Difficulty in complete transarterial embolization for pulmonary benign metastasizing leiomyoma with massive hemoptysis

Abstract

A 43-year-old woman suffering from massive hemoptysis from pulmonary benign metastasizing leiomyoma (BML) at the left lung hilum underwent bronchial and nonbronchial transarterial embolization (TAE) using gelatin sponge particles and n-butyl 2-cyanoacrylate during three interventional procedures. However, since complete embolization of the tumor was difficult despite decreased tumor size, the tumor was surgically resected 3 months after the last interventional procedure. This case demonstrates the difficulty of complete TAE for pulmonary BML because of its hypervascularity and the rich communications between bronchial and nonbronchial anastomotic arteries.

Benign metastasizing leiomyoma of the lung: A case report and literature review

“…The majority of tumors are asymptomatic and are found incidentally on routine chest roentgenograms, however, coughing, dyspnea and chest pain have also been reported as symptoms (18). Recently, Miyazaki et al (19) presented a case of massive hemoptysis from pulmonary BML, and transarterial embolization was attempted in the treatment as the thoracic surgeon expected that resection of the tumor may be difficult due to the tumor location. The majority of reports of BML describe a chronic, benign, indolent course, but Bachman and Wolff reported a case of mortality due to of acute respiratory distress syndrome from multiple lesions with massive pulmonary and hilar lymphatic metastasis (20).…”

Embolization of Chest Neoplasms: The Next Frontier in Interventional Oncology?

“…In other case reports, preoperative TAE has been described for resection of a variety of tumors, including a massive, anterior mediastinal thymoma, 20 benign metastasizing leiomyoma of the hilum, 21 bronchial mucoepidermoid, 22 giant fibrous tumor of the pleura, 23 angiosarcoma, 24 and metastasis from endometrial sarcoma. 25…”

“…8 TAE has been used to defunctionalize parathyroid adenomas in the aorticopulmonary window, 11 and shrink benign tumors such as Castleman lymphadenopathy, 26 racemose hemangioma, 6 and benign leiomyomas of the hilum. 21 Preliminary CTA, diligent intraprocedural, selective angiography, and intraprocedural cone-beam CT 21 have been applied to ensure that every possible artery is embolized since most benign tumors are supplied by multiple bronchial and nonbronchial feeders.…”

Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors

“…Lesions are usually slow-growing, although symptoms such as cough and chest pain are not rarely reported (28,29). At least one case of death from respiratory failure due to massive hilar metastases and a case of potentially fatal haemoptysis have been described (30,31). Cases of malignant transformation have also been described (32,33).…”