Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

Abstract

Background/Aim: Leiomyoma is a rare benign tumor originating from smooth muscle fibres. In the respiratory tract, these tumors are rare and in the pleura, cases are exceptional, with only a few reported so far. This is the main reason we decided to present this case of primary leiomyoma of the visceral pleura. Case Report: We present a case of a 51-year-old asymptomatic patient who, during a routine medical examination using standard chest radiography, presented with a 3 by 2 cm homogenous mass in the right superior pulmonary area, tangent to the chest wall (same level with the 3 rd rib). Further investigation using computed tomography (CT) in the chest confirmed the presence of a 31/18 mm solid mass in the right upper lobe, in contact with the parietal pleura. Surgery was performed for two reasons: i) removal of the tumoral mass and ii) establishing a histopathological diagnosis. Intraoperatively, a well-defined, homogenous, ivory white non-infiltrating mass was discovered in the right upper lobe on the visceral pleura and in close proximity to the minor fissure. The mass was removed with negative surgical margins and was left with healthy tissue. Histopathological examination and immunohistochemistry came as a surprise, establishing our diagnosis of leiomyoma. Conclusion: Primitive pleural leiomyoma must remain a possibility when considering the differential diagnosis of pleural tumors. The main course of treatment is complete surgical resection. In our case, longterm follow up did not present any local recurrence.Leiomyoma is a tumor originating in smooth muscular fibres and can occur anywhere in the body where this cell type exists. Leiomyomas are part of the mesenchymal tumor category. Most often, these tumors are present in the uterus, esophagus and small intestine (1, 2). The first description of leiomyoma belongs to Wirshaw in 1854 (1) while Steinard reported the first case of pulmonary leiomyoma in 1939 in a patient that also presented with a uterine fibroma (3). In 1958, Kloepfer described the presence of hereditary leiomyomatosis (2). Other hereditary leiomyomatosis have since been described with multiple simultaneous locations (4); however, the presence in the respiratory tract of a leiomyoma is rare, representing 2% of benign tumors found in this region (5,6).Primary pulmonary leiomyoma was first described in 1907 as a standalone pathology (7), with the first case of pulmonary leiomyoma being reported by Forkel, in 1910 (8).

The panorama of pulmonary leiomyoma: A tale of two tumours

“…PPLs of the tracheobronchial tree either originate from smooth muscle fibres of the bronchial wall or vessels 4 . As seen in our first patient, in two thirds of cases, PPL arises in the proximal airways 5 as an endobronchial lesion.…”

Massive Primary Leiomyosarcoma on Cavum Thorax : A Very Rare Case

“…Leiomyosarcoma arises from a variety of primary anatomic sites but commonly comes from the uterus. In pathological findings, leiomyosarcoma is usually a solitary and large tumor (>5 cm) in ≥75 % cases [1][2][3] . In the case of primary leiomyosarcoma in the chest wall is extremely rare and unusual, an estimated only 1-4% of all soft tissue sarcoma case 4,5 .…”

“…This tumor comes from various part of body from pulmonary to testicles, but this tumor commonly found in uterine and called as uterine leiomyosarcoma. [1][2][3] . The primary cavum thorax leiomyosarcoma was extremely rare case and estimated only 1-4 % of all soft tissue carcinoma case 4,5 .…”