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Patient With a Lung Mass and Multiple Lung Nodules, a Clinical Dilemma FREE TO VIEW

Dipen Kadaria, MD; Scott Duncan, MD; Wael Nasser, MD; Ibrahim Sulatan Ali, MD
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University of Tennessee HSC, Memphis, TN

Chest. 2012;142(4_MeetingAbstracts):963A. doi:10.1378/chest.1367270
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SESSION TYPE: Miscellaneous Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Patients presenting with multiple lung lesions are common problem faced by pulmonologists. Usual causes for these presentations are malignancy, lung abscess, septic emboli etc. Some benign conditions can also have this type of presentation. We present an interesting case of a female presenting with a lung mass and multiple lung nodules.

CASE PRESENTATION: A 41 yr old African American non-smoker female presented with complaints of nonproductive cough, shortness of breath and decrease in exercise tolerance for few months. She denied any complaints of fever, night sweats and weight loss. She had hysterectomy done nearly nine years back. Physical examinations were within normal limits. Chest X-ray followed by CT scan of chest was done. It showed a right infrahilar mass (3.5 x 2.5 cm) along with multiple bilateral lung nodules (9-11 mm). Results of bronchoscopy with Trans bronchial needle aspiration (TBNA) and Trans bronchial biopsy (TBB) were not suggestive of any malignancy, infection and inflammation. CT guided biopsy of the mass also failed to suggest any diagnosis. Patient was seen in follow up after three months with similar complaints. CT scan of chest showed stable right infrahilar lesion with multiple bilateral nodules again. Bronchoscopy with TBB and TBNA failed to suggest any diagnosis again. Follow up CT scan after six months showed increase in size of right infrahilar mass to 4.2 x 4.1 cm along with stable multiple bilateral lung nodules. Patient then underwent open lung biopsy from the right infrahilar mass. The histologic examination showed well circumscribed border to the nodule along with interfasciculating bundles of ovoid to elongated spindled cells without areas of necrosis or mitosis suggestive of bening metastasizing leiomyoma (BML). Patient was started on leuprolide (a GnRH agonist) and is currently feeling better with improved exercise tolerance.

DISCUSSION: BML is a rare condition in which multiple leiomyoma- like nodules are present in a distant location most commonly the lungs. It occurs predominantly in women of reproductive age. Etiology is uncertain but most probably results from venous embolism from uterine vessels to lung. Patients are usually asymptomatic but some patients present with cough, dyspnea, chest pain. Patient can present even after few years of hysterectomy for leiomyoma. Conservative management is suggested for asymptomatic disease. Treatment with oopherectomy, agents that decrease estrogen or progestins has resulted in tumor regression.

CONCLUSIONS: BML should be considered as a differential in females presenting with lung mass and multiple lung nodules.

1) Awonuga AO, Shavell VI, Imudia AN, et al. Pathogenesis of benign metastasizing leiomyoma: a review. Obstet Gynecol Surv. 2010;65(3):189

DISCLOSURE: The following authors have nothing to disclose: Dipen Kadaria, Scott Duncan, Wael Nasser, Ibrahim Sulatan Ali

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