A Rare Complication Post-Hysterectomy for Fibroids: a Case Report and Literature Review of Pulmonary Benign Metastasising Leiomyoma

Abstract

Benign metastasising leiomyoma is a rare complication of a common gynaecological condition, often requiring multidisciplinary team input. No guidelines exist for its management. We aim to highlight an unusual case and summarise international practice of investigation and management from existing literature, to facilitate better recognition and management in the future. We present a challenging case of progressive pulmonary BML in a woman with previous lung cancer. An extensive Pubmed search was performed using search terms: benign, metastasising, metastasizing, parasitic, leiomyoma, leiomyomata, leiomyomatosis, fibroid and fibroids. All English papers available in free text were reviewed for the literature review. Seventy-eight relevant papers reporting 118 cases of histopathology-confirmed BML were included. We report common demographics, gynaecological backgrounds and presenting symptoms of the women. Diagnosis involved CT imaging in 95% of cases and immunohistochemistry in 85% with the most common markers used being ER, PR, SMA and Ki-67. PET scan was performed in 25%. We summarise also the management options, including an overview of current hormonal treatment options, and follow-up regimes which typically involves regular CT-scans. Pulmonary BML is a benign condition but it presents similarly to lung cancer, making our case especially complex. Malignancy must therefore always be a differential diagnosis. Management is individualised as shown in our review but may be expectant, medical or surgical, with a strong emphasis on follow-up.