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Communications to the Editor |

Natural Decrease of Benign Metastasizing Leiomyoma FREE TO VIEW

Tadashi Arai, MD; Yo Yasuda, MD; Tadatake Takaya, MD; Maroki Shibayama, MD
Author and Funding Information

Affiliations: Gihoku General Hospital Gifu, Japan,  University Hospitals of Cleveland Cleveland, OH

Correspondence to: Tadashi Arai, MD, Department of Internal Medicine, Gihoku General Hospital, 1187-3 Takatomi-Cho Yamagata, Gifu 501-2105, Japan



Chest. 2000;117(3):921-922. doi:10.1378/chest.117.3.921
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Published online

To the Editor:

We read with interest the report by Abramson and Gilkeson (July 1999)1 regarding the benign metastasizing leiomyoma (BML). We report herein our experience of natural decrease of BML in size.

A 52-year-old woman was admitted to our hospital due to abnormal shadows found on chest roentgenograms (Fig 1, top left), and CT (Fig 1, bottom left) detected a number of pulmonary nodules in whole lung fields. Her medical history included uterine myomectomy at the age of 43 years. A thoracoscopic lung biopsy revealed leiomyomatous tumors that were histologically similar to the uterine myoma removed 9 years previously. The final diagnosis was BML. The values of estrogen and progesterone receptors in the resected specimen were 136.9 fmol/mg and 5.6 fmol/mg, respectively.

Although we recommended treatments such as hormone therapy, she strongly refused them. Therefore, she was discharged from hospital on the condition that she would be followed up on an outpatient basis.

After that, she was not seen for about 1 year, and she visited the outpatient department on July 13, 1999. Chest roentgenogram (Fig 1, top right) and CT (Fig 1, bottom right) showed significantly reduced tumors in size. When asked if she had noted any prominent changes since leaving the hospital, she informed us that she had undergone menopause. The serum estrogen and serum progesterone levels before menopause were 20.4 μg/dL and 1.5 ng/mL, which decreased to 4.3 μg/dL and 0.3 ng/mL after menopause, respectively. BML is said to be hormone dependent23; therefore, the present case suggests that menopause may play a role in the natural decrease of its size.

Figure Jump LinkFigure 1. Frontal chest radiograph (top left) and CT scan (bottom left) demonstrating a number of pulmonary nodules in whole lung fields. Top right and bottom right: significant improvement 1 year later.Grahic Jump Location

References

Abramson, S, Gilkeson, RC (1999) Multiple pulmonary nodules in an asymptomatic patient.Chest116,245-247. [PubMed] [CrossRef]
 
Cohen, JD, Robins, HI Response of “benign” metastasizing leiomyoma to progestin withdrawal.Eur J Gynaecol Oncol1993;1,44-45
 
Jacobson, TZ, Rainey, EJ, Turton, CWG Pulmonary benign metastasizing leiomyoma: response to treatment with goserilin.Thorax1995;50,1225-1226. [PubMed]
 
To the Editor:

The authors present a very interesting case of spontaneous regression of benign metastasizing leiomyoma (BML). BML may contain estrogen and progesterone receptors and is thought to be hormone responsive.1The literature includes instances in which pulmonary lesions may regress spontaneously or after hormonal manipulation (surgical oophorectomy and medical treatment such as progesterone or anti-estrogen therapy).23 In addition, the effects of natural hormonal changes in women (pregnancy, menopause) on tumor growth have been described. For example, a case of a 30-year-old pregnant woman with presumed BML demonstrated spontaneous regression of pulmonary nodules during pregnancy and into the postpartum period.4 On the other hand, the lesions in our patient showed no significant change in size despite separate 6- to 12-month trials of tamoxifen, progesterone, and an aromatase inhibitor (anastrozole). This occurred in spite of the presence of positive estrogen and progesterone receptors on smooth muscle cells. Although there are cases that suggest that menopause may play a role in the decrease of tumor size, other growth factors may contribute.

References
Uchida, T, Tokumuru, T, Kojima, H, et al A case of multiple leiomyomatous lesions of the lung: an analysis of flow cytometry and hormone receptors.Surg Today1992;22,265-268. [PubMed] [CrossRef]
 
Abu-Rustum, NR, Curtin, JP, Burt, M, et al Regression of uterine low-grade smooth-muscle tumors metastatic to the lung after oophorectomy.Obstet Gynecol1997;89,850-852. [PubMed]
 
Jacobsen, TZ, Rainey, EJ, Turton, CWG Pulmonary benign metastasizing leiomyoma: response to treatment with goserilin.Thorax1995;50,1225-1226. [PubMed]
 
Horstmann, JP, Pietra, GG, Harman, JA, et al Spontaneous regression of pulmonary leiomyomas during pregnancy.Cancer1977;39,314-321. [PubMed]
 

Figures

Figure Jump LinkFigure 1. Frontal chest radiograph (top left) and CT scan (bottom left) demonstrating a number of pulmonary nodules in whole lung fields. Top right and bottom right: significant improvement 1 year later.Grahic Jump Location

Tables

References

Abramson, S, Gilkeson, RC (1999) Multiple pulmonary nodules in an asymptomatic patient.Chest116,245-247. [PubMed] [CrossRef]
 
Cohen, JD, Robins, HI Response of “benign” metastasizing leiomyoma to progestin withdrawal.Eur J Gynaecol Oncol1993;1,44-45
 
Jacobson, TZ, Rainey, EJ, Turton, CWG Pulmonary benign metastasizing leiomyoma: response to treatment with goserilin.Thorax1995;50,1225-1226. [PubMed]
 
Uchida, T, Tokumuru, T, Kojima, H, et al A case of multiple leiomyomatous lesions of the lung: an analysis of flow cytometry and hormone receptors.Surg Today1992;22,265-268. [PubMed] [CrossRef]
 
Abu-Rustum, NR, Curtin, JP, Burt, M, et al Regression of uterine low-grade smooth-muscle tumors metastatic to the lung after oophorectomy.Obstet Gynecol1997;89,850-852. [PubMed]
 
Jacobsen, TZ, Rainey, EJ, Turton, CWG Pulmonary benign metastasizing leiomyoma: response to treatment with goserilin.Thorax1995;50,1225-1226. [PubMed]
 
Horstmann, JP, Pietra, GG, Harman, JA, et al Spontaneous regression of pulmonary leiomyomas during pregnancy.Cancer1977;39,314-321. [PubMed]
 
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