대한흉부영상의학회 Weekly Chest Cases

Case No : 413 Date 2005-09-26

Courtesy of Kun Young Lim, MD, Su Hyun Lee, MD, Hyae Young Kim / National Cancer Center, Goyang-si, Kyeonggi-do, Korea
Age/Sex 45 / F
Chief ComplaintIncidentally found lung nodules A history of hysterectomy eight years ago

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Diagnosis With Brief Discussion

Diagnosis: Benign Metastasizing Leiomyoma
Radiologic Findings: Simple chest radiograph shows variable sized nodular lesions on both lung fields. Chest CT scans show well-circumscribed multiple pulmonary nodules ranging in size from a few millimeters to several centimeters in diameter scattered. No nodules contained calcification. There was no evidence of pleural effusions or significant mediastinal lymphadenopathy. Wedge resection of lingula segment of left upper lobe revealed benign metastasizing leiomyoma. The patient has undergone hysterectomy for uterine leiomyomas 8 years ago.
Brief Review: Benign metastasizing leiomyoma is a rare entity that usually affects women after hysterectomy for leiomyomas. Patients are usually asymptomatic with incidental observation of pulmonary lesions, although symptoms such as cough, chest pain, and dyspnea have been described. The lung is the most common site of involvement and other sites of involvement include lymph nodes, peritoneum, and retroperitoneal structures. Nodules can be seen 3 months to 20 years after hysterectomy.

Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging in size from a few millimeters to several centimeters in diameter scattered among normal interstitium. A miliary pattern is less common. Additionally, there are single case reports of benign metastasizing leiomyoma manifesting as cavitary lung nodules and interstitial lung disease. Typically, nodules are not calcified and do not enhance after IV contrast medium administration.

Pulmonary nodules usually show little change and may even spontaneously regress. Endobronchial and pleural sparing is characteristic.

Most pathologists now accept these lesions as hematogenous metastases from morphologically benign uterine tumors, although there is a continuum with lesions that show increased mitotic activity. Some authors have proposed classifying the latter cases as low-grade leiomyosarcoma.
References: 1. 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. Pathol Res Pract. 1996;192:215-223.

2. Lipton JH, Fong TC, Burgess KR. Miliary pattern as presentation of leiomyomatosis of the lung. Chest. 1987;91:781-782.

3. Shin MS, Fulmer JD, Ho KJ. Unusual computed tomographic manifestations of benign metastasizing leiomyomas as cavitary nodular lesions or interstitial lung disease. Clin Imaging. 1996;20:45-49.

4. Abramson S, Gilkeson RC, Goldstein JD, Woodard PK, Eisenberg R, Abramson N. Benign metastasizing leiomyoma: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol. 2001;176:1409-1413.
Keywords: Lung, Benign tumor,

No. of Applicants : 47

▶ Correct Answer : 32/47, 68.1%

- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Max Hospital, New Delhi, India Anurag Jain
- Kyungpook National University Hospital, Korea Han Young Jung
- Busan National UniversityHospital, Korea Su-mi Shin
- Fleury Medical Center, Sao Paulo, Brazil Gustavo Meirelles
- Pgimer, Chandigarh, India Ramprakash Galwa
- Kosin University Gospel Hospitalm Busan, Korea Mi Hee Jung
- G.T.B. Hospital, Delhi, India Lalendra Upreti
- Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
- B.J.Medical College, University of Pune (retired), India Bankim J. Amin
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- Seoul National University Hospital, Korea Young Ae Kang
- Maiminides Medical Center, New York, USA Naomi Twersky
- Monaldi Hospital, Naples, Italy Gaetano Rea
- IRCCS S.Luca Hospital, Milano, Italy Filippo Casolo
- Rotherdam General Hospital, UK Balaz Forgacs
- MH (CTC), India Vivek Sharma
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Seoul National University Hospital, Korea Eun Ju, Chun
- Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
- Annecy Hospital, France Gilles Genin
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- CIM Saint-Dizier, France Jean-Charles Leclerc
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Max Hospital, New Delhi, India Vickrant Malhotra
- Ultracare, Coimbatore, India Debabrata Das
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Daejon St Mary's Hospital ChaeHun Lim
- Hospital of the University of Pennsylvania Lisa Jones
- Seoul National University Hospital, Korea Heesun Park
- Homs National Hospital, Homs, Syria Rami Abou Zalaf

▶ Correct Answer as Differential Diagnosis : 2/47, 4.3%

- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh

▶ Semi-Correct Answer : 10/47, 21.3%

- Ping-Tung Christian Hospital , Taiwan Chi-Kuei Hsu
- SSGH, Vadodara, India Sushil Mansingani
- New Hyde Park, New York, USA Pinar Karakas
- Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung
- Yonsei University Hospital, Korea Eun Hye Yoo
- Ismailia Chest Hospital,Egypt Zakaria Elzoghbi
- Samsung Medical Center, Seoul, Korea Sung Mok Kim
- Masih Daneshvary Hospital (NRITLD), Tehran, Iran Mohammad Omid Tahbaz
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Hangang SacredHeart Hospital, Korea Eil Seong Lee

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 413 Date 2005-09-26

Discussion

No. of Applicants : 47