1
|
Piórek A, Płużański A, Wiśniewski P, Tabor S, Winiarczyk K, Knetki-Wróblewska M, Kowalski DM, Krzakowski M. Pulmonary Benign Metastasizing Leiomyoma in a Postmenopausal Woman: A Case Report and Review of the Literature. Diseases 2024; 12:181. [PMID: 39195180 DOI: 10.3390/diseases12080181] [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: 05/31/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition characterized by the spread of uterine leiomyomas to the lungs, typically observed in premenopausal women with a history of hysterectomy or myomectomy. This report presents a unique case of a postmenopausal woman, aged 65, that emphasizes the clinical, radiological, histologic, and immunohistochemical aspects of the disease. On presentation, the patient suffered from severe pain. On imaging, a sizable lung tumor was found. Histopathological examination and immunoprofiling confirmed PBML. The patient underwent various treatments, including surgery, radiation therapy, and hormonal therapy, illustrating the challenges in managing PBML. A literature review underscores the rarity of PBML and its diverse clinical manifestations. This study provides valuable insights into the complexities of PBML.
Collapse
Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Adam Płużański
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Piotr Wiśniewski
- Department of Pathology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Abu Saadeh F, Riain CO, Cormack CM, Gleeson N. Lung metastases from benign uterine leiomyoma: does 18-FDG-PET/CT have a role to play? Ir J Med Sci 2018; 188:619-624. [DOI: 10.1007/s11845-018-1876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/16/2018] [Indexed: 12/26/2022]
|
4
|
Unusual Case of a Torted Mesenteric Fibroid. Case Rep Obstet Gynecol 2018; 2018:8342127. [PMID: 29977634 PMCID: PMC6011103 DOI: 10.1155/2018/8342127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/18/2018] [Indexed: 12/11/2022] Open
Abstract
Extrauterine leiomyomas are very rare and present a clinical and diagnostic challenge due to their unusual growth patterns and behaviours. A 47-year-old woman was transferred to our tertiary specialist obstetrics and gynaecology hospital with acute abdominal pain and a palpable abdominal mass. She was taken immediately to theatre with the presumptive diagnosis of an ovarian torsion. Intraoperatively, a large necrotic mass originating from the mesentery and attachments to the bowel at the ileocaecal junction was noted. When converted to laparotomy due to limited access and poor visualisation, the uterus, ovaries, and tubes were found to be normal. A right partial hemicolectomy was performed with the assistance of the colorectal surgeon due to suspicion of bowel malignancy. Histology revealed a benign infarcted leiomyoma with adhesions to the adjacent ileum. The diagnosis of a primary torted mesenteric fibroid was made.
Collapse
|
5
|
Barnaś E, Książek M, Raś R, Skręt A, Skręt- Magierło J, Dmoch- Gajzlerska E. Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery. PLoS One 2017; 12:e0175875. [PMID: 28426767 PMCID: PMC5398563 DOI: 10.1371/journal.pone.0175875] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/31/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. OBJECTIVES To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. METHODS A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. RESULTS AND CONCLUSIONS The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient's initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research.
Collapse
Affiliation(s)
- Edyta Barnaś
- Institute of Obstetrics and Emergency Medicine, Medical Faculty, University of Rzeszow, Rzeszow, Poland
- * E-mail:
| | - Mariusz Książek
- Clinical Department of Pathology, Frederick Chopin Clinical Provincial Hospital No 1, Rzeszow, Poland
| | - Renata Raś
- Obstetrics and Gynecology Clinic, Frederick Chopin Clinical Provincial Hospital No 1 Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Frederick Chopin Clinical Provincial Hospital No 1 Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Joanna Skręt- Magierło
- Obstetrics and Gynecology Clinic, Frederick Chopin Clinical Provincial Hospital No 1 Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Ewa Dmoch- Gajzlerska
- Faculty of Health Sciences, Gynaecological and Obstetrics Department, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
6
|
Kołaczyk K, Chamier-Ciemińska K, Walecka A, Chosia M, Szydłowska I, Starczewski A, Grodzki T, Smereczyński A, Sawicki M. Pulmonary benign metastasizing leiomyoma from the uterine leiomyoma: a case report. Pol J Radiol 2015; 80:107-10. [PMID: 25774240 PMCID: PMC4345854 DOI: 10.12659/pjr.892733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/23/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor. CASE REPORT A 45-year-old woman was referred to our hospital with suspicion of left adnexal tumor. The control transvaginal ultrasound examination performed at admission to the Gynecological Department excluded adnexal neoplasm. However, a large amount of fluid within the Douglas pouch raised the oncological concern. The patient underwent myomectomy in 2005. In the same year she was diagnosed with multiple lung nodules and underwent pulmonary wedge resection with the diagnosis of pulmonary benign metastasizing leiomyoma being stated. The decision of reevaluation of the specimen, control CT and puncture of the Douglas pouch fluid was made. Computed tomography performed at the Department of Diagnostic Imaging and Interventional Radiology of the Pomeranian Medical University Hospital revealed multiple, bilateral nodules. The microscopic examination of the samples confirmed the initial diagnosis of benign metastasizing leiomyoma with no evidence of neoplastic cells within the fluid. CONCLUSIONS Pulmonary benign metastasizing leiomyoma is a rare entity. However, it should be always taken into consideration in women with a previous or coincident history of uterine leiomyoma, especially when no evidence of other malignancy is present.
Collapse
Affiliation(s)
- Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Chamier-Ciemińska
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Anna Walecka
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Maria Chosia
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Iwona Szydłowska
- Clinic of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Starczewski
- Clinic of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Smereczyński
- Self-Educational Ultrasonographic Section of Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Sawicki
- Self-Educational Ultrasonographic Section of Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
7
|
Leiomyomas beyond the uterus; benign metastasizing leiomyomatosis with paraaortic metastasizing endometriosis and intravenous leiomyomatosis: a case series and review of the literature. Arch Gynecol Obstet 2014; 291:223-30. [PMID: 25047270 DOI: 10.1007/s00404-014-3356-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
Uterine leiomyomas affect 20-30 % of women 35 years and older. Extrauterine leiomyomas are rare and present a greater diagnostic challenge. Those unusual growth patterns occur more often in women of reproductive age with a history of hysterectomy or surgery for uterine leiomyomas. They have been reported in the literature in case reports and small case series and include benign metastasizing leiomyoma (BML), disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis (IVL), parasitic leiomyomas, and retroperitoneal growth. In this case series we present a case of BML with a first report of concomitant endometriosis metastasis to paraaortic lymphnodes, and a case of IVL. The findings and surgical management of those cases, as well as a review of the literature pertinent to those entities, are also presented.
Collapse
|
8
|
Chen S, Liu RM, Li T. Pulmonary benign metastasizing leiomyoma: a case report and literature review. J Thorac Dis 2014; 6:E92-8. [PMID: 24977035 DOI: 10.3978/j.issn.2072-1439.2014.04.37] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 11/14/2022]
Abstract
Benign metastasizing leiomyoma (BML) is a rare condition that occurs in all age groups and that is particularly prevalent among women of late childbearing age. All patients have a history of uterine leiomyoma and/or myomectomy, often associated with distant metastases from the uterus, which commonly occurs in the lung. We report the case of a 32-year-old young woman suffering from chest stuffiness, labored respiration and weakness after a myomectomy performed one month earlier. The chest CT showed a diffuse miliary shadow in both sides of her lungs, but serum tumor markers such as CA125, CA199, carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and CYFRA21-1 were normal. The patient underwent a lung biopsy by thoracoscopic surgery after four weeks of anti-TB treatment; there were no significant changes in the chest CT. H&E staining showed that the tumor cells had characteristics of smooth muscle cell differentiation. Immunohistochemical staining showed a low tumor cell proliferation index, which indicated that the likelihood of a malignancy was not high. There was no expression of CD10, indicating a diagnosis of pulmonary benign metastasizing leiomyoma (PBML). Smooth muscle actin (SMA) and desmin as specific markers of smooth muscle and the estrogen receptor (ER) and progesterone receptor (PR) were all strongly positive, which is characteristic of PBML. The patient was given the anti-estrogen tamoxifen for 3 months. With no radiological evidence of disease development and further distant metastasis, the patient will continue to be followed.
Collapse
Affiliation(s)
- Shi Chen
- 1 Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China ; 2 Department of Internal Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China
| | - Rui-Ming Liu
- 1 Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China ; 2 Department of Internal Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China
| | - Tian Li
- 1 Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China ; 2 Department of Internal Medicine, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China ; 3 Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing 210029, China
| |
Collapse
|
9
|
Ki EY, Hwang SJ, Lee KH, Park JS, Hur SY. Benign metastasizing leiomyoma of the lung. World J Surg Oncol 2013; 11:279. [PMID: 24134076 PMCID: PMC3842688 DOI: 10.1186/1477-7819-11-279] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/01/2013] [Indexed: 11/30/2022] Open
Abstract
Benign leiomyomas of the uterus are uncommonly found in association with benign smooth muscle tumors beyond the confines of the uterus. Benign metastasizing leiomyoma (BML) is a rare disease in which the lung is described to be the most afflicted extrauterine organ. We present a brief review of the literature, along with case reports for four patients who were followed up after resection of a pulmonary lesion or after pathological confirmation by biopsy. The clinical course of BML varies from chronic asymptomatic appearance to rapid progression, leading to respiratory failure and death. Our BML patients did not complain of pulmonary symptoms, such as cough, dyspnea, or chest tightness. Pathology revealed benign leiomyomas with no atypia and mitotic activity <5 per 10 high-power field. Immunohistochemical staining was positive for actin and desmin. A standard treatment for BML has not yet been established. Because of the hormone-sensitive characteristics of BML, treatments are based on hormonal manipulation along with either surgical or medical oophorectomy. Benign metastasizing leiomyoma can be observed in postmenopausal women. We observed four patients who did not receive adjuvant hormonal therapy because they were postmenopausal or perimenopausal. All patients are still healthy and show no evidence of recurrence or progression of the disease.
Collapse
Affiliation(s)
| | | | | | | | - Soo Young Hur
- Department of Obstetrics and Gynecology, Seoul St, Mary's Hospital, The Catholic University of Korea, #505 Banpo-Dong, Seocho-Gu, Seoul, South Korea.
| |
Collapse
|
10
|
Lim SY, Park JC, Bae JG, Kim JI, Rhee JH. Pulmonary and retroperitoneal benign metastasizing leiomyoma. Clin Exp Reprod Med 2011; 38:174-7. [PMID: 22384439 PMCID: PMC3283070 DOI: 10.5653/cerm.2011.38.3.174] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/23/2011] [Accepted: 09/05/2011] [Indexed: 11/06/2022] Open
Abstract
Benign metastasizing leiomyoma (BML) is a rare disease, which usually occurs in women with a history of a prior hysterectomy or myomectomy for benign uterine leiomyoma, and has the potential to metastasize to distant sites, such as the lung, lymph nodes, muscular tissue, heart, or retroperitoneum. These lesions are slow-growing, asymptomatic, and usually found incidentally. The prognosis of BML is also excellent. However, there has been debate on the origin and the correct classification of BML, and there are no guidelines for the treatment of BML. We report here on a rare case of BML in both the retroperitoneal cavity and lung in a 48-year-old woman with a history of hysterectomy due to histologically benign uterine leiomyoma. The patient underwent retroperitoneal mass excision and bilateral salpingo-oophorectomy, and then wedge biopsy of two pulmonary nodules was performed additionally 9 days later. Until now, there has been no sign of recurrence and the patient remains asymptomatic. To our knowledge, pulmonary BML is rare and the co-existence of the retroperitoneal metastases after previous hysterectomy is even rarer.
Collapse
Affiliation(s)
- Su Yeon Lim
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | | | | | | | | |
Collapse
|