Benign Metastasizing Leiomyoma of the Lung: Diagnostic Process and Treatment Based on Three Case Reports and a Review of the Literature

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.

Rare benign lung tumours presenting with high clinical suspicion for malignancy: a case series and review of the literature

“…Gross examination included a well demarcated, white nodule, 11 mm in diameter, with a moderately firm consistency, which correlates with findings in other cases [73]. Cut surface often reveals a whorl-like pattern [73]. Microscopic findings show bundles of uniform, spindle-shaped cells, without nuclear pleomorphism and visible mitosis.…”

“…Metastatic leiomyomas have a similar pathohistological morphology to their uterine counterparts [71,72]. Gross examination included a well demarcated, white nodule, 11 mm in diameter, with a moderately firm consistency, which correlates with findings in other cases [73]. Cut surface often reveals a whorl-like pattern [73].…”

“…These cells can often be arranged in a palisade, bundle, or whorl pattern. The smooth muscle cells have abundant eosinophilic cytoplasm and uniform nuclei that are cigar or boxcar shaped [73,74]. The interstitium was made up of a large amount of collagen fibres.…”

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices

“…Moreover, pulmonary echinococcosis in patients with a previous history of cancer suggests the dissemination of a neoplastic disease [ 56 ]. Furthermore, radiological examination may suggest the presence of other benign and rare pulmonary pathologies, such as benign metastasizing leiomyomas [ 57 , 58 ]. Additionally, simultaneous infections represent another diagnostic challenge.…”

Incidental detection of benign metastasizing leiomyoma in asymptomatic female

“…Since Steiner first proposed the diagnosis in 1939, at least 164 cases have been described in literature. [ 1 , 2 ] Most cases have been reported in women of late childbearing age with a history of uterine leiomyoma. The previous hysterectomy for fibroids is a typical finding.…”