Metastasising Leiomyoma of the Uterus with Pulmonary Involvement—Case Report

Abstract

Benign metastasising leiomyoma (BML) is characterised by extrauterine smooth muscle tumours in women after surgical treatment for uterine leiomyoma. Usually manifested as solitary or multiple focal lesions in various organs, it imposes a scrutinous diagnostic work-up to exclude a malignant disease and requires confirmation in microscopic examination of the extrauterine focus. The authors present a case of a 56-year-old woman with BML manifesting as bilateral multiple pulmonary nodules, with a tentative diagnosis of a disseminated malignant disease of mesenchymal origin. The patient underwent multiple diagnostic tests, which excluded malignancy. The definite diagnosis was established after the microscopic reevaluation of an excised pulmonary nodule. The patient is monitored with chest magnetic resonance. BML should be considered in the differential diagnosis of multiple pulmonary nodules in asymptomatic women. Patients with BML require long-term monitoring, therefore the selected imaging method should not carry the risk of cumulative side effects.

Benign metastasizing leiomyoma of the lung: diagnostic process and treatment based on three case reports and a review of the literature

“…In all cases, the patients underwent a signi cant number of tests before a decision to use invasive diagnostics and surgery was made. This is the typical course of events for "yet to be diagnosed" BPML patients: only unspeci c clinical features are revealed by the examinations of rst resort [22].…”

“…In accord with other authors, in the two patients the neoplastic changes were found years (12 and 17 years, respectively) after the operation for uterine leiomyoma, and their presence failed to be noted in any of the routine chest X-rays over this time. This makes the question of whether the myometrium is truly the primary locus of the BPML even more valid [22]. In the third case lung lesions have been diagnosed before the hysterectomy.…”

“…There have been few studies on the risk factors, related etiology, and clinical behavior of BML [16,17,18,19]. The diagnosis of BML remains challenging, as patients are often asymptomatic and the mean interval between initial surgery and diagnosis of BML is approximately 9 years, though cases of BML have been identi ed as early as the time of initial surgery and as late as 31 years post-operatively [20,21,22].…”

“…In the case of the rst and third patient, only a few of the multiple subcentimeter nodules were obtained, while in the second patient, the solitary mass of the tumor was resected in toto. The resected material was sent for postoperative histopathological examination, which remains the only method of obtaining the nal, incontestable diagnosis [1][2][3][4][6][7][8][14][15][16][17][18][19][20][21][22].…”

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

“…The diagnosis of BML remains challenging, as patients are often asymptomatic, and the mean interval between initial surgery and diagnosis of BML is approximately nine years. However, cases of BML have been identified as early as the time of initial surgery and as late as 31 years postoperatively [ 20 , 21 , 22 ]. The patients described in this paper had notably different histories.…”