대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Benign Metastasizing Pulmonary Leiomyoma

Radiologic Findings

Initial chest radiograph showed multiple variable sized nodular lesions on both lung fields, which have not been noted 6 months ago when vaginal myoma operation was performed. On CT, multiple nodular masses on both lung parenchyma with smooth or spiculated margin with close association with vascular structure and subpleural location. Percutaneous cutting needle biopsy of left lower lung nodule revealed characteristic findings of leiomyoma showing spindle cells, which was confirmed by immunohistochemical stain.

Brief Review

It is quite uncommon that histologically benign leiomyomas of the uterus are associated with independent extrauterine leiomyomas. Common sites of metastasis include the lung and pelvic lymph nodes. This disease is characterized by a less aggressive course than leiomyosarcoma, especially in postmenopausal patients. Typical manifestation of this disease is asymptomatic, middle-aged women showing multiple nodules in the lung, who have had a history of previous hysterectomy for uterine leiomyoma. Although typical appearance of this disease is multiple parenchymal nodules, a pedunculated leiomyoma with cystic dilated glands, large cyst formation or a giant cyst with multiple nodules have also been reported. The primary source for the pulmonary metastasis is the uterus in women, while primary lesions in man include the saphnous vein, diaphragm and soft tissue.
There is a controversy regarding the pathogenesis of uterine leiomyomas and related extrauterine leiomyomatous tumors. Some authors suggest that such conditions are multicentric benign leiomyomatous growths, rather than embolic metastases from benign uterine leiomyomas by way of blood and lymphatic vessels. There are several reports about uterine and other smooth muscle neoplasms co-occurring in various organs such as lung parenchyma, cardiac, intracaval and regional lymph nodes.

References

1. Steiner PE. Metastasizing fibroleiomyoma of the uteus : Report of a case and review of the literature. Am J Med 1939;15:89-107
2. Wolff M, Silva F, Kaye F. Pulmonary metastases (with admixed epithelial elements) from smooth muscle neoplasm. Report of nine cases, including three males. Am J Surg Pathol 1979;3:325-342
3. Silverman JF, Kay S. Multiple pulmonary leiomyomatous hamartomas. Report of a case with ultrastructure examination. Cancer 1976;38:1199-1204
4. Marshall JF, Morris DS. Intravenous leiomyomatosis of the uterus and pelvis. Case report. Ann Surg 1959;149:126-134
5. Takemura G, Takatsu Y, Kaitani M, etc. Metastasizing uterine leiomyoma: a case with cardiac and pulmonary metastasis. Path. Res. Pract. 1996;192:622-629
6. Lipton JH, Fong TC, Burgess KR. Miliary pattern as presentation of leiomyomatosis of the lung. Chest 1987;91:781-782
7. Gotti G, Haid MM, Palatini P, etc. Pedunculated pulmonary leiomyoma with large cyst formation. Ann Thorac Surg 1993;56:1178-1180
8. Abell MR, Litter ER. Benign uterine metastasizing leiomyoma: Multiple lymph node metastases. Cancer 1977;39:314-321
9. Bachman D, Wolff M. Pulmonary metastases from benign appearing smooth muscle tumors of the uterus. Am J Roentogenol 1976;127:441-446
10. Maredla S, Synder BJ, Harvey LA Schwarz AM. Benign metastasizing leiolyoma in the lung. Radiographics 1998;18:779-782

Keywords

Lung, Benign tumor, Benign Metastasizing Pulmonary Leiomyoma