An Unusual Cause of Pulmonary Nodules in the Emergency Department

Abstract

We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

Multiple organ benign metastasizing leiomyoma: A case report and literature review

“…Several hypotheses had been proposed in history. Some people argued that BML represents proliferation of smooth muscle cells that is native to the lungs, but this theory could not explain other sites of BML . Others believed that smooth muscle cells transferred by blood vessel from the trauma of myomectomy or hysterectomy while BML may also occur in absence of myomectomy or hysterectomy.…”

“…Clinical manifestations of BML depends largely on its site of involvement but usually asymptomatic and found incidentally on imaging examination. Uncommon presentations of pulmonary BML include chest pain, hemoptysis, hemothorax, pneumothorace and empyema . Extrapulmonary manifestations such as abdominal pain by pelvic metastasis, jaundice by pancreas metastasis, limb pain and shoulder pain by metastatic compression were also reported .…”

“…Some people argued that BML represents proliferation of smooth muscle cells that is native to the lungs, but this theory could not explain other sites of BML. 5 Others believed that smooth muscle cells transferred by blood vessel from the trauma of myomectomy or hysterectomy while BML may also occur in absence of myomectomy or hysterectomy. The theory that BML is a very lowgrade leiomyosarcoma that has the potential for metastasis to other organs through lymphatic or hematological metastasis route was also accepted by studies.…”

“…Uncommon presentations of pulmonary BML include chest pain, hemoptysis, hemothorax, pneumothorace and empyema. 5 Extrapulmonary manifestations such as abdominal pain by pelvic metastasis, jaundice by pancreas metastasis, limb pain and shoulder pain by metastatic compression were also reported. 10 In this case, chest distress by pulmonary BML and the pain of left hip and back of thigh by thigh and ilium BML were demonstrated.…”

Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix

“…Only in two studies the time from surgery to the clinically confirmed metastasis was two and four weeks, respectively [18, 19]. Interestingly, the shortest time to metastasis was connected with the pulmonary location, associated with previous myomectomy.…”