PURPOSE: Benign metastasizing leiomyosarcoma is a rare entity that results predominantly in reproductive aged females that have uterine leiomyomata; benign smooth muscle neoplasms. Often, these lesions can cause excessive uterine bleeding and surgical intervention is needed. When present, leiomyosarcoma in the uterus can have a very unpredictable clinical course. Even when surgically removed, metastatic seeding can occur and remain dormant for many years before declaring itself. We present a case of a 55 year old female that presented with a three week history of shortness of breath, cough and right-sided pleuritic chest pain. The patient had no significant past medical history and she was a non-smoker. She had undergone a complete hysterectomy in 2004 for bleeding uterine fibroids. Pathology at that time had shown the fibroids to be leiomyomas. On presentation to us, her chest x-ray showed multiple pulmonary nodules with a large right sided pleural effusion. Subsequent CT scan of the chest, abdomen and pelvis revealed too numerous to count bilateral pulmonary nodules with a large, bloody pleural effusion and near complete collapse of the right middle and right lower lobes. There were no abnormal lesions seen under the diaghragm. Two serial thoracentesis revealed bloody, exudative, pleural fluid but cytology failed to show any evidence of malignancy. Bronchoscopy of the right lung revealed extrinsic compression of the airways in the right middle and right lower lobe with no intra-bronchial lesions. Inspection of the left lung revealed at least two endobronchial lesions; one in the apico-posterior segment of the left upper lobe and one in the basilar segments of the left lower lobe. The lesions were smooth, round and freely mobile with the patient's inspiration/expiration. They were anchored to the inside of the airways by a thin stalk. Forceps biopsy of one of these showed the lesions to be very vascular. Pathologic staining of the lesion showed proliferating spindle cells which were highlighted with smooth muscle actin and desmin. The patient subsequently underwent a VATS procedure to obtain more tissue for pathologic investigation. Results of the VATS revealed a low grade leiomyosarcoma. The patient was referred to Hematology/Oncology and a PET-CT scan was requested.
CLINICAL IMPLICATIONS: none
DISCLOSURE: The following authors have nothing to disclose: Speros Livieratos, W. Bruce Davis, Thomas Dillard
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