Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Benign metastasizing leiomyomatosis in the lung
- Radiologic Findings
- Figure 1. Conventional radiograph demonstrates a well defined mass measuring 3 cm in diameter in right infrahilar area and a small nodule in right upper lung zone.
Figure 2, 3, 4, 5. CT scans depict multiple well circumscribed nodules with homogeneous enhancement.
Figure 6. Pelvic CT scan depicts the surgical clips and the uterus is not found where it should be.
Figure 7. FDG PET-CT. Axial PET image shows a nodule without hypermetabolism.
- Brief Review
- Benign metastasizing leiomyoma is a rare condition characterized by numerous well-differentiated leiomyomas at sites distant from the uterus.
Metastases most often affect the lungs, whereas the heart, brain, lymph nodes,
bone, and skin are more rarely affected. The condition usually manifests as multiple incidentally detected pulmonary nodules in middle-aged women. A history of hysterectomy for uterine leiomyoma may be indicative, with the mean reported interval between hysterectomy and the appearance of pulmonary nodules ranging from 3 months to 20 years.
Symptoms of chest pain, shortness of breath, and cough have been described.
Although the clinical course is usually indolent, a more rapid progression to severe respiratory symptoms also has been reported.
It is now largely accepted that the lesions arise as hematogenous metastases from benign tumors.
The radiologic imaging appearance of pulmonary nodules in benign metastasizing leiomyomas varies from solitary subcentimeter lesions to multiple lesions mimicking pulmonary metastases from malignant tumors. Cavitation of lesions occasionally take place and rarely may be accompanied by pneumothorax. Calcification is rare. Occasional cases with a military pattern and a pattern simulating interstitial lung disease have been documented. Both CT and MR imaging may be used to depict the pulmonary nodules in benign metastasizing leiomyoma, which have a nonspecific appearance and usually enhance homogeneously. The inclusion of particular entities in the differential diagnosis depends on the size of the nodules, but the most commonly included are metastases from malignant tumors.
The absent FDG uptake of the pulmonary lesions on PET imaging can help to rule out metastasis from extrathoracic tumors or uterine sarcoma. However, nodular lung lesions without FDG uptake and malignant behavior have been described, so we should keep in mind that the differential diagnosis also includes well-differentiated neoplasms, metastasis of tumors with a mucinous component (breast, renal, and gastrointestinal), neuroendocrine tumors, multifocal bronchioloalveolar carcinoma, and carcinoid tumors.
- References
- 1. Fasih N, Prasad Shanbhogue AK, Macdonald DB et al. Leiomyomas
beyond the uterus: unusual locations, rare manifestations. Radiographics 2008; 28(7):1931?948.
2. 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(6):1409?413.
3. di Scioscio V, Feraco P, Miglio L. Benign Metastasizing Leiomyoma of the Lung
PET Findings: J Thorac Imaging 2009;24:41?4.
- Keywords
- Lung, Benign tumor,