Pulmonary benign metastasizing leiomyoma: a study of six cases

Abstract

Objective To investigate the clinical, radiological and pathological characteristics, treatment and prognosis of pulmonary benign metastasizing leiomyoma (PBML). Methods The clinical and image data of 6 patients with PBML confirmed by pathology from October 2012 to December 2016 were retrospectively analyzed, and the related literature was reviewed. Results Six cases were female, age was from 32 to 55 (43.80 ± 7.17) years. Two cases were found by physical examination, 2 cases had chest distress and asthma, 1 case had chest pain, and 1 case had hemoptysis. Pulmonary abnormalities were detected between 1 month and 15 years after uterine myomectomy. Chest CT showed that multiple lung nodules or masses were observed in 5 patients, among which random distribution was in 3 cases, diffuse military nodule pattern was in 2 cases, and single mass combined with primary lung adenocarcinoma was in 1 case. Fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) of one patient showed no obvious uptake of the maximum standardized uptake value. All patients were confirmed histologically with CT guided lung biopsy (2 cases), thoracoscopic lung biopsy (2 cases), and thoracoscopic lobectomy with wedge resection (2 cases). Tumor cells revealed the characteristics of smooth muscle cell differentiation. Immunohistochemistry showed strong positive express of Desmin, SMA smooth muscle specific markers, estrogen receptor and progesterone receptor. Three patients were treated with oral tamoxifen anti estrogen therapy with follow-up from 5 months to 5 years. Four cases had a good prognosis, and 2 cases were lost in follow-up. Conclusions PBML is a rare disease that is prone to occur in women of childbearing age. The clinical symptoms are atypical. Imaging examination and pathology are necessary for diagnosis. Surgery combined with endocrine therapy is effective. Key words: Leiomyoma; Lung; Metastasis