Case Report
Pulmonary Benign Metastasizing Leiomyoma in a Postmenopausal Woman

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Abstract

Pulmonary benign metastasizing leiomyoma (BML) is a rare disease occurring predominantly in women of reproductive age and usually develops several years after the resection of a uterine leiomyoma. A 52-year-old postmenopausal woman was admitted to our hospital because of a right-sided empyema. Contrast-enhanced computed tomography showed a multiloculated pleural effusion on the right side and multiple small nodules in the left lung. A wedge biopsy revealed the pulmonary nodule consisting of branching glandular structures surrounded by abundant smooth muscle cells with no atypia. We performed a gynecologic examination to identify the primary origin of the pulmonary smooth muscle tumors. A uterine leiomyoma was found, and the patient underwent a total hysterectomy. Both pulmonary nodules and uterine leiomyoma were positive for estrogen and progesterone receptors. Therefore, we diagnosed the pulmonary lesions as BMLs. This is an interesting case of pulmonary BML identified simultaneously with uterine myoma in a postmenopausal woman. BML should be considered in women with multiple pulmonary nodules, even though it is rare.

Section snippets

CASE REPORT

A 52-year-old woman was admitted because of fever, cough, and dull pain on the right side of the chest for 1 month. There was no significant medical history, including gynecologic problems. The patient reported menopause about 1 year ago. On physical examination, the breathing sounds were decreased on the right side of the chest.

Blood test showed a white blood cell count of 21,040/μL with 82% neutrophils and a hemoglobin of 10.5 g/dL. The cancer antigen (CA) 125 was elevated (53 U/mL) above the

DISCUSSION

BML is a rare disease, which is thought to be derived from uterine leiomyomas.1., 2., 3., 4., 5., 6. Although leiomyomas are histologically benign, they have the potential to metastasize to distant sites, such as lungs, skin, bones, mediastinum, lymph nodes, muscular tissue, heart, and retroperitoneum.1., 7. BML usually occurs in women with a history of a prior hysterectomy or myomectomy for benign uterine leiomyoma, and an interval between the surgical removal of the uterine leiomyoma and the

ACKNOWLEDGMENTS

We thank professor Mie-Jae Im for critical reading of the manuscript.

REFERENCES (21)

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    These rare metastatic patterns are referred to in the literature by many titles such as benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal leiomyomatosis.3 Although premenopausal women(reproductive age group) are the most commonly affected age group, they can be diagnosed in postmenopausal women but on much fewer occasions.5 Furthermore, the mechanism of BML is not well established currently.

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    At present, more than 160 cases of BML have been reported in the literature. Almost all BMLs occur in premenopausal women, but some cases have been reported in postmenopausal woman (Barnas et al., 2017; Moon et al., 2009). In the literature, most cases of BML have been reported in patients with a history of uterine leiomyoma.

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