Case Report -Benign Metastasizing Leiomyoma

Dr. Netaji Patil - Radiologist

History -

A female patient(Age 30), normotensive, nondiabetic came with chief complaints of Dyspnea and cough.

• Myomectomy done 3 years back (Intramural Leiomyoma)
• O/E-  Conscious, Oriented, Dyspnea  and Cyanosis present
• RR-45/min,PO2-60%, P- 90/ min, BP – 110/70 mm/Hg
• CVS-  S1 & S2 normal
• P/A – Soft, Nontender
• Respiratory system – Bilateral crepts and rhonchi noted

Investigation -

CBC- Normal, BSL- Normal, BUN and Creatinine - Normal

Radiological Investigations -

Chest X-Ray -

C. T. Examination -

 

 

 

 

 

 

 

 

 

 

 

Diffrential Diagnosis -

1. Milliary koch’s,
2. Alveolar cell carcinoma,
3. Lymphangitis carcinomatosis,
4. Microlithiasis
5. Silicosis

Right Lung Biopsy -

Metastasizing Leiomyoma- Lung

Discussion -

Benign Metastasizing Leiomyoma -

These are group of tumors of smooth muscle neoplasms associated with uterine leiomyomas. These are considered to represent metastasis from this site and are known as benign metastasizing leiomyoma.

In fact majority of these tumors represent metastatic well differentiated leiomyosarcoma. By far the most common primary site of these neoplasms is uterus. Usual diagnosis in this site is leiomyoma, the tumor not being deemed maliganant by criteria of invasion or increased mitotic count. Uncommon other primary sites are diaphragm, skin, soft tissues of extremities and systemic veins.

Pulmonary nodules are usually fairly well demarcated grossly. Histologically they consist of interlacing fascicles of spindle shaped cells with variable admixture of collagen. Nuclei are typically uniform in size and shape with little hypochromesia, mitotic are often few in number.

Radiographicaly, the tumors are usually multiple and bilateral, ranging from 0.5 to 5.0 cm in diameter. Rarely the pattern is micronodular or milliary. The nodules can increase in size  and in number or can remain fairly stable over long period of time. New nodules may appear, while others shrink and actually disappear. Such regression seen to follow termination of pregnancy or progestin withdrawal, implaying the hormonal effect on tumor growth.

These tumors exclusively occurs in females. The nodules may present at the same time the uterine neoplasm is recognized, more often they appear after hysterectomy, sometimes after an interval as long as 20 to 30 yrs. Metastasis usually do not produce symptoms and are discovered incidentally on a screening chest x ray. Occasionally patient have  dysponea, cough or chest  pain. Rarely tumors are large in size and number to cause severe pulmonary function impairment or respiratory failure.
The diagnosis is confirmed by cytological examination of sputum.