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Grant L, Chipwete S, Soo Hoo S, Bhatnagar A. Extrapulmonary uterine lymphangioleiomyomatosis (LAM) and dysfunctional uterine bleeding: the first presentation of LAM in a tuberous sclerosis complex patient. BMJ Case Rep 2019; 12:12/2/e226358. [PMID: 30804158 DOI: 10.1136/bcr-2018-226358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease that typically affects women of childbearing age. It most commonly affects the lungs (P-LAM) but can occasionally occur in extra-pulmonary sites (E-LAM). There is a strong association between LAM and the tuberous sclerosis complex (TSC). We report a case of a 42-year-old female TSC sufferer who presented with dysfunctional uterine bleeding. She was not known to have LAM. An endometrial biopsy revealed a spindled-cell lesion suspicious of leiomyosarcoma, which correlated with cross-sectional imaging. She underwent a hysterectomy that showed a bizarre (symplastic) leiomyomatous endometrial polyp with background uterine LAM. We discuss the clinical and pathological implications of this unusual case of E-LAM and the importance of clinicopathological correlation in TSC sufferers. The association of uterine LAM with TSC is important and LAM should be considered as a differential of dysfunctional uterine bleeding and a benign mimic to uterine leiomyosarcoma in patients with TSC.
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Affiliation(s)
- Lucy Grant
- Department of Cellular Pathology, New Cross Hospital, Wolverhampton, UK
| | - Saliya Chipwete
- Department of Obstetrics and Gynaecology, New Cross Hospital, Wolverhampton, UK
| | - San Soo Hoo
- Department of Obstetrics and Gynaecology, New Cross Hospital, Wolverhampton, UK
| | - Anjali Bhatnagar
- Department of Cellular Pathology, New Cross Hospital, Wolverhampton, UK
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Suzuki K, Nagasaka K, Oda K, Abe H, Maeda D, Matsumoto Y, Arimoto T, Kawana K, Fukayama M, Osuga Y, Fujii T. A case of lymphangioleiomyomatosis associated with endometrial cancer and severe systemic lupus erythematosus. BMC Cancer 2016; 16:390. [PMID: 27377753 PMCID: PMC4932736 DOI: 10.1186/s12885-016-2413-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/24/2016] [Indexed: 01/09/2023] Open
Abstract
Background Lymphangioleiomyomatosis (LAM) is a rare idiopathic disorder that occurs in women of childbearing age, and consists of a diffuse proliferation of abnormal smooth muscle cells along the thoracic and abdominal lymphogenous route. Case presentation We experienced a case of a 47-yo woman with recent history of systemic lupus erythematosus (SLE) diagnosed with endometrial cancer, initially suspected to have metastasized to pelvic and para-aortic lymph nodes based on preoperative diagnostic imaging. Subsequent pathological diagnosis revealed stage IB endometrial cancer without evidence of lymph node involvement. Instead, enlarged pelvic and para-aortic lymph nodes were found to be due to extrapulmonary LAM, from a primary lesion found inside the uterine myometrium. SLE improved after surgery. Conclusion This is the first reported case of comorbid endometrial cancer, SLE, and aggressive LAM metastasizing to regional lymph nodes, and strengthens the clinical evidence for a common role of mTOR pathway hyperactivity and estrogen responsiveness in the pathophysiology of metastasizing lesions of the genital tract.
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Affiliation(s)
- Kensuke Suzuki
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daichi Maeda
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoko Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahide Arimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Basnet A, Shaaban H, Kessler W. A case of recurrent retroperitoneal lymphangioleiomyomatosis treated with progesterone therapy. Urol Ann 2015; 7:127-8. [PMID: 25657565 PMCID: PMC4310104 DOI: 10.4103/0974-7796.148664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alina Basnet
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Hamid Shaaban
- Department of Hematology and Oncology, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - William Kessler
- Department of Medical Oncology, Trinitas Regional Medical Center, Elizabeth, USA
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