PurposeBenign Metastasising Leiomyomatosis is a rare complication of a common gynaecological condition, often requiring multidisciplinary team input. No guidelines exist for its management. We aim to highlight an unusual case and summarise international practice of investigation and management from existing literature, to facilitate better recognition and management in the future. MethodsWe present a challenging case of progressive pulmonary BML in a woman with previous lung cancer. An extensive Pubmed search was performed using search terms: benign, metastasising, metastasizing, parasitic, leiomyoma, leiomyomata, leiomyomatosis, fibroid and fibroids. All English papers available in free text were reviewed for the literature review.Results80 relevant papers reporting 123 cases were included. We report common demographics, gynacological backgrounds and presenting symptoms of the women. Diagnosis involved CT imaging in 96% of cases, histopathology in 93% and immunohistochemistry in 83% with the most common markers used being ER, PR, SMA and Ki-67. PET scan was performed in 24%. We summarise also the management options, including an overview of current hormonal treatment options, and follow-up regimes which typically involves regular CT-scans. ConclusionPulmonary BML is a benign condition but it presents similarly to lung cancer, making our case especially complex. Malignancy must therefore always be a differential diagnosis. Management is individualised as shown in our review but may be expectant, medical or surgical, with a strong emphasis on follow-up.
PurposeBenign Metastasising Leiomyomatosis is a rare complication of a common gynaecological condition, often requiring multidisciplinary team input. No guidelines exist for its management. We aim to highlight an unusual case and summarise international practice of investigation and management from existing literature, to facilitate better recognition and management in the future. MethodsWe present a challenging case of progressive pulmonary BML in a woman with previous lung cancer. An extensive Pubmed search was performed using search terms: benign, metastasising, metastasizing, parasitic, leiomyoma, leiomyomata, leiomyomatosis, broid and broids. All English papers available in free text were reviewed for the literature review.Results 80 relevant papers reporting 123 cases were included. We report common demographics, gynacological backgrounds and presenting symptoms of the women. Diagnosis involved CT imaging in 96% of cases, histopathology in 93% and immunohistochemistry in 83% with the most common markers used being ER, PR, SMA and Ki-67. PET scan was performed in 24%. We summarise also the management options, including an overview of current hormonal treatment options, and follow-up regimes which typically involves regular CT-scans. ConclusionPulmonary BML is a benign condition but it presents similarly to lung cancer, making our case especially complex. Malignancy must therefore always be a differential diagnosis. Management is individualised as shown in our review but may be expectant, medical or surgical, with a strong emphasis on follow-up.
Objectives Evaluate the management of pregnant women with inflammatory bowel disease. Method We collected data from maternity records for women with IBD who gave birth at The Royal London Hospital between January 2018 and February 2019. Results Twenty-three pregnancies were identified where 8/23 (35%) women had a peri-conception flare and 7/23 (30%) had a flare during pregnancy. Two women received pre-conception counselling. The obstetric medicine team reviewed a patient on average three times and the gastroenterologists twice, during pregnancy. Nine women (39%) gave birth pre-term. Mean birthweight was lower in the group with active disease at conception compared with those in remission (2173 g vs. 2807 g, p = 0.03). Conclusions Women with IBD should all receive pre-conception counselling to reduce the risk of pregnancy complications. By developing a multidisciplinary care pathway for pregnant women with IBD (which includes a joint obstetric/gastroenterology clinic), this will ensure care is standardised throughout the pregnancy and puerperium.
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