Unexpected pulmonary tumor: metastasis from a benign uterine leiomyoma in a post-menopausal woman: a case report

Abstract

BackgroundThe occurrence of lung metastasis from benign uterine leiomyomas is rarely reported especially in post menopausal women. The pathogenesis of these metastatic benign tumors still remains a subject of various speculations.Case presentationA 57-year-old woman presented with a chronic cough and dyspnea. She had undergone 8 years previously, hysterectomy for benign leiomyomas. A chest computed tomography scan showed a 4 cm solitary nodular parenchymal tumor that increased in size after 12 months. The histological analysis of the biopsy from this nodule showed a benign tumor with regular spindle cells disposed in intersected fascicles. At immunohistochemical analysis, the tumor cells were positive for smooth muscle markers and oestrogen-progesterone receptors with a low mitotic index assessed by Ki-67. These features were consistent with a benign metastasizing uterine leiomyoma. At the multidisciplinary meeting, prescription of an aromatase inhibitor has been decided for the patient.ConclusionsBenign metastasizing uterine leiomyomas of the lung are very rare tumors. Although extremely rare in post menopausal women, their diagnosis should be considered in symptomatic patients with a history of hysterectomy for leiomyomas.

Benign metastasizing leiomyoma in femur and thigh with a history of uterine leiomyoma: A case report and literature review

“…Most cases of BML have occurred after a uterine leiomyoma surgery. Therefore, it was suggested that the smooth muscle cells may be hemodynamically or directly seeded due to tissue damage caused by the surgical procedure 1,3,4 . However, there were a few reports in which BML were found in women with no history of uterus surgeries, 5 and the surgical procedures were not always associated with the development of metastatic leiomyoma.…”

“…Therefore, it was suggested that the smooth muscle cells may be hemodynamically or directly seeded due to tissue damage caused by the surgical procedure. 1,3,4 However, there were a few reports in which BML were found in women with no history of uterus surgeries, 5 and the surgical procedures were not always associated with the development of metastatic leiomyoma. It has been also proposed that the primary lesion of the uterus itself had the potential of an extremely low-grade leiomyosarcoma, 6 but it is very difficult to clearly histopathological classify benign and malignant tumors.…”

Benign Metastasizing Leiomyoma to the Lung and Spine: A Case Report and Literature Review

“…There are currently no guidelines for treatment of BML, given how rare the condition is, and most treatment is based on location and disease burden [2, 5]. BML are indolent in nature and treatment can involve targeted hormonal therapies and surgery [2].…”

“…At this point it was decided to proceed with right oophorectomy to decrease hormonal exposure. As BML are an indolent disease long term radiological surveillance is required with either CT or MRI to monitor for disease progression [5]. …”

“…The majority of women diagnosed with BML are premenopausal, however a small percentage are found in menopausal or postmenopausal women [4]. The majority of menopausal or postmenopausal cases occur in women who underwent hysterectomy for leiomyomas and were subsequently found to have metastases many years later [5, 6]. Multiple theories exist regarding the mechanism of BML although no clear consensus currently exists.…”