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All That Metastasizes Is Not Malignant FREE TO VIEW

Edwin Jackson, DO; Debasis Sahoo, MD; Ruchi Yadav, MD; Valeria Arossi, MD; Carol Farver, MD; Loutfi Aboussouan, MD; Joe Parambil, MD
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2013;144(4_MeetingAbstracts):962A. doi:10.1378/chest.1702556
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SESSION TITLE: Miscellaneous Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Benign metastasizing leiomyoma (BML) is a rare condition affecting late reproductive age females. BML is characterized by low-grade, benign appearing smooth muscle proliferations outside the uterus in patients with history of uterine leiomyomas and no evidence of leiomyosarcoma. The pathogenesis of this condition is thought to be the result of hematogenous spread of uterine leiomyomas following surgical manipulation. We present two middle age females with remote history of hysterectomy and bilateral lung nodules confirmed as BML.

CASE PRESENTATION: Case 1 A 53 y/o female presented to the ED complaining of chest pain. Initial cardiac work up was unrevealing, however a CXR showed a 1.6 cm right hilar nodule. Subsequent chest CT showed multiple nodules throughout both lung fields ranging from 2 mm to 2 cm. She then underwent a right lower lobe wedge resection. Pathology of the nodules revealed smooth muscle proliferations without cytologic atypia, immunoreactivity to smooth muscle actin and estrogen receptors, consistent with BML. The patient had history of previous total abdominal hysterectomy (TAH) due to uterine fibroids in 1989. She underwent laparoscopic bilateral oophorectomy after the diagnosis of BML. Case 2 A 49 y/o female with uterine fibroids s/p TAH in 1992 presented with left sided chest pain and respiratory failure. Computed tomography revealed a large left pleural opacity with multiple cystic nodules. She underwent resection of a giant pleural-based tumor. Pathologic findings were consistent with a diagnosis of BML. Following the tumor resection anostrazole was started, her respiratory symptoms improved with regression of the cystic nodules on repeat imaging.

DISCUSSION: BML most commonly affects the lung, however it has been reported in lymph nodes, bone, CNS, and cardiac tissue. The average age of patients with BML is 48 years, with the period from hysterectomy to nodule detection varying from 3 months to 26 years. There are currently no standard treatment guidelines for BML. Oophorectomy alone or with hormone therapy consisting of anti-estrogens, aromatase inhibitors or LHRH agonist is believed to be the best choice to promote regression of disease and the prevention of future lesions.

CONCLUSIONS: BML is an rare condition that presents with striking thoracic imaging and a variable course. The diagnosis must be considered in appropriately aged females with a history of uterine leiomyomas and multiple pulmonary nodules.

Reference #1: Yili Fu, Hui Li*, Bo Tian and Bin Hu : Pulmonary benign metastasizing leiomyoma: Case Report & Review of the literature World Journal of Surgical Oncology 2012, 10:268

DISCLOSURE: The following authors have nothing to disclose: Edwin Jackson, Debasis Sahoo, Ruchi Yadav, Valeria Arossi, Carol Farver, Loutfi Aboussouan, Joe Parambil

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