Treatment decision based on the biological behavior of pulmonary benign metastasizing leiomyoma

Abstract

Benign metastasizing leiomyoma (BML) is a rare disease in women undergoing surgery for uterine leiomyoma. About 100 cases have been reported in the literature, none of which describe the biological behavior of lesions. The authors present the case of a 36-year-old, asymptomatic woman who had undergone uterus extirpation seven years earlier for leiomyoma of the uterus. Routine chest radiography revealed multiple nodules in both lungs. Biopsy verified metastases from the original uterine leiomyoma. of the seven metastasectomies was 95% (range: 40-150%). Pathological examination of the nodules proved that, despite continuous oncological treatment, there were no signs of necrosis, thrombosis, or fibrosis. The number of mitoses within the nodules did not change. According to our surgical results and the fact that oncological treatment did not have a significant effect on the course of the disease, we conclude that in the management of multiple BML lesions, surgically removing as many lesions as possible is advised.

Benign Metastasizing Leiomyoma of the Uterus: Rare Manifestation of a Frequent Pathology

“…Several theories have been proposed along the years regarding the etiology of BML, including [ 5 – 10 ] hematogenous spread of uterine leiomyoma; in situ proliferation of smooth muscle induced by hormonal stimulation; metastasis of low-grade uterine leiomyosarcoma previously subdiagnosed; peritoneal seeding after surgery for uterine leiomyoma and metaplastic transformation. Since most cases of BML occur from 8,8 to 15 years after gynecological surgery [ 2 , 5 , 6 , 8 ], we hypothesize that surgically induced vascular spread is the most likely cause [ 1 , 10 ]. In addition, we agree with the majority of researchers who consider that BML is clonally derived from uterine leiomyoma [ 3 – 8 ].…”

“…Histopathological confirmation is required for definitive diagnosis of BML [ 1 , 5 ]. These lesions reveal a smooth muscle phenotype with low mitotic activity, limited vascularization and lacks of anaplasia and necrosis [ 4 – 8 , 10 – 13 ]. Its immunohistochemical features include positivity for smooth muscle actin, desmin, caldesmon, calponin, vimentin [ 1 , 2 ], and hormonal receptors (estrogen and progesterone receptors) [ 1 , 5 ].…”

“…For pulmonary BML, although primary option consists in surgical excision of the maximum possible number of pulmonary nodules, it may not be technically feasible. Alternative therapies include surgical castration by bilateral oophorectomy, chemical castration [ 1 , 2 , 5 , 10 , 11 ], or combined therapy [ 2 ]. Some researchers advocate expectant treatment in climacteric women [ 2 ].…”

Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors

“…Cases of BML diagnosed in patients with previous history of malignant cancers (renal, bone sarcoma, ovarian) have been reported (35)(36)(37)(38), and as prognosis for treated BML is very good compared to metastatic cancer, surgical biopsy should be considered when previous history of uterine myoma is also present, justifying in this case even a very aggressive removal of all lesions (39).…”

Benign Uterus Cancer With Lung Metastases: Leiomyomatosis, Lymphangioleimyomatosis, Thoracic Endometriosis (Literature Review, Personal Clincial Observations)

“…Эти данные, хотя и в 2,5 раза превышают известную из литературы статистику, со-гласно которой к 2016 году задокументировано около 100 случаев заболевания ДМЛ [58], все же свидетель-ствуют о том, что данная патология встречается в прак- Вероятность истинного роста заболеваемости ДМЛ подкрепляется тем, что не все специалисты-гинекологи подтверждают рост заболеваемости лейомиомой матки (без метастазов) [25].…”