A case of benign metastasizing leiomyoma treated by surgical castration followed by an aromatase inhibitor, anastrozole

Nasu, Kaei; Tsuno, Akitoshi; Takai, Noriyuki; Narahara, Hisashi

doi:10.1007/s00404-008-0698-0

Cited by 48 publications

(32 citation statements)

References 17 publications

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“…Immunohistochemistry revealed that most BML tumor cells are positive for estrogen receptor and progesterone receptor; consequently, the disease is considered hormonedependent [2,5,8]. Some authors stated that bilateral oophorectomy should be considered as a treatment in premenopausal patients [10,14]. Ip et al [2] suggested that in patients with symptomatic metastasis, resection should be undertaken whenever possible.…”

Section: Discussionmentioning

confidence: 96%

“…GnRH agonist treatment is also predominantly performed against residual tumors or for preoperative tumor reduction. Other therapeutic agents include aromatase inhibitors [9,14], selective estrogen receptor modulators (such as tamoxifen or raloxifene) [9], and progesterone (such as medroxyprogesterone acetate) [5,7,12] in some case reports. Rivera et al [9] reported a clear effect when an aromatase inhibitor (such as anastrozole) was used, whereas a GnRH agonist failed to control tumor progression.…”

Section: Discussionmentioning

confidence: 98%

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Clinical benefit of endocrine therapy for benign metastasizing leiomyoma

et al. 2010

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Benign metastasizing leiomyoma (BML) is a rare disease that is caused by metastasis of a histologically benign leiomyoma that spreads to distant organs. Metastasis commonly follows surgical treatment of myomectomy or hysterectomy for benign uterine leiomyoma. Since the work of Steiner in 1939, several other studies have been published, but a unified view has not emerged regarding the biological nature, pathogenesis, and prognosis of this disease. In particular, a standard treatment has not been established. Here we report a case of BML of the lung and peritoneum in a premenopausal 45-year-old woman who underwent hysterectomy for uterine leiomyoma 10 years earlier. A computed tomography (CT) scan showed multiple pulmonary nodules (maximum size 48 mm) and a solitary intra-peritoneal nodule. The lung nodules were diagnosed as BML following a CT-guided needle biopsy. Histologically, the biopsied tumor was composed of spindle cells without significant atypia, and mitosis was not observed. Immunohistochemically, the tumor cells were strongly positive for smooth muscle actin, desmin, and estrogen receptor, suggesting a uterine leiomyomatous lineage. The patient was treated with a gonadotropin-releasing hormone agonist for 36 months, during which time the nodules reduced in size slightly. No new lesions appeared, and the tumors were stable at 15 months after the cessation of treatment. In conclusion, endocrine therapy can serve as one of the conservative treatments for premenopausal women with BML, rather than surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Clinical benefit of endocrine therapy for benign metastasizing leiomyoma

et al. 2010

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“…Although LPD is a different entity when compared with UMs, there might be a relation between morcellation of UMs and an iatrogenic development of this disease. Several studies which presented that LPD shrink under sex steroid hormone manipulation, including BSO [53][54][55], menopause [65], megestrol [66], SERM [55], AI [55,67], and GnRHa [55,56,68]. Laparoscopic myomectomy might result in the growth of multiple PM nodules mimicking LPD [31].…”

Section: Discussionmentioning

confidence: 99%

Oestrogen-Induced Angiogenesis and Implantation Contribute to the Development of Parasitic Myomas after Laparoscopic Morcellation

Lin

Huang

Chen³

et al. 2017

Journal of Minimally Invasive Gynecology

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“…Occasionally, pelvic surgery combined with hormonal treatment has been proposed. 17 Other reported treatment methods include chemotherapy, ovarian radiotherapy, pulmonary nodule resection, and careful observation, especially in women in menopause with declining estrogen levels. Most BML lesions remain constant or decrease in size during follow-up after bilateral salpingo-oophorectomy.…”

Section: Discussionmentioning

confidence: 99%

Benign Metastasizing Leiomyoma Presenting as Cavitating Lung Nodules

Loukeri¹,

Pantazopoulos

Tringidou

et al. 2013

Respir Care

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Benign metastasizing leiomyoma (BML) was initially used to describe single or multiple pulmonary nodules composed of proliferating smooth muscle cells (lacking cellular atypia) in premenopausal females 3 months to 20 y after hysterectomy for uterine leiomyoma. The lung is the most commonly involved site, thus including many malignant and benign entities in the differential diagnosis. The present case refers to a 47-y-old premenopausal woman with a history of subtotal hysterectomy for a uterine leiomyoma presenting with bilateral cavitating pulmonary nodules. A number of nodules were resected by video-assisted thoracoscopic surgery. The histological findings in correlation with the immunohistochemical results were consistent with the diagnosis of BML. A bilateral salpingooophorectomy was performed, combined with complete removal of the remaining cervix. One year later, the subject remains asymptomatic, and the pulmonary nodules are stable with regard to number, size, location, and morphology.

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A case of benign metastasizing leiomyoma treated by surgical castration followed by an aromatase inhibitor, anastrozole

Abstract: In addition to castration by bilateral oophorectomy or gonadotropin-releasing hormone agonist, the use of aromatase inhibitor is one of the treatment options for the further suppression of peripheral estrogen production in these patients.

Cited by 48 publications

References 17 publications

Clinical benefit of endocrine therapy for benign metastasizing leiomyoma

Clinical benefit of endocrine therapy for benign metastasizing leiomyoma

Oestrogen-Induced Angiogenesis and Implantation Contribute to the Development of Parasitic Myomas after Laparoscopic Morcellation

Benign Metastasizing Leiomyoma Presenting as Cavitating Lung Nodules

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