52-year-old female who presented with postmenopausal bleeding and was found to have an endocervical mass. Imaging demonstrated retroperitoneal lymphadenopathy and biopsy of the cervical mass showed adenocarcinoma of either uterine or cervical origin. Patient underwent hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy for bulky pelvic and para-aortic lymph nodes. Final pathology was consistent with FIGO 2019 stage IB2 adenocarcinoma of the cervix with concurrent and benign metastasizing leiomyomas involving retroperitoneal lymph nodes.
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Affiliation(s)
- Danielle Glassman
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, NJ, USA
- Corresponding author at: 135 Somerset Street, Apt 1605, New Brunswick, NJ 08901, USA.
| | - Jharna M. Patel
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, NJ, USA
| | - Lara Hathout
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ, USA
| | - Sumi Thomas
- Rutgers Robert Wood Johnson Medical School, Department of Pathology, New Brunswick, NJ, USA
| | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, Department of Gynecologic Oncology, New Brunswick, NJ, USA
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30
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Liu S, Zhou W, Fu W. Multiple Leiomyomas in a Patient with Benign Metastasizing Leiomyoma: A Case Report. Curr Med Imaging 2022; 18:996-999. [PMID: 35339186 DOI: 10.2174/1573405618666220325094428] [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: 11/03/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Benign metastasizing leiomyoma (BML) is a rare disease and mostly affects females with a history of uterine leiomyoma, particularly the presence of multiple leiomyomas in BML patients is extremely rare. CASE PRESENTATION This paper reported the clinical and imaging data of a BML patient with multiple leiomyomas involving bilateral pulmonary, mediastinum, pericardium, spine, peritoneum, and left thigh. Multiple BML lesions exhibited consistent imaging examinations, significantly improving the delayed phase enhancement. After multi-stage targeted therapy for multiple systemic metastases and the development of drug resistance, the patient was treated with hysterectomy and bilateral adnexectomy along with letrozole-based endocrine therapy. BML lesions, both pulmonary and mediastinum, became significantly smaller than before. CONCLUSION This paper aims to analyze the imaging and clinical features of multiple leiomyomas in this BML case, thus strengthening the understanding of the rare type of leiomyoma for effective preoperative diagnosis and clinical treatment. Furthermore, it is noteworthy that gynecologists should avoid the manifestation of BML when performing uterine fibroids surgery.
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Affiliation(s)
- Shuangjiao Liu
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
| | - Wenming Zhou
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
| | - Weidong Fu
- Department of Radiology, YueYang Central Hospital, Hunan Province, China
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31
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Lung metastases and subsequent malignant transformation of a fumarate hydratase -deficient uterine leiomyoma. Exp Mol Pathol 2022; 126:104760. [DOI: 10.1016/j.yexmp.2022.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
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32
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Ferreira A, Malheiro M, Martins A. Spinal Cord Compression Secondary to Benign Metastasizing Leiomyoma. Cureus 2022; 14:e21845. [PMID: 35291519 PMCID: PMC8896877 DOI: 10.7759/cureus.21845] [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] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Benign metastasizing leiomyoma is an extremely rare disease characterized by the presence of extrauterine spread of smooth muscle cells with histological, molecular, and immunological patterns similar to those of benign uterine leiomyomas. Benign metastasizing leiomyoma is often asymptomatic, and it presents as an incidental radiology finding of well-defined multiple pulmonary nodules with varying sizes. It is more frequent in premenopausal women, and a previous history of uterine leiomyomas resected in the past is found in most of the cases. There are very few case reports of benign metastasizing leiomyoma causing spinal cord compression. The authors report an uncommon case of a premenopausal woman with spinal cord compression one year after the diagnosis of benign metastasizing leiomyoma to the lung. Given that spinal cord compression is an oncologic neurosurgical emergency, rapid diagnosis and management are essential to prevent irreversible neurological deficits.
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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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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.
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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
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Jimoh O, Adeniran A, Omoyiola O, Vaughan A. Benign metastasizing leiomyoma: A rarely reported case in low-resource settings. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_137_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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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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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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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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Primary Pulmonary Leiomyoma: A First for Peripheral Diagnostic Bronchoscopy? J Bronchology Interv Pulmonol 2021; 27:e54-e56. [PMID: 32960860 DOI: 10.1097/lbr.0000000000000659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[18F]-FDG PET/CT of the Pulmonary Benign Metastasizing Leiomyoma in a Breast Cancer Patient: A Case Report. SURGERIES 2021. [DOI: 10.3390/surgeries2030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
18F-fluorodeoxyglucose ([18F]-FDG) positron emission tomography/computed tomography (PET/CT) is a useful functional image technique to evaluate the disease extent in many cancers, as well as differentiate benign disease from malignant metastasis. We report the case of a 49-year-old woman with breast cancer and suspected lung metastasis by conventional images. After FDG-PET/CT demonstrating faint, or even no FDG uptake in bilateral pulmonary nodules, accompanied with obvious uterine fibroids, benign metastasizing leiomyoma (BML) of the lung was included in a differential diagnosis and finally confirmed by surgical pathology. FDG PET/CT showed its value in the diagnosis of BML in the breast cancer patient who was misleading as lung metastasis during outpatient follow-up.
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Benign Metastasizing Leiomyoma of the Uterus with Pulmonary and Bone Metastases. Case Rep Obstet Gynecol 2021; 2021:5536675. [PMID: 34211791 PMCID: PMC8205596 DOI: 10.1155/2021/5536675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare spindle cell neoplasm seen in middle-aged women who have a history of leiomyoma of the uterus. The most common sites of metastases are the lungs; however, other sites of spread have been documented. These tumors by definition have no malignant features on histology and tend to be estrogen and progesterone positive. We present a middle-aged woman who was incidentally found to have multiple pulmonary nodules and a mass on her sternum after she was involved in a motor vehicle accident. She had a history of uterine leiomyoma and had undergone a hysterectomy ten years prior to the accident. Biopsies were performed of the lung nodules and sternum mass and compared to her hysterectomy specimen, and they were identical, and hence, she was diagnosed with BML. Due to the growing tumor of her sternum, she was started on tamoxifen with stability of her tumors. These tumors, since they are benign, tend to have an indolent course. However, in the instances that treatment is warranted, options include surgery or antiestrogen therapy. We will be discussing the pathogenesis, histological findings, and treatment options of this rare condition. Our case is unique because BML in general do not tend to spread to multiple organs and tend to be limited to one site of disease.
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Demonstration of in vivo estrogen receptor status with 16α- [ 18F]fluoro-17ß-oestradiol (FES) PET/CT in a rare case of benign metastasizing leiomyoma. Eur J Nucl Med Mol Imaging 2021; 48:4101-4102. [PMID: 34031720 DOI: 10.1007/s00259-021-05410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
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Chatzopoulos K, Johnson TF, Boland JM. Clinical, Radiologic, and Pathologic Characteristics of Pulmonary Hamartomas With Uncommon Presentation. Am J Clin Pathol 2021; 155:903-911. [PMID: 33258901 DOI: 10.1093/ajcp/aqaa193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the clinicopathologic and radiologic features of pulmonary hamartomas (PHs) with uncommon clinical presentation. METHODS A retrospective clinicopathologic and radiologic review was performed for patients diagnosed (1999-2019) with multiple hamartomas, lesions arising adjacent to a coexisting pulmonary malignancy, and tumors with predominantly extrapulmonary localization. RESULTS Of 979 patients diagnosed with PHs, 6 (0.6%) had multiple hamartomas, 4 (0.4%) had hamartomas adjacent to lung adenocarcinoma, and 2 (0.2%) had large mediastinal masses. Patients with multiple lesions had a median age of 65 years and mean tumor size of 0.9 cm; 1 patient had 3 hamartomas, and 5 patients had 2. Lesions next to adenocarcinomas had a mean size of 1.4 cm, and affected patients had a median age of 69 years. Predominantly mediastinal PHs, diagnosed in a 63-year-old woman and a 68-year-old man, measured 4.1 to 6 cm and were connected to the lung. All lesions were solid on imaging with absence of definitive fat or calcification, concerning for granuloma or malignancy. All cases had typical histology of PH, although one of the mediastinal tumors had an unusual amount of epithelial hyperplasia. CONCLUSIONS PHs can be clinically and radiologically challenging to diagnose. Histopathologic examination of biopsies and resection specimens is diagnostically crucial in this setting.
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Chandarana K, Caruana EJ, Richards CJ, Rathinam S, Nakas A. Pulmonary benign metastasising leiomyoma: a single-institution case series. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign metastasising leiomyoma (BML) is a rare and often asymptomatic presentation of smooth muscle tumour of uterine origin, occurring outside the uterus. We present the first case series of pulmonary BML in a contemporary UK population.
Patients were identified from prospective histopathological databases spanning from 2003 to 2019. Data was collected retrospectively from physical and electronic data sources.
Results
Six post-menopausal females were identified with an average age of 44±8 years (mean±SD). Fifty percent of our cohort was asymptomatic with an incidental finding of pulmonary nodules, whilst the others complained of non-specific respiratory symptoms. Five patients (88%) had multiple lesions (median 9, range 2 to 12)—with bilateral distribution, measuring an average of 11 mm (range 7 to 27) in size on cross-sectional imaging. All patients underwent diagnostic surgical pulmonary wedge resection, with no perioperative morbidity.
Immunohistochemistry confirmed the presence of ‘spindle cells’, staining positive for smooth muscle actin, desmin and progesterone receptors for all patients (100%), and oestrogen receptors in five patients (87%). Four patients (67%) underwent a hysterectomy prior to diagnosis of BML and one (17%) due to the diagnosis itself. Four patients (67%) underwent oophorectomy, whilst one patient required hormonal suppression therapy. Survival was 100% at a median follow-up of 59.5 months (range 29 to 166).
Conclusions
BML is a rare clinical entity accounting for a small proportion of patients presenting with pulmonary nodules. Following successful tissue diagnosis, outcomes with conservative or medical management are excellent.
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Pedrosa C, Miotto HC, Drumond LF, Andrade MM, Zille PC, Palhares GT, Abrahao-Machado LF. Right heart failure due to benign metastasizing leiomyoma: a case report of this exceedingly rare condition and review of the literature. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 33442611 PMCID: PMC7793117 DOI: 10.1093/ehjcr/ytaa468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a smooth muscle tumour of genital origin occurring in women with a history of uterine or pelvic leiomyoma. Although histologically benign, it exhibits metastatic behaviour. Lungs are the most common site of metastasis. The heart is a rare site and metastasis at this location has been described in just few cases. CASE SUMMARY A 42-year-old woman with a resected uterine leiomyoma and a subsequent and still not-resected left periovarian solid mass began complaining of shortness of breath 2 weeks before presentation. Echocardiography showed a mass located in the right ventricular cavity, enlargement of the right ventricle, and severe tricuspid regurgitation. Cardiac magnetic resonance revealed two masses suggestive of tumours in the right ventricle causing right ventricular outflow tract obstruction. Cardiac surgery was performed and, intraoperatively, a third small mass was detected on the tricuspid valve. The masses were resected, and tricuspid valve replacement was performed. Ten days later, the patient underwent an abdominal surgery for the pelvic mass resection. Immunohistochemical analysis of the cardiac and pelvic masses corroborated the diagnosis of benign leiomyomas. The patient was discharged in good clinical condition. DISCUSSION Benign metastasizing leiomyoma to the heart is a rare condition. The pathogenesis remains controversial and includes: (i) vascular or lymphatic spread of myomatous tissue cells when leiomyoma resection or hysterectomy is performed and (ii) smooth muscle cell proliferation in multiple regions. The more usual locations of BML in the heart seem to be the tricuspid valve and the right face of the interventricular septum.
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Affiliation(s)
- Cesar Pedrosa
- Biocor Instituto, Alameda Oscar Niemeyer, 217, Nova LIma, MG, Brazil, 34006-056
| | | | | | | | - Paula Chaves Zille
- Biocor Instituto, Alameda Oscar Niemeyer, 217, Nova LIma, MG, Brazil, 34006-056
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Reis Soares R, Ferber Drumond L, Soares da Mata D, Miraglia Firpe L, Tavares Mendonça Garretto JV, Ferber Drumond M. Cardiac metastasizing leiomyoma: A case report. Int J Surg Case Rep 2020; 77:647-650. [PMID: 33395865 PMCID: PMC7708872 DOI: 10.1016/j.ijscr.2020.11.095] [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: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cardiac intracavitary growth of metastasizing tumour is unusual. Benign Metastasizing Leiomyoma (BML) from the uterus to the heart is extremely rare. It affects premenopausal women with a history of uterine leiomyoma. PRESENTATION OF CASE We report a case of a 42-year-old woman who presented three tumours in the right side of the heart, two years after a hysterectomy due to leiomyomatosis. The cardiac tumours were resected and the diagnosis was uterine leiomyoma. DISCUSSION The patient developed cardiac failure due to three masses at the right side of the heart. Cardiac involvement in BML is usually asymptomatic and rare. The heart masses were surgically removed and a peri ovarian mass was detected and also removed. Although histologically benign, BML exhibits metastatic qualities. CONCLUSION It suggests that BML should be included as a differential diagnosis when a female patient presents an intra cardiac mass and a history of hysterectomy.
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Affiliation(s)
| | | | | | | | | | - Matheus Ferber Drumond
- Biocor Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazilian Society of Cardiac Surgery, Brazil
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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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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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Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review. J Thorac Imaging 2020; 36:263-278. [PMID: 33165163 DOI: 10.1097/rti.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.
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