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Weekly Chest CasesArchive of Old Cases

Case No : 1080 Date 2018-07-09

  • Courtesy of So Youn Shin, Dong Wook Sung / Kyung Hee University Hospital
  • Age/Sex 70 / F
  • Chief Complaintchest pain (onset: 2 days ago), past history of pelvic surgery (50 years ago), non-smoker
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Benign metastasizing leiomyomatosis of the lung
Radiologic Findings
Figure 1. Chest PA shows multiple nodules and masses in both lungs with left pneumothorax. There was another previous chest PA from outside hospital taken 10 years ago.
Figure 2-4. On chest CT after chest tube insertion in left hemithorax, there are multiple nodules and masses with/without cavity in both lungs.
After VATS biopsy, benign metastasizing leiomyomatosis of the lung was finally diagnosed. The patient had a past history of hysterectomy about 50 years ago for uterine leiomyoma.
Brief Review
Benign metastasizing leiomyomatosis (BML) is a rare disorder and has been described as originating from a uterine smooth muscle tumor of an unknown malignant potential and may actually represent a heterogeneous group of smooth muscle tumor, ranging from leiomyomas to low grade leiomyosarcomas.
BML refers to numerous well-differentiated leiomyomas at sites distant from uterus that are histologically identical to uterine leiomyoma. It is largely accepted that they arise as hematogeneous metastases from benign tumors. BML usually manifests as multiple incidentally detected pulmonary nodules in middle-aged women with a history of hysterectomy for uterine leiomyoma.
The imaging findings are pulmonary nodules, varying from solitary lesions to multiple lesions mimicking pulmonary metastases. The nodules may occasionally show cavitation, rarely pneumothorax, or calcification. Disease progression is indolent, and symptomatic disease is rare. The differential diagnosis is metastases from malignant tumors.
Please refer to
Case 215, Case 394, Case 413, Case 667, Case 847, Case 952, Case ,
References
1. Abramson S. et al. Benign metastasizing leiomyoma Clinical, imaging, and pathologic correlation. Am J Roentgenol. 2001; 176:1409-13.
2. Kwon YI et al. Benign pulmolnary leiomyomatosis: Case report and a review of the literature. Korean J Intern Med. 2006 Sep; 21(3):173-177.
3. Miller et al. Benign metastasizing leiomyomas to the lungs: an institutional case series and a review of the recent literature. Ann Thorac Surg 2016; 101:253-8.
Keywords
Lung, Neoplasm_benign, Metastasis,

No. of Applicants : 88

▶ Correct Answer : 53/88,  60.2%
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ajou University Hospital , Korea (South) PAE SUN SUH
  • - Soonchunhyang University College of Medicine , Korea (South) GOUN CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) DA HYUN LEE
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - privato , Italy VINCENZO ENZO GENCHI
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Other , Korea (South) SUNGWON KIM
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - , United States MAANSI P
  • - MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Maimonides Medical Center , United States NAOMI TWERSKY
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - The University of Tokyo Hospital , Japan TOMOKI WADA
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Chonnam National University Hospital , Korea (South) YU BIN LEE
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 13/88,  14.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 3/88,  3.4%
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
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