Benign metastasizing leiomyoma in the lung.

Maredia, Rozina; Snyder, Bradley J.; Harvey, L.; Schwartz, Alan M.

doi:10.1148/radiographics.18.3.9599398

Cited by 33 publications

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“…Typically, nodules are homogeneous and not calcified. Obvious enhancement after administration of iv contrast medium is not a commonly described feature [8,9,12]. The masses rarely cavitate [4,8,9].…”

Section: Discussionmentioning

confidence: 94%

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Large pulmonary masses containing varicose veins: a rare presentation of benign metastasising leiomyomas

Challa

Irion²,

Hochhegger³

et al. 2010

BJR

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ABSTRACT.A 48-year-old woman presented with cough and chest pain. A chest radiograph and CT scans showed bilateral lung masses containing massive venous varices. A core biopsy specimen revealed benign metastasising leiomyoma with strong expression of progesterone receptors. A review of her medical history revealed a hysterectomy 11 years earlier. The lung masses showed significant reduction in size after induction of artificial menopause, although the pulmonary varices persisted. A pulmonary varix is a localised enlargement of a segment of a pulmonary vein [1]. Lung varices have been associated with mitral valve disease, tuberculosis, emphysema, systemic hypertension and arteriovenous fistulae. Benign metastasising leiomyoma (BML) is a rare condition characterised by the presence of histologically benign smooth muscle tumours at extra-uterine sites in the presence of uterine leiomyomas [2][3][4]. Pelvic varices are a common finding in patients with uterine leiomyomas (fibroids); however, varices do not normally occur within the leiomyomas. We report CT findings observed in a 48-year-old woman who developed large varices inside BML lung masses. To our knowledge, this finding has not been previously described in the literature. Case reportA 48-year-old woman was referred for CT evaluation of pulmonary abnormalities that had appeared on a chest radiograph. She initially presented with a cough and pleuritic chest pain on the right side. Her medical history included a hysterectomy for fibroids 11 years earlier. On examination, she was clearly unwell and had a fever. A chest radiograph showed bilateral volume loss with bilateral indistinct hemidiaphragm and a possible mass in the left lower zone (Figure 1). She was hypoxic in room air. Routine haematological tests were unremarkable except for a C-reactive protein level that increased from 31 to 244 mg L 21. An electrocardiogram was unremarkable and D-dimer and troponin T levels were normal.A multislice CT scan of the chest with injection of intravenous contrast medium was performed. The resulting images demonstrated bilateral lung masses up to 9 cm in diameter with obvious venous varices. Vein diameters were as large as 1.2 cm in the lung cortex (Figure 2). Images of the lung varices were demonstrated by CT angiography three-dimensional reconstructions using maximum intensity projection (MIP) and volumerendering techniques (Figure 3).A CT-guided biopsy of the left lung lesion was performed, targeting the less vascularised area. Histological sections showed bland, predominantly fusiform, cells displaying no mitotic activity and arranged in a whorled pattern, typical of leiomyoma. These results were confirmed by immunolabelling for smooth muscle actin (SMA). Cell nuclei strongly expressed the receptor protein for progesterone, but not the oestrogen receptor, indicating that the cells might be responsive to hormonal manipulation. These features are diagnostic of BML. The patient was treated by inducing artificial menopause, which resulted in partial regression of the lun...

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Section: Discussionmentioning

confidence: 94%

“…The masses rarely cavitate [4,8,9]. Unusual appearances of metastasising leiomyomas include cyst formation [8], tiny calcifications [9], dissemination in a miliary pattern [2,12], interstitial lung disease [4,12], pneumothorax [8,10] and pericardial effusion [12].…”

Section: Discussionmentioning

confidence: 99%

Large pulmonary masses containing varicose veins: a rare presentation of benign metastasising leiomyomas

Challa

Irion²,

Hochhegger³

et al. 2010

BJR

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“…Although few cases of pulmonary BML may be associated with respiratory symptoms, most of them are asymptomatic and diagnosed incidentally by routine chest X-rays [8] . The typical radiographic appearance shows multiple pulmonary nodules with a pattern similar to malignancy or miliary tuberculosis [9][10][11] . In general BML lesions have the same histological appearance as the initial uterine leiomyoma [4,12] .…”

Section: Discussionmentioning

confidence: 99%

Is a Miliary Chest Pattern Always Indicative of Tuberculosis or Malignancy?

Koutsopoulos

Mitrouska²,

Dambaki³

et al. 2006

Respiration

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“…4,5 Although leiomyoma is histologically benign, it has the potential to metastasize to distant sites such as the lungs, pelvic and retroperitoneal lymph nodes, omentum, inferior vena cava, right atrium, and muscular tissue of the limbs. 1,2 The interval between surgery for the initial uterine leiomyoma and detection of distant metastasis has been reported to be 10 years on average. 4 The differential diagnosis for pulmonary leiomyoma after hysterectomy includes metastasizing leiomyoma of the uterus, metastasizing low-grade leiomyosarcoma, multiple leiomyoma, and pulmonary leiomyomatous hamartoma, 6 although pulmonary leiomyomas without uterine leiomyoma sometimes occur.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] There is much controversy about the pathogenesis and etiology of this disease. We report a case of pulmonary BML from the uterus in an elderly postmenopausal woman.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Benign Metastasizing Leiomyoma from the Uterus in a Postmenopausal Woman: Report of a Case

et al. 2004

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We report a case of pulmonary benign metastasizing leiomyoma (BML) from the uterus in a 77-year-old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. Because a preoperative diagnosis could not be made, the largest tumor, 3.5 cm in diameter, was resected from the right lower lobe, and histological examination confirmed BML. She had undergone hysterectomy with oophorectomy for uterine leiomyomas 12 years earlier, at the age of 65. The microscopic findings of the lung tumor were similar to those of the uterine leiomyoma, and both lesions were histologically benign. Although this disease is considered to be hormone-dependent, metastasis was found in this elderly postmenopausal woman whose tumor was negative for estrogen receptor.

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Benign metastasizing leiomyoma in the lung.

Cited by 33 publications

References 0 publications

Large pulmonary masses containing varicose veins: a rare presentation of benign metastasising leiomyomas

Large pulmonary masses containing varicose veins: a rare presentation of benign metastasising leiomyomas

Is a Miliary Chest Pattern Always Indicative of Tuberculosis or Malignancy?

Pulmonary Benign Metastasizing Leiomyoma from the Uterus in a Postmenopausal Woman: Report of a Case

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