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Signs and Symptoms of Chest Diseases |

Benign Metastasizing Leiomyoma After Uterine Artery Embolization

Dmitriy Kogan*, MD; Cristina Reichner, MD; Mary Fishman, MD; Gloria Bowles-Johnson, MD; Eric Anderson, MD
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Georgetown University, Washington, DC


Chest. 2012;142(4_MeetingAbstracts):978A. doi:10.1378/chest.1388097
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters I

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

INTRODUCTION: Uterine artery Embolization (UAE) is a minimally invasive treatment for uterine fibroids and is an alternative to hysterectomy. Particles of polyvinyl alcohol are injected under fluoroscopy into the uterine artery to block vascularization to the fibroids. Common adverse effects include fever, nausea, cramping abdominal pain, and vaginal discharge of necrotic tissue and blood. Other complications such as uterine injury, infection and even sepsis are rare. Several case reports described patients developing pulmonary emboli following this procedure including 2 fatalities. We report a patient with a benign course of multiple leiomyomata in the lungs discovered 8 years after UAE.

CASE PRESENTATION: 44 year old female with history of uterine fibroids status post UAE 8 years ago presented with symptoms of productive cough and shortness of breath. Chest X-ray showed multiple well circumscribed bilateral pulmonary nodules. On tomography (CT) scan the largest nodule was 2.8 x 2.6 cm. There was also some airspace disease noted in the right upper lobe. Patient was treated with antibiotics for community acquired pneumonia and her symptoms resolved. She underwent bronchoscopy with transbronchial biopsy which was non-diagnostic. Percutaneous CT guided biopsy of one of the peripheral nodules showed smooth muscle cells of uterine origin. Cells appeared to be well differentiated which is consistent with leiomyoma. Patient was monitored with biannual CT scans and the nodules remained stable on two follow-up scans. She remains asymptomatic. Patient was encouraged to undergo hysterectomy to prevent any further leiomyomatous metastases.

DISCUSSION: UAE remains a popular and minimally invasive alternative to hysterectomy. Leiomyomatous tissue can be dislodged during this procedure and embolize in the pulmonary vasculature. Implantation into the parenchyma can lead to subsequent nodule formation. Benign metastasizing leiomyoma has been described after uterine manipulation. We report a patient who developed benign metastasizing leiomyoma discovered 8 years after UAE. Our patient has had a benign course and the pulmonary nodules have been stable in size for over one year.

CONCLUSIONS: Benign metastasizing leiomyoma may occur after UAE. It appears to have a benign course and patients may not be symptomatic. Consideration of imaging after this procedure may be appropriate.

1) Hamoda H, Tait P, Edmonds DK. Fatal Pulmonary Embolus After Uterine Artery Fibroid Embolisation. Cardiovasc Intervent Radiol 2009; 32:1080-1082.

2) Poujade O, Genin AS, Dhouha M, Luton D. A Benign Metastasizing Leiomyoma Involving a Nodule in the Pulmonary Artery: Case and Literature Review. Eur J of Gynaecol Oncol 2010; 31:329-32.

DISCLOSURE: Eric Anderson: Consultant fee, speaker bureau, advisory committee, etc.: Honoraria for educational lectures from superDimension

The following authors have nothing to disclose: Dmitriy Kogan, Cristina Reichner, Mary Fishman, Gloria Bowles-Johnson

No Product/Research Disclosure Information

Georgetown University, Washington, DC

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