Tuberc Respir Dis.  2006 Jan;60(1):92-96.

Benign Metastasizing Pulmonary Leiomyoma with Hemoptysis

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea. bfspark@medimail.co.kr
  • 2Department of Thoracic surgery, College of Medicine, Hallym University, Chuncheon, Korea.
  • 3Department of Anatomical Pathology, College of Medicine, Hallym University, Chuncheon, Korea.

Abstract

A benign metastasizing pulmonary leiomyoma(BMPL) is a rare disease that is usually detected years after a hysterectomy or myomectomy. Despite the benign pathological appearance, these tumors can metastasize and become clinically malignant. Recently, we experienced case of BMPL with hemoptysis. A 43-year-old woman, who had undergone a hysterectomy due to uterine leiomyoma 8 years ago, visited our department complaining of intermittent hemoptysis. A chest CT showed bilateral multiple nodular lesions. Video-associated thoracoscopy was performed. The resected small nodular lesion revealed the proliferation of spindle cells without mitosis or nuclear atypism. The lesions tested positive to the smooth muscle marker (actin) by immunohistochemical staining. Therefore, the multiple nodules were considered as benign metastasizing pulmonary leiomyoma from a uterine leiomyoma. GnRH analogue therapy was initiated. A chest CT showed that the size and number of pulmonary lesions did not change after 3 months, and the patient was symptom free.

Keyword

Benign metastasizing pulmonary leiomyoma; Uterine leiomyoma; GnRH analogue

MeSH Terms

Adult
Female
Gonadotropin-Releasing Hormone
Hemoptysis*
Humans
Hysterectomy
Leiomyoma*
Mitosis
Muscle, Smooth
Rare Diseases
Thoracoscopy
Tomography, X-Ray Computed
Gonadotropin-Releasing Hormone

Figure

  • Figure 1 CT scan reveals multiple nodular opacities on both lung fields.

  • Figure 2 A : On the lowest magnification view, a well-circumscribed round nodular solid mass is found at the peripheral lung parenchyme(H&E, ×10). B : On the high magnification view, the tumor demonstrates high cellular smooth muscle cells showing multiply fascicular arrangement. There is no evidence of atypical mitosis, necrosis or pleomorphism. (H&E, ×200). C : The immunohistochemical stain shows actin-positive smoothe muscle cells (×100). D : Sections of uterine leiomyoma from hystrectomy show lower cellular smooth muscle cells (H&E, ×100).


Reference

1. Steiner PE. Metastasizing fibroleiomyoma of the uterus. Report of a and review of the literature. Am J Pathol. 1939. 15:89–109.
2. Bachmann D, Wolff M. Pulmonary metastases from benign appearing smooth muscle tumors of the uterus. AJR Am J Roentogenol. 1976. 127:441–446.
3. Canzonieri V, D'Amore ES, Bartoloni G, Piazza M, Blandamura S, Carbone A. Leiomyomatosis with invasion: a unified pathogenesis reguarding leiomyoma with microinvasion, benign metastasizing leiomyoma and leiomyomatosis. Virchows Arch. 1994. 425:541–545.
4. Maheux R, Samson Y, Farid NR, Parent JG, Jean C. Utilization of luteinizing hormone-releasing hormone agonist in agonist in pulmonary leiomyomatosis. Fertil Steril. 1987. 48:315–317.
5. Park GC, Song JS, Lee K. A case report of benign metastasizing leiomyoma of the uterus to the lung and soft tissues of lower extremities. Korean J Obstet Gynaecol. 1986. 29:881–888.
6. Tietze L, Gunther K, Horbe A, Pawlik C, Klosterhalfen B, Handt S, et al. Benign metastasizing leiomyoma: a cytogenetically balnanced but clonal disease. Hum Pathol. 2000. 31:126–128.
7. Wolff M, Silva F, Kaye G. Pulmonary metastases (with admixed epithelial elements) from smooth muscle neoplasms. Am J Surg Pathol. 1979. 3:325–342.
8. Zaloudek C, Norris HJ. Kurman , editor. Mesenchymal tumors of the uterus. Blaustein's pPathology of the female tract. 1994. 4th ed. New York: Springer-Verlag;487–525.
9. Abramson S, Gilkeson RC. Multiple pulmonary in an asymptomatic patients. Chest. 1999. 116:245–247.
10. Banner AS, Carrington CB, Emory WB, Kittle F, Leonard G, Ringus J, et al. Efficacy of oophorectomy in lymphangioleiomyomatosis and benign metastasizing leiomyoma. N Engl J Med. 1981. 305:204–209.
11. Kang SA, Choi SI, Kim YA, Kim CJ, Yang DG, Kang JH, et al. A case of benign metastasizing pulmonary leiomyoma. Tuber Respir Dis. 2005. 58:614–618.
12. Hague WM, Abdulwahid NA, Jacobs HS, Craft I. Use of LHRH analogue to obtain reversible castration in a patient with benign metastasizing leiomyoma. Br J Obstet Gynaecol. 1986. 93:455–460.
13. Sandow J. Clinical application of LHRH and its analogues. Clin Endocrinol. 1983. 18:571–592.
14. Rhie SY, Yeo BG, Kim SH, Yang SK, Yoo WK, Baik JJ, et al. A case of benign metastasizing leiomyoma in the lung of woman with a history of myomectomy. Korean J Med. 2004. 67:s857–s861.
15. Horstmann JP, Pietra GG, Harman JA, Cole NG, Grinson S. Spontaneous regression of pulmonary leiomyomas during pregnancy. Cancer. 1997. 39:314–321.
Full Text Links
  • TRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr