Pulmonary Benign Metastasizing Leiomyoma: A Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Shi ^1,2 , LIU Ruimin ³ , ZHANG Jingying ² , HUANGMao. ¹

Department of Respiratory Disease, First Affiliated Hospital of Nanjing Medical University. Nanjing, Jiangsu, 210029, ChinaCorresponding Author: HUANGMao, E-mail: hm6114@ 126. com;

Corresponding author：

Keywords：

Benign metastasizing leiomyoma; Myomectomy; Pulmonary metastases; Lung biopsy

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130114

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Objective To improve the knowledge of pulmonary benign metastasizing leiomyoma.
Methods A case of pulmonary benign metastasizing leiomyoma diagnosed in the First Affiliated Hospital of Nanjing Medical University was analyzed.
Results A 32-year-old woman suffered from chest stuffiness,heavy pant and weakness after myomectomy in amonth. Chest CT showed miliary shadowwas diffused in both sides of her lungs, but serumtumor marker was normal. When the chest CT result did not change significantly after four-week’s anti-tuberculosis treatment, the patient accepted lung biopsy by thoracoscopic surgery. HE staining showed that the tumor cells had characteristics of smooth muscle cell differentiation.Immunohistochemical staining showed a low proliferation index of tumor cells, which did not indicate the
existence of pulmonary malignant tumor. Smooth muscle actin ( SMA) and desmin as the specific markers of smooth muscle, estrogen receptor ( ER) and progesterone receptor ( PR) were all bly positive, which was the characteristic of pulmonary benign metastasizing leiomyoma. The patient was given the anti-estrogen tamoxifen for 3 months.Without radiological evidence of disease development and further distant metastasis,the patient had been followed up.
Conclusions Pulmonary benign metastasizing leiomyoma is a rare disease which can occur in any age group, particularly prevalent among late childbirth women. All patients have uterine leiomyoma history and/ or myomectomy operation, often associated with uterine metastasis, which commonly occurs in lung.

Citation： CHEN Shi,LIU Ruimin,ZHANG Jingying,HUANGMao.. Pulmonary Benign Metastasizing Leiomyoma: A Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(5): 472-476. doi: DOI: 10 . 7507 /1671 -6205 . 20130114 Copy

1.	Kayser K, Zink S, Schneider T, et al. Benign metastasizing leiomyoma of the uterus: documentation of clinical,immunohistochemical and lectin-histochemical data of ten cases.Virchows Arch,2000, 437: 284 -292.
2.	Kwon YI, Kim TH, Sohn JW, et al. Benign pulmonary metastasizing leiomvomatosis: case report and a review of the literature. Korean J Intern Med, 2006, 21: 173 -177.
3.	Jo JH, Lee JH, Kim DC, et al. A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast. Korean J Intern Med, 2006, 21: 199-201.
4.	Yoon G, Kim TJ, Sung CO, et al. Benign metastasizing leiomyoma with multiple lymph node metastasis: a case report. Cancer Res Treat, 2011 , 43: 131-133.
5.	Kang SA, Choi SI, Kim YA, et al. A case of benign metastasizing pulmonary leiomyoma. Tuberc Respir Dis, 2005, 58: 614-618 .
6.	Egberts JH, Schafmayer C, Bauerschlag DO, et al. Benign abdominal and pulmonary metastasizing leiomyoma of the uterus. Arch Gynecol Obstet, 2006, 274 : 319-322.
7.	Abramson S, Gilkeson RC, Goldstein JD, et al. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. Am J Roentgenol, 2001, 176: 1409-1413.
8.	Patton KT, Cheng L, Papavero V, et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.Mod Pathol, 2006 , 19 : 130-140.
9.	Esteban JM, Allen WM, Schaerf RH. Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions. Arch Pathol Lab Med, 1999, 123 : 960-962.
10.	Jautzke G, Muller-Ruchholtz E, Thalmann U. Immunohistological detection of estrogen and progesterone receptors in multiple and well differentiated leiomyomatous lung tumors in women with uterine leiomyomas ( so-called benign metastasizing leiomyomas) . A report on 5 cases. Pathol Res Pract, 1996, 192 : 215-223.
11.	Nucci MR, Drapkin R, Cin PD, et al. Distinctive cytogenetic profile in benign metastasizing leiomyoma: pathogenic implications. Am J Surg Path, 2007, 31: 737 -743.
12.	Tietze L, Gunther K, Horbe A, et al. Benign metastasizing leiomyoma: a cytogenetically balanced but clonal disease. Hum Pathol, 2000 , 31: 126-128.
13.	Nuovo GJ, Schmittgen TD. Benign metastasizing leiomyoma of the lung: clinicopathologic, immunohistochemical, and micro-RNA analyses. Diagn Mol Pathol, 2008, 17: 145-150.
14.	Steiner P. Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature. Am J Pathol, 1939, 15: 89 -107.
15.	Robboy SJ, Bentley RC, Butnor K, et al. Pathology and pathophysiology of uterine smooth muscle tumors. Environ Health Perspect, 2000, 5 Suppl: 779-784.
16.	Canzonieri V, D′Amore ES, Bartoloni G, et al. Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis. Virchows Arch, 1994, 425 : 541-545.
17.	Koh DM, Burn PR, King DM. Benign metastasizing leiomyoma with intracaval leiomyomatosis. Br J Radio, 2000, 73: 435-437.
18.	Martin E. Leiomyomatous lung lesions: a proposed classification.Am J Roentgenol, 1983, 141 : 269-272.
19.	Horstmann JP, Pietra GG, Harman JA, et al. Spontaneous regression of pulmonary leiomyomas during pregnancy. Cancer, 1977,39:314-321.
20.	Fu Y, Li H, Tian B, et al. Pulmonary benign metastasizing leiomyoma: a case report and review of the literature. World J Surg Oncol, 2012 , 10 : 268.
21.	Radzikowska E, Szczepulska-Wójcik E, Langfort R, et al. Benign pulmonary metastasizing leiomyoma uteri. Case report and review of literature. Pneumonol Alergol Pol, 2012, 80: 560 -564.
22.	Rivera JA, Christopoulos S, Small D, et al. Hoimonalmanipulation of benign metastasizing leiomyomas: report of two case and review of the literature. J Clin Endocrinol Metab, 2004 , 89: 3183-3188.
23.	Ni Y, Shi G, Wan H, et al. Pulmonary benign metastasizing leiomyoma: case report and review of the literature. Clin Exp Obstet Gynecol, 2012, 39: 249 -251.
24.	Goyle KK, Moore DF Jr, Garrett C, et al. Benign metastasizing leiomyomatosis: case report and review. Am J Clin Oncol, 2003, 26 :473-476.
25.	Yamazaki K. CD102 and CD342 positive periglandular stromalcells in pulmonary bening metastasizing leiomyoma with metaplastic adenomyomatous glands: an ultrastructural and immunohistochemical study. Virchow Arch, 2005 , 446: 270-277.
26.	张云, 杨小丰, 王瑜, 等. 肺良性转移性平滑肌瘤PET/CT 显像一例. 中华核医学杂志, 2007, 27 : 380.
27.	Yonezawa K, Yokoo N, Yamaguchi T. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery. Surg Today, 1999 , 29 :.
28.	Abu-Rustum NR, Curtin JP, Burt M, et al. Regression of utenine low-grade smooth muscle tumors metastatic to the lung after ooghorectomy. Obstet Gynecol, 1997 , 89( 5 Pt 2) : 850-852.
29.	Mogi A, Hirato J, Kosaka T, et al. Benign metastasizing leiomyoma of the lung: report of a case. Gen Thorac Cardiovasc Surg, 2012. [ Epub ahead of print].
30.	Lewis EI, Chason RJ, Decherney AH, et al. Novel hormone treatment of benign metastasizing leiomyoma: an analysis of five cases and literature review. Fertil Steril, 2013 , 99: 2017-2024.
31.	张雯月, 李敏, 杨红忠, 等. 肺良性转移性平滑肌瘤1 例. 中国肺癌杂志, 2012, 15 : 56 -58.
32.	倪颖梦, 时国朝, 沈继敏, 等. 肺良性转移性平滑肌瘤一例. 中华结核和呼吸杂志, 2009, 32: 779 -780.
33.	朱富新, 孙恒. 肺良性转移性平滑肌瘤( 附1 例临床与病理分析) . 中国肿瘤临床, 2011, 38: 533.
34.	-824.

1. Kayser K, Zink S, Schneider T, et al. Benign metastasizing leiomyoma of the uterus: documentation of clinical,immunohistochemical and lectin-histochemical data of ten cases.Virchows Arch,2000, 437: 284 -292.
2. Kwon YI, Kim TH, Sohn JW, et al. Benign pulmonary metastasizing leiomvomatosis: case report and a review of the literature. Korean J Intern Med, 2006, 21: 173 -177.
3. Jo JH, Lee JH, Kim DC, et al. A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast. Korean J Intern Med, 2006, 21: 199-201.
4. Yoon G, Kim TJ, Sung CO, et al. Benign metastasizing leiomyoma with multiple lymph node metastasis: a case report. Cancer Res Treat, 2011 , 43: 131-133.
5. Kang SA, Choi SI, Kim YA, et al. A case of benign metastasizing pulmonary leiomyoma. Tuberc Respir Dis, 2005, 58: 614-618 .
6. Egberts JH, Schafmayer C, Bauerschlag DO, et al. Benign abdominal and pulmonary metastasizing leiomyoma of the uterus. Arch Gynecol Obstet, 2006, 274 : 319-322.
7. Abramson S, Gilkeson RC, Goldstein JD, et al. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. Am J Roentgenol, 2001, 176: 1409-1413.
8. Patton KT, Cheng L, Papavero V, et al. Benign metastasizing leiomyoma: clonality, telomere length and clinicopathologic analysis.Mod Pathol, 2006 , 19 : 130-140.
9. Esteban JM, Allen WM, Schaerf RH. Benign metastasizing leiomyoma of the uterus: histologic and immunohistochemical characterization of primary and metastatic lesions. Arch Pathol Lab Med, 1999, 123 : 960-962.
10. Jautzke G, Muller-Ruchholtz E, Thalmann U. Immunohistological detection of estrogen and progesterone receptors in multiple and well differentiated leiomyomatous lung tumors in women with uterine leiomyomas ( so-called benign metastasizing leiomyomas) . A report on 5 cases. Pathol Res Pract, 1996, 192 : 215-223.
11. Nucci MR, Drapkin R, Cin PD, et al. Distinctive cytogenetic profile in benign metastasizing leiomyoma: pathogenic implications. Am J Surg Path, 2007, 31: 737 -743.
12. Tietze L, Gunther K, Horbe A, et al. Benign metastasizing leiomyoma: a cytogenetically balanced but clonal disease. Hum Pathol, 2000 , 31: 126-128.
13. Nuovo GJ, Schmittgen TD. Benign metastasizing leiomyoma of the lung: clinicopathologic, immunohistochemical, and micro-RNA analyses. Diagn Mol Pathol, 2008, 17: 145-150.
14. Steiner P. Metastasizing fibroleiomyoma of the uterus: report of a case and review of the literature. Am J Pathol, 1939, 15: 89 -107.
15. Robboy SJ, Bentley RC, Butnor K, et al. Pathology and pathophysiology of uterine smooth muscle tumors. Environ Health Perspect, 2000, 5 Suppl: 779-784.
16. Canzonieri V, D′Amore ES, Bartoloni G, et al. Leiomyomatosis with vascular invasion. A unified pathogenesis regarding leiomyoma with vascular microinvasion, benign metastasizing leiomyoma and intravenous leiomyomatosis. Virchows Arch, 1994, 425 : 541-545.
17. Koh DM, Burn PR, King DM. Benign metastasizing leiomyoma with intracaval leiomyomatosis. Br J Radio, 2000, 73: 435-437.
18. Martin E. Leiomyomatous lung lesions: a proposed classification.Am J Roentgenol, 1983, 141 : 269-272.
19. Horstmann JP, Pietra GG, Harman JA, et al. Spontaneous regression of pulmonary leiomyomas during pregnancy. Cancer, 1977,39:314-321.
20. Fu Y, Li H, Tian B, et al. Pulmonary benign metastasizing leiomyoma: a case report and review of the literature. World J Surg Oncol, 2012 , 10 : 268.
21. Radzikowska E, Szczepulska-Wójcik E, Langfort R, et al. Benign pulmonary metastasizing leiomyoma uteri. Case report and review of literature. Pneumonol Alergol Pol, 2012, 80: 560 -564.
22. Rivera JA, Christopoulos S, Small D, et al. Hoimonalmanipulation of benign metastasizing leiomyomas: report of two case and review of the literature. J Clin Endocrinol Metab, 2004 , 89: 3183-3188.
23. Ni Y, Shi G, Wan H, et al. Pulmonary benign metastasizing leiomyoma: case report and review of the literature. Clin Exp Obstet Gynecol, 2012, 39: 249 -251.
24. Goyle KK, Moore DF Jr, Garrett C, et al. Benign metastasizing leiomyomatosis: case report and review. Am J Clin Oncol, 2003, 26 :473-476.
25. Yamazaki K. CD102 and CD342 positive periglandular stromalcells in pulmonary bening metastasizing leiomyoma with metaplastic adenomyomatous glands: an ultrastructural and immunohistochemical study. Virchow Arch, 2005 , 446: 270-277.
26. 张云, 杨小丰, 王瑜, 等. 肺良性转移性平滑肌瘤PET/CT 显像一例. 中华核医学杂志, 2007, 27 : 380.
27. Yonezawa K, Yokoo N, Yamaguchi T. Effectiveness of an inferior vena caval filter as a preventive measure against pulmonary thromboembolism after abdominal surgery. Surg Today, 1999 , 29 :.
28. Abu-Rustum NR, Curtin JP, Burt M, et al. Regression of utenine low-grade smooth muscle tumors metastatic to the lung after ooghorectomy. Obstet Gynecol, 1997 , 89( 5 Pt 2) : 850-852.
29. Mogi A, Hirato J, Kosaka T, et al. Benign metastasizing leiomyoma of the lung: report of a case. Gen Thorac Cardiovasc Surg, 2012. [ Epub ahead of print].
30. Lewis EI, Chason RJ, Decherney AH, et al. Novel hormone treatment of benign metastasizing leiomyoma: an analysis of five cases and literature review. Fertil Steril, 2013 , 99: 2017-2024.
31. 张雯月, 李敏, 杨红忠, 等. 肺良性转移性平滑肌瘤1 例. 中国肺癌杂志, 2012, 15 : 56 -58.
32. 倪颖梦, 时国朝, 沈继敏, 等. 肺良性转移性平滑肌瘤一例. 中华结核和呼吸杂志, 2009, 32: 779 -780.
33. 朱富新, 孙恒. 肺良性转移性平滑肌瘤( 附1 例临床与病理分析) . 中国肿瘤临床, 2011, 38: 533.
34. -824.

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